Lyden Thrombolytic Therapy for Stroke

Erscheinungsjahr 2001
ISBN: 978-1-59259-131-2
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 410 Seiten, Web PDF

Reihe: Medicine

Thrombolytic Therapy for Stroke is intended for physicians who will be treating patients in the first few hours after stroke: neurologists, neurosurgeons, emergency medicine physicians, internists, and radiologists. In some areas, fam ily medicine general practice physicians may provide the majority of acute stroke care. We will provide the reader with all the data necessary to understand the utility and limitations of thrombolytic therapy. By reading the protocols, and working through the case tutorials, the reader will become sufficiently familiar with the indications and contraindications of thrombolytic therapy to begin evalu ating potential patients. Although nothing can replace direct instruction by more experienced physicians, we hope that by imparting our accumulated knowledge we may guide those physicians who cannot attend a "hands-on" workshop, or who, having heard the appropriate lectures, feel the need for further guidance. We will review the scientific rationale for thrombolysis: first, most ischemic stroke is caused by thrombo-emboli; second, a portion of brain, the penumbra, remains salvageable for a few hours after vascular occlusion; and third, promptly delivered thrombolysis can remove the offending occlusion and restore cerebral blood flow to the penumbra in time to salvage brain and neurologic function. Then we will review the preclinical development of thrombolytics for stroke pa tients and the early pilot trials. Next, we will present the pivotal clinical trials that demonstrated the efficacy and safety of thrombolysis.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Lyden, Patrick D.

Inhaltsverzeichnis

I Background and Basic Investigations.- 1 Mechanisms of Thrombolysis.- 2 Pathogenesis of Cervico-cranial Artery Occlusion.- 3 The Ischemic Penumbra and Neuronal Salvage.- II Scientific Rationale and Clinical Trials.- 4 Pre-Clinical Testing of Thrombolytic Therapy for Stroke.- 5 Combination of Thrombolytic Therapy with Neuroprotectants.- 6 Early Studies of Thrombolytic Therapy for Stroke.- 7 Phase 2 Experience with Intravenous Thrombolytic Therapy for Acute Ischemic Stroke.- 8 Intravenous Thrombolytic Therapy for Acute Ischemic Stroke: Results of Large, Randomized Clinical Trials.- 9 Further Analysis of NINDS Study: Long-Term Outcome, Subgroups, and Cost Effectiveness.- 10 Intra-Arterial Thrombolysis in Acute Ischemic Stroke.- 11 Combinations of Intravenous and Intra-Arterial Thrombolysis.- III Using Thrombolysis for Acute Stroke.- 12 The Case for Thrombolytic Therapy in Stroke Patients.- 13 The Case Against the Present Guidelines for Stroke Thrombolysis: The Present Recommendations for Clinical Use Should Be Modified.- 14 How to Run a Code Stroke.- 15 Interpretation of CT Scans for Acute Stroke.- 16 Identifying and Overcoming Obstacles to Acute Stroke Treatment with rt-PA: Establishing Hospital and EMS Protocols.- 17 The NINDS t-PA for Acute Stroke Protocol.- 18 Research Directions and the Future of Stroke Therapy.- IV: Illustrative Cases.