Ischemic stroke--novel therapeutic strategies.
Acta Neurol Scand Suppl
; (191): 28-37, 2011.
Article
em En
| MEDLINE
| ID: mdl-21711254
ABSTRACT
OBJECTIVES:
Treatment of acute, ischemic stroke has changed markedly during the last two decades. We review existing data for optimizing modern stroke care.RESULTS:
Implementation of stroke units, giving systematic treatment and observation to stroke patients, has lead to a significant reduction in death and dependency. Introduction of intravenous rt-PA (IVT) within 3 h for selected stroke patients and recent extension of the time window to 4.5 h improved the outcome even further. Still, one must consider that IVT has several limitations, such as a narrow time window and several contraindications, and the effect is modest, particularly in strokes with a large vessel occlusion. Recanalization of the occluded vessel is a major predictor for good outcome and should be set as a goal. Intra-arterial rt-PA (IAT) and the concept of bridging therapy (IVT prior to IAT or thrombectomy with a mechanical device) may improve recanalization rates and outcome. Randomized controlled trials (RCT) are available for IAT, but not for thrombectomy with devices, and we mostly have retrospective non-controlled data. The Merci- and Penumbra system are the most studied devices, for which recent studies report acceptable safety and efficacy.CONCLUSIONS:
Sufficiently powered RCTs to evaluate the effect of thrombectomy with mechanical devices are warranted, but as the natural course of a large vessel stroke carries a devastating prognosis, a proactive recanalization approach is justified based on today's knowledge.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Terapia Trombolítica
/
Isquemia Encefálica
/
Acidente Vascular Cerebral
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article