| Does intra-arterial thrombolysis have a role as first-line intervention in acute ischaemic stroke? | |
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MedLine Citation:
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PMID: 21138512 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Minimization of the clinical impact of acute ischaemic stroke depends largely on prompt restoration of blood flow to underperfused regions of the brain. Intravenous thrombolysis (IVT) is currently the first-line intervention for acute ischaemic stroke, with proven efficacy in randomized controlled trials. There are several major limitations associated with IVT, in particular, the relatively poor outcomes in large artery occlusions. A major emerging modality in acute stroke management is intra-arterial thrombolysis (IAT), whereby clot-retrieval or thrombolytics are applied under angiographic guidance to the site of the clot. Strong arguments exist for the use of IAT as first-line ischaemic stroke management in preference of IVT, especially with large intracranial artery occlusion. Despite these arguments, the lack of data from randomized controlled studies in IAT means that it is appropriate to continue the current practice of IVT as first-line treatment for the majority of acute ischaemic strokes at this stage. Advanced neuroimaging techniques, in particular a 'multimodal' computed tomography (CT) approach combining non-contrast CT, CT angiography and perfusion CT, may serve as a valuable triage tool for patient selection. Ongoing research is required in endovascular approaches to stroke; in particular, randomized controlled trials with a focus on clinical outcomes and tackling the inherent delays between symptom onset and treatment. |
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Authors:
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D A Syfret; P Mitchell; R Dowling; B Yan |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Internal medicine journal Volume: 41 ISSN: 1445-5994 ISO Abbreviation: Intern Med J Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101092952 Medline TA: Intern Med J Country: Australia |
Other Details:
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Languages: eng Pagination: 220-6 Citation Subset: IM |
Copyright Information:
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© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians. |
Affiliation:
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Departments of Neurology RadiologyThe Royal Melbourne Hospital and Departments of Radiology Medicine, University of Melbourne, Melbourne, Victoria, Australia. |
Export Citation:
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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