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Embolic Intracranial Strokes: Catheter-Directed Thrombolysis

  • Maxim Mokin
  • Shady Jahshan
  • Travis M. Dumont
  • Elad I. Levy
Chapter

Abstract

In the setting of acute ischemic stroke, an intra-arterial (IA) pharmacological approach allows catheter-directed delivery of thrombolytic agents to the clot, offering several potential advantages by comparison with systemic (intravenous, IV) thrombolysis. First, a smaller dose of thrombolytic agent is utilized, thereby minimizing systemic hemorrhagic side effects; at the same time, a high concentration of the agent is locally delivered to the occlusion site. Second, using direct fluoroscopic guidance, a microcatheter can be placed immediately next to or directly into the thrombus. Third, both continuous and bolus delivery of thrombolytics can be given, based on specific features of the clot and the degree of response to lysis, which can be directly visualized during a microcatheter angiogram. IA thrombolysis can be used for thrombi located within smaller vessels, such as distal M2 or M3 branches of the middle cerebral artery (MCA), which often cannot be reached with mechanical thrombectomy devices. The angiographic appearance of a normal intracranial arterial anatomy is shown in Fig. 2.1.

Keywords

Acute Ischemic Stroke Stroke Onset Thrombolytic Agent European Cooperative Acute Stroke Study Bolus Delivery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ACT

Activated coagulation time

AP

Anteroposterior

CBF

Cerebral blood flow

CBV

Cerebral blood volume

CT

Computed tomographic

ECASS

European Cooperative Acute Stroke Study

FDA

Food and Drug Administration

F

French

IA

Intra-arterial

ICA

Internal carotid artery

ICH

Intracranial hemorrhage

IMS

Interventional Management of Stroke

IV

Intravenous

MCA

Middle cerebral artery

MTT

Mean transit time

NIHSS

National Institutes of Health Stroke Scale

NINDS

National Institute of Neurological Disorders and Stroke

PROACT

Prolyse in Acute Cerebral Thromboembolism

PTT

Partial thromboplastin time

rtPA

Recombinant tissue plasminogen activator

Solitaire

FR™ With the Intention For Thrombectomy (SWIFT)

TIMI

Thrombolysis in Myocardial Infarction

tPA

Tissue plasminogen activator

TTP

Time-to-peak

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maxim Mokin
    • 1
    • 2
    • 3
  • Shady Jahshan
    • 1
    • 2
    • 4
  • Travis M. Dumont
    • 1
    • 2
  • Elad I. Levy
    • 2
    • 5
    • 6
  1. 1.Department of Neurosurgery, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  2. 2.Department of NeurosurgeryGates Vascular Institute, Kaleida HealthBuffaloUSA
  3. 3.Department of NeurosurgeryUniversity at Buffalo NeurosurgeryBuffaloUSA
  4. 4.Stroke Intervention Unit, The Tel-Aviv Sourasky Medical CenterTel-AviIsrael
  5. 5.Department of Neurosurgery and Department of Radiology, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA
  6. 6.Toshiba Stroke Research Center, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffaloUSA

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