| Extending reperfusion therapy for acute ischemic stroke: emerging pharmacological, mechanical, and imaging strategies. | |
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MedLine Citation:
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PMID: 16179577 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Reperfusion is the most beneficial of all therapeutic strategies for acute ischemic stroke. However, the standard cerebral reperfusion treatment of the first decade of the reperfusion era, noncontrast computed tomography (CT)-guided, < or =3 hours, intravenous tissue plasminogen activator, has many limitations. This review surveys emerging strategies that have the potential to extend cerebral reperfusion therapy to larger numbers of patients. SUMMARY OF REVIEW: Innovative intravenous pharmacological reperfusion strategies include novel fibrinolytic agents (tenecteplase, reteplase, desmetolplase, plasmin, and microplasmin), glycoprotein (GP) IIb/IIIa antagonists with platelet disaggregating effects (abciximab and tirofiban), combination therapies to improve efficacy of clot lysis (fibrinolytics and GP IIb/IIIa agents, and fibrinolytics and direct thrombin inhibitors), increase the time window for clot lysis (fibrinolytics and neuroprotectants), and reduce the frequency of hemorrhagic complications (fibrinolytics and vasoprotectants), and externally applied ultrasound to enhance enzymatic fibrinolysis. Promising intra-arterial pharmacological reperfusion approaches include novel fibrinolytic agents, combined intravenous and intra-arterial fibrinolysis, and combined fibrinolytics and GP IIb/IIIa agents. Emerging endovascular mechanical reperfusion strategies include intra-arterial thrombectomy (clot retrieval devices and suction thrombectomy devices), mechanical disruption (micro-guidewire passage, laser photoacoustic emulsification, and primary intracranial angioplasty), and augmented fibrinolysis by endovascular ultrasound. Multimodal imaging, with magnetic resonance (MR) or CT, can rapidly assess infarct core, penumbra, site of vessel occlusion, and tissue hemorrhagic propensity, enabling improved selection of patients for reperfusion therapy beyond any arbitrary fixed time window. CONCLUSIONS: Therapeutic reperfusion is emerging as a treatment strategy of remarkable power and scope for rescuing patients experiencing acute brain ischemia, applicable within and beyond the 3-hour time window. |
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Authors:
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Carlos A Molina; Jeffrey L Saver |
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Publication Detail:
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Type: Journal Article; Review Date: 2005-09-22 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 36 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2005 Oct |
Date Detail:
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Created Date: 2005-09-29 Completed Date: 2006-01-12 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 2311-20 Citation Subset: IM |
Affiliation:
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Hospital Universitar Vall d'Hebron, Barcelona, Spain. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Algorithms Brain / pathology Brain Ischemia / therapy* Drug Therapy, Combination Fibrinolytic Agents / therapeutic use Humans Magnetic Resonance Imaging / methods Neuroprotective Agents / pharmacology Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Reperfusion* Stroke / therapy* Thrombectomy / methods Thrombolytic Therapy / methods Time Factors Tomography, X-Ray Computed / methods |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Neuroprotective Agents; 0/Platelet Glycoprotein GPIIb-IIIa Complex |
| Comments/Corrections | |
Erratum In:
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Stroke. 2006 Mar;37(3):931 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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