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The exact science of stroke thrombolysis and the quiet art of patient selection

Citation

Balami, JS and Hadley, G and Sutherland, BA and Karbalai, H and Buchan, AM, The exact science of stroke thrombolysis and the quiet art of patient selection, Brain, 136, (Pt 12) pp. 3528-3553. ISSN 0006-8950 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 The Author(s)

DOI: doi:10.1093/brain/awt201

Abstract

The science of metric-based patient stratification for intravenous thrombolysis, revolutionized by the landmark National Institute of Neurological Disorders and Stroke trial, has transformed acute ischaemic stroke therapy. Recanalization of an occluded artery produces tissue reperfusion that unequivocally improves outcome and function in patients with acute ischaemic stroke. Recanalization can be achieved mainly through intravenous thrombolysis, but other methods such as intra-arterial thrombolysis or mechanical thrombectomy can also be employed. Strict guidelines preclude many patients from being treated by intravenous thrombolysis due to the associated risks. The quiet art of informed patient selection by careful assessment of patient baseline factors and brain imaging could increase the number of eligible patients receiving intravenous thrombolysis. Outside of the existing eligibility criteria, patients may fall into therapeutic 'grey areas' and should be evaluated on a case by case basis. Important factors to consider include time of onset, age, and baseline blood glucose, blood pressure, stroke severity (as measured by National Institutes of Health Stroke Scale) and computer tomography changes (as measured by Alberta Stroke Programme Early Computed Tomography Score). Patients with traditional contraindications such as wake-up stroke, malignancy or dementia may have the potential to receive benefit from intravenous thrombolysis if they have favourable predictors of outcome from both clinical and imaging criteria. A proportion of patients experience complications or do not respond to intravenous thrombolysis. In these patients, other endovascular therapies or a combination of both may be used to provide benefit. Although an evidence-based approach to intravenous thrombolysis for acute ischaemic stroke is pivotal, it is imperative to examine those who might benefit outside of protocol-driven practice.

Item Details

Item Type:Refereed Article
Keywords:acute stroke, multimodal imaging, thrombolytic therapy, interventional therapy, multimodal therapy
Research Division:Medical and Health Sciences
Research Group:Neurosciences
Research Field:Central Nervous System
Objective Division:Expanding Knowledge
Objective Group:Expanding Knowledge
Objective Field:Expanding Knowledge in the Medical and Health Sciences
Author:Sutherland, BA (Dr Brad Sutherland)
ID Code:113621
Year Published:2013
Web of Science® Times Cited:23
Deposited By:Office of the School of Medicine
Deposited On:2017-01-09
Last Modified:2017-04-10
Downloads:0

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