| Improving reperfusion therapy for acute ischaemic stroke. | |
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MedLine Citation:
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PMID: 21781270 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Summary. Background: The first generation of clinical reperfusion treatment, intravenous (IV) fibrinolysis with tissue plasminogen activator (tPA), was a transformative breakthrough in stroke care, but is far from ideal. Objectives: To survey emerging strategies to increase the efficacy and safety of cerebral reperfusion therapy. Methods: Narrative review. Results and Conclusions: Innovative IV pharmacologic reperfusion strategies include: extending IV tPA use to patients with mild deficits; developing novel fibrinolytic agents (tenecteplase, desmetolplase, plasmin); using ultrasound to enhance enzymatic fibrinolysis; combination clot lysis therapies (fibrinolytics with GPIIb/IIIa agents or direct thrombin inhibitors); co-administration of MMP-9 inhibitors to deter haemorrhagic transformation; and prehospital neuroprotection to support threatened tissues until reperfusion. Endovascular recanalisation strategies are rapidly evolving, and include intra-arterial fibrinolysis, mechanical clot retrieval, suction thrombectomy, and primary stenting. Combined approaches appear especially promising, using IV fibrinolysis to rapidly initiate reperfusion, mechanical endovascular treatment to debulk large, proximal thrombi, and intra-arterial (IA) fibrinolysis to clear residual distal thrombus elements and emboli. |
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Authors:
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J L Saver |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of thrombosis and haemostasis : JTH Volume: 9 Suppl 1 ISSN: 1538-7836 ISO Abbreviation: J. Thromb. Haemost. Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-07-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101170508 Medline TA: J Thromb Haemost Country: England |
Other Details:
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Languages: eng Pagination: 333-43 Citation Subset: IM |
Copyright Information:
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© 2011 International Society on Thrombosis and Haemostasis. |
Affiliation:
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Stroke Center and Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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