caa a22 4500 445299223 CHVBK 20180317142551.0 cr unu---uuuuu 170323e20100301xx s 000 0 eng 10.1007/s11940-010-0064-y doi (NATIONALLICENCE)springer-10.1007/s11940-010-0064-y Reperfusion Therapies for Acute Ischemic Stroke [Elektronische Daten] [David Goldemund, Robert Mikulik] Opinion statement: Ischemic stroke is most often caused by an acute extracranial or intracranial thromboembolic lesion obstructing an artery. It has been demonstrated that recanalization is the most important modifiable predictor of a good clinical outcome. Reperfusion strategies focus on early reopening of the vessel to reestablish antegrade flow within the penumbra. Current standard therapy within 4.5h is intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA, 0.9mg/kg body weight, maximum dose 90mg). Thrombolytic therapy appears to be safe and effective across various types of hospitals, if the treatment is conducted by a physician with stroke expertise. New imaging methods (MR diffusion/perfusion, CT perfusion) are being investigated in order to better select patients who are most likely to benefit from recanalization therapy based on current clinical evidence. Neither perfusion imaging with CT or MR nor the mismatch concept are recommended for routine treatment decisions within or beyond the 4.5h available for IVT. If major vessel occlusion is proven but IVT is contraindicated, intra-arterial thrombolysis (IAT) with tPA or mechanical thrombectomy with the Merci Retriever or Penumbra System may be a treatment option. The availability of IAT generally should not preclude the intravenous administration of tPA in otherwise eligible patients. Intra-arterial treatment can be performed within 8h after stroke onset. Combining intravenous tPA pretreatment with subsequent IAT or mechanical thrombectomy may improve the recanalization rate and may be used as a rescue therapy in cases of persistent major vessel occlusion after unsuccessful IVT. Despite testing, no thrombolytic agent other than tPA (e.g., IIb/IIIa antagonists, heparin, etc.) has yet been approved for routine practice for either intravenous or intra-arterial application, alone or in combination with tPA. Continuous transcranial Doppler (TCD) monitoring of an occluded vessel may increase the rate of early recanalization after tPA; this effect may be facilitated by the administration of microbubbles. This method is still considered experimental. Springer Science+Business Media, LLC, 2010 Goldemund David Department of Neurology, Masaryk University, St. Anne's University Hospital, Pekařská 53, 656 91, Brno, Czech Republic aut Mikulik Robert Department of Neurology, Masaryk University, St. Anne's University Hospital, Pekařská 53, 656 91, Brno, Czech Republic aut Current Treatment Options in Neurology Current Science Inc. 12/2(2010-03-01), 155-166 1092-8480 12:2<155 2010 12 11940 https://doi.org/10.1007/s11940-010-0064-y text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11940-010-0064-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Goldemund David Department of Neurology, Masaryk University, St. Anne's University Hospital, Pekařská 53, 656 91, Brno, Czech Republic aut NATIONALLICENCE 700 1- Mikulik Robert Department of Neurology, Masaryk University, St. Anne's University Hospital, Pekařská 53, 656 91, Brno, Czech Republic aut NATIONALLICENCE 773 0- Current Treatment Options in Neurology Current Science Inc 12/2(2010-03-01), 155-166 1092-8480 12:2<155 2010 12 11940 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer