Tissue plasminogen activator (t-PA) is the only treatment currently proven to benefit stroke victims, but no physician guide to its safe and proper use exists. In Thrombolytic Therapy for Stroke, the world's leading experts detail the basic rationale, scientific evidence, and treatment protocol for thrombolytic therapy in acute stroke patients. These experienced clinicians show how promptly delivered thrombolysis can restore cerebral blood flow in time to salvage brain and neurologic function, first by reviewing the preclinical development of thrombolytics, and then by presenting the pivotal clinical trials that proved their efficacy and safety. Their description of the treatment protocol discusses field triage and management, emergency department therapy, brain imaging, clinical decision making and patient selection, drug administration, post--thrombolysis management, and the treatment of complications. Real-life programmed case histories-complete with commentary and brain images-illustrate the use of the thrombolytic therapy protocol and illuminate its special indications and contraindications.
Comprehensive and highly practical, Thrombolytic Therapy for Stroke offers the practicing physician everything necessary-background, protocols, and case studies-for the safe and effective treatment of the emergency stroke patient today.

Klappentext

Thrombolytic Therapy for Stroke is intended for physicians who will be treating patients in the first few hours after stroke: neurologists, neurosurgeons, emergency medicine physicians, internists, and radiologists. In some areas, fam­ ily medicine general practice physicians may provide the majority of acute stroke care. We will provide the reader with all the data necessary to understand the utility and limitations of thrombolytic therapy. By reading the protocols, and working through the case tutorials, the reader will become sufficiently familiar with the indications and contraindications of thrombolytic therapy to begin evalu­ ating potential patients. Although nothing can replace direct instruction by more experienced physicians, we hope that by imparting our accumulated knowledge we may guide those physicians who cannot attend a "hands-on" workshop, or who, having heard the appropriate lectures, feel the need for further guidance. We will review the scientific rationale for thrombolysis: first, most ischemic stroke is caused by thrombo-emboli; second, a portion of brain, the penumbra, remains salvageable for a few hours after vascular occlusion; and third, promptly delivered thrombolysis can remove the offending occlusion and restore cerebral blood flow to the penumbra in time to salvage brain and neurologic function. Then we will review the preclinical development of thrombolytics for stroke pa­ tients and the early pilot trials. Next, we will present the pivotal clinical trials that demonstrated the efficacy and safety of thrombolysis.

Inhalt

Part I. Background and Basic Investigations. Mechanisms of Thrombolysis, Gregory J. del Zoppo and Naohisa Hosomi. Pathogenesis of Cervico-cranial Artery Occlusion, Louis R. Caplan. The Ischemic Penumbra and Neuronal Salvage, Patrick D. Lyden. Part II. Scientific Rationale and Clinical Trials. Pre-Clinical Testing of Thrombolytic Therapy for Stroke, Anne M. Guyot and Steven R. Levine. Combination of Thrombolytic Therapy with Neuroprotectants, James C. Grotta. Early Studies of Thrombolytic Therapy for Stroke, Anne M. Guyot, Luchi Quinones, and Steven R. Levine. Phase 2 Experience with Intravenous Thrombolytic Therapy for Acute Ischemic Stroke, E. Clarke Haley, Jr. Intravenous Thrombolytic Therapy for Acute Ischemic Stroke: Results of Large, Randomized Clinical Trials, Rashmi U. Kothari and Joseph P. Broderick. Further Analysis of NINDS Study: Long-Term Outcome, Subgroups, and Cost Effectiveness, Susan C. Fagan, Thomas Kwiatkowski, and Patrick D. Lyden. Intra-Arterial Thrombolysis in Acute Ischemic Stroke, Anthony J. Furlan, Randall Higashida, Irene Katzan, and Alex Abou-Chebl. Combinations of Intravenous and Intra-Arterial Thrombolysis, Joseph P. Broderick and Rashmi Kothari. Part III. Using Thrombolysis for Acute Stroke. The Case for Thrombolytic Therapy in Stroke Patients, Patrick D. Lyden. The Case Against the Present Guidelines for Stroke Thrombolysis: The Present Recommendations for Clinical Use Should Be Modified, Louis R. Caplan. How to Run a Code Stroke, Christopher Lewandowski. Interpretation of CT Scans for Acute Stroke, Rüdiger von Kummer. Identifying and Overcoming Obstacles to Acute Stroke Treatment with rt-PA: Establishing Hospital and EMS Protocols, Karen S. Rapp and Patti Bratina. The NINDS t-PA for Acute Stroke Protocol, John R. Marler and Patrick D. Lyden. Research Directions and the Future of Stroke Therapy, Patrick D. Lyden. Part IV. Illustrative Cases. Illustrative Cases. Index.