Stroke treatment

Ribo M, Molina CA, Rovira A, Quintana M, Delgado P, Montaner J, Grive E, Arenillas JE, Alvarez-Sabin J. Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimodal transcranial Doppler/MRI selection protocol. Stroke 2005 36 602-606. 

There have been three large randomized trials of streptokinase in acute ischemic stroke treatment, all of which were terminated early because of increased sICH and mortality in the treatment group (Table 3.1)." " " ... 

Adams HP, Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 24 35 1. 

Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JR, Brott T, Frankel M, Grotta JC, Haley EC, Jr., Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden R, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S. Association of outcome with early stroke treatment Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004 363 768-774. 

Sherman DG, Atkinson RR Chippendale T, Levin KA, Ng K, Futrell N, Hsu CY, Levy DE. Intravenous ancrod fortreatment of acute ischemic stroke The STAT study A randomized controlled trial. Stroke Treatment with Ancrod Trial. JAMA. 2000 283 2395-2403. 

Wojner-Alexandrov AW, Alexandrov AV, Rodriguez D, Persse D, Grotta JC. Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO). Stroke. 2005 36 1512-1518. 

Lindsberg PJ, Happola O, Kallela M, Valanne L, Kuisma M, Kaste M. Door to thrombolysis ER reorganization and reduced delays to acute stroke treatment. Neurology. 2006 67 334-336. 

Martinez-Vila E, Mmia P. Challenges of neuroprotection and neurorestoration in ischemic stroke treatment. Cerebrovasc Dis. 2005 20 Suppl 2 148-158. 

Other snare devices that potentially can be used for embolectomy include (1) the Alligator Retrieval Device, which is a retriever with grasping jaws attached to the tip of a flexible wire designed to be used in conjunction with 0.21-inch micro-catheter " and (2) the EnSnare device, which has a tulip-shaped, three-loop design that opens distally. These devices, which are approved for foreign body removal/coil retrieval, have not been reported in embolectomy for stroke treatment. 

Diener HC, Cortens M, Eord G, Grotta J, Hacke W, Kaste M, Koudstaal PJ. Lubeluzole in acute ischemic stroke treatment a double-bhnd study with an 8-hour inclusion window comparing a 10-mg daily dose of lubeluzole with placebo. Stroke 2000 31 2543-2551. 

The Trial of Org 10172 in Acute Stroke Treatment (TOAST) was a randomized, double-blind, placebo-controlled trial of danaparoid in 1281 patients within 24 hours of onset of acute ischemic stroke. A three-stage dosage regime was used to achieve plasma anti-factor Xa activity of 0.8 unit/mL. Favorable outcome was defined as the combination of a Glasgow Outcome Scale (GOS) score of 1 or 2 and a modified Barthel Index (BI) score of 12 or greater (on a scale of 0-20) at 3 months or 7 days. Very favorable outcome required the combination of a GOS score of 1 and a Barthel Index (BI) score of 19 or 20 at 3 months or 7 days. 

Relatively few data exist concerning the relative benefits of UFH, LMWH, and heparinoids in acute stroke treatment. In 2005, the Cochrane Collaboration reviewed trials comparing LMWHs or heparinoids with UFH in acute ischemic... 

In 2004, the abciximab and rt-PA in Acute Ischemic Stroke Treatment trial treated hve patients with abciximab and half dose of rt-PA within 3 hours of symptom onset. The primary aim was to examine the frequency of SICH at 24 hours. This occurred in one of the five patients. The median NIHSS improvement was 6. 

Publications Committee for the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparinoid ORG 10172 (Danaparoid) and outcome after acute ischemic stroke. JAMA 1998 279 1265-1272. 

Abciximab Emergent Stroke Treatment Trial Investigators. Emergency administration of abciximab for treatment of patients with acute ischemic stroke results of a randomized phase 2 trial. Stroke 2005 36 880-890. 

Stroke Trials Registry. Abciximab in Emergent Stroke Treatment Trial - 11. www. strokecenter.org/trials. Accessed on July 15, 2007. 

Abciximab and rt-PA in acute ischemic stroke treatment. Presented at the 28th International Stroke Conference February 2003. Acad Emerg Med 2003 10(12) 1396-1399. 

Wagner KR, Zuccarello M. Local brain hypothermia for neuroprotection in stroke treatment and aneurysm repair. Neurol Res 2005 27(3) 238-245. 

Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley Jr. EC, Lewandowski CA, Kwiatkowski TP. Early stroke treatment associated with better outcome the NINDS rt-PA stroke study. Neurology 2000 55 1649-1655. 

Hanson SK, Brauer DJ, Anderson DC, Roller RL, Davenport JG, Ramirez-Lassepas M, Klassen AC, Altafullah IM, Brown RD. Stroke Treatment in the Community (STIC)— intravenous rt-PA in clinical practice. Neurology 1998 50 A155-A156 [abstract]. 

I am greatly indebted to the authors of this book, who have painstakingly waded through the data to provide a comprehensive and thorough evaluation of the literature. We hope that you will find herein a guide to support your practice and research interests, and perhaps a clue to how we might together further the field of acute stroke treatment. 

Alteplase (rt-PA Activase) is an IV thrombolytic (fibrinolytic) that was approved for acute stroke treatment in 1996 based on the results of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial.10 The current American Stroke Association guidelines include alteplase as the only Food and Drug Administration (FDA) approved acute treatment for ischemic stroke and strongly encourage early diagnosis and treatment of appropriate patients.11... 

Streptokinase is not indicated for use in acute ischemic stroke treatment. Three large randomized controlled trials evaluating streptokinase were stopped early due to a high incidence of hemorrhage in the streptokinase-treated patients.14-16 At the present time, there is no indication for the use of streptokinase or thrombolytics other than alteplase in the acute treatment of ischemic stroke. 

Source Garber K. Stroke treatment—light at the end of the tunnel Nature Biotechnology 25 838-840 (2007). 

The ATLANTIS, ECASS and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004 363 768-74. 

Hypertensive crises are characterized initially by headache, but can evolve to include neck stiffness, chest discomfort, palpitations, confusion, and, ultimately, hemorrhage or stroke. Treatment of MAOI-associated hypertension may include a watch-and-wait stance by the patient if the symptoms are mild. Some patients have the ability to check and monitor their own blood pressure. Others may consult with a physician for blood pressure checks and observation, but if symptoms are severe, the patient may need to go to an emergency room or self-medicate. Standard emergency room treatment is intravenous phentolamine, an a-adrenergic blocker, continuous monitoring and management until blood pressure is normalized without medication. Some doctors will provide patients with small doses of chlorpromazine or nifedipine to treat hypertension if a problem arises. 

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