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Review

Systemic thrombolytic therapy of acute ischemic stroke with rtPA

Pages 187-201 | Published online: 10 Jan 2014

References

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  • ••Although more than 5 years old, these guidelines, which are mainly derived from the NINDS trial, are still a valid basis for everyone performing iv. thrombolysis.
  • Quality Standards Subcommittee of the American Academy of Neurology. Practice Advisory: Thrombolytic therapy for acute ischemic stroke - summary statement. Neurology 47, 835–839 (1996).
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  • ••The pivotal trial for iv. thrombolysis withrtPA; logistically unsurpassed and (perhaps) unreproducable. Based on the results of this trial, rtPA was approved for ischemic stroke.
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  • ••Actually the first published large-scale randomized controlled trial of rtPA for ischemic stroke. Provides important contributions to define the limitations (practically and with regard to rtPA dose) of iv. thrombolysis with rtPA.
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  • •To date, the largest randomized controlled trial. For the first time, a favorable outcome is defined in terms of independence, probably a more realistic approach.
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  • •Largest Phase IV study published to date. The results indicate that systemic thrombolysis with rtPA can be performed safely and effectively in daily routine.
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  • •This study dampened the growing enthusiasm about thrombolysis, but nevertheless provides much needed cautions with respect to extending thrombolytic therapy to routine clinical practice.
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  • •Suggests that neurological and netu-oradiological advice and supervision enables non-neurologists to perform iv. thrombolysis safely and effectively.
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  • •Emphasizes that modifications of the emergency system can markedly increase the proportion of thrombolyses among stroke patients.
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  • •Demonstrates the learning-by-doing' effect with respect to in-hospital logistics in the management of hyperacute stroke.
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  • •Emphasizes the usefulness and potential of CT in the evaluation of patients for thrombolytic treatment based on the experiences from the ECASS I trial.
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  • •The effect of thrombolytic treatnent is persuasively demonstrated by modem brain imaging techniques.
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  • •Illustrative examples of possible criteria to identify ideal and non-ideal candidates for thrombolysis by means of 'stroke MRI'.
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  • •See [43].
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  • •This study validates an interesting new grading system for early ischemic changes on CT, which might help to reduce inter-rater variabilities in CT interpretation.
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  • •Interesting debate regarding thrombolysis for ischemic stroke. A more conservative attitude is confronted with pragmatism and a more optimistic approach.
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  • •See [55].
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  • •Helpful analysis of the shortcomings in the treatment of hyperacute ischemic stroke.
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