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Intravenous Thrombolytic and Endovascular Treatment of Acute Ischemic Stroke

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Abstract

Acute ischemic stroke is a disease with an immense global impact. The past 30 years has seen an explosion in diagnostic and therapeutic options that has changed the way stroke is treated. We will review the scientific evidence for acute ischemic stroke therapy, discuss new treatment algorithms and systems of care, and also review the available imaging modalities utilized for patient selection as well as endovascular devices/techniques that are employed to treat acute large vessel intracranial occlusions, one of the most difficult subtypes of acute ischemic stroke.

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Notes

  1. 1.

    Actually the history of AMI systemci fibrinolysis starts with Chazov, a russian cardiologist in 1976, followed by Rentrop with intracoronary fibrinolysis; the first trial on systemic lysis was done by Schroeder, published in Circulation. The article cited by Maroo and Topol is a review of the history of MI lysis and not meant to be a credit.

Abbreviations

Tissue Plasminogen Activator (TPA):

A fibrinolyic medication that can be administered both intravenously and intraarterially.

Large Vessel Occlusion:

Intracranial occlusion of one of the major arteries of the circle of willis including the internal carotid artery, anterior cerebral artery, middle cerebral artery, vertebral artery, basilar artery, and posterior cerebral arteries

Mechanical Embolectomy:

A catheter based technique used to perform acute ischemic stroke surgery that utilizes fluoroscopically visualized devices that remove emboli with suction/aspiration or retrievable stents.

Multi-Modal Stroke Imaging:

CT or MRI based techniques employing a combination of image sequences that evaluate brain tissue integrity, the cervico-cerebral vasculature, and brain perfusion in order to best select patients for thrombolysis with IV TPA and/or mechanical embolectomy

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Further Reading

  • Moll R, Dinkel HP (2001) Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler. Eur J Radiol 39:155–162

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  • Solitaire™ FR as primary treatment for acute ischemic stroke (SWIFT PRIME). NCT01657461

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Authors and Affiliations

  1. Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA

    Ameer Al-Wafai & Lucas Elijovich

  2. Department of Neurosurgery, Semmes-Murphey Neurologic Institute, University of Tennessee Health Sciences Center, 6325 Humphries Blvd, Memphis, TN, 38140, USA

    William Humphries & Lucas Elijovich

Authors
  1. Ameer Al-Wafai
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  2. William Humphries
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  3. Lucas Elijovich
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Correspondence to Lucas Elijovich .

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Editors and Affiliations

  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Al-Wafai, A., Humphries, W., Elijovich, L. (2015). Intravenous Thrombolytic and Endovascular Treatment of Acute Ischemic Stroke. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_96

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