The Treatment of Stroke
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
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The screen versions of these slides have full details of copyright and acknowledgements |
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
A possible combined intravenous thrombolysis – thrombectomy strategy
(Kharitonova et al.)
Kharitonova et al.,Cerebrovasc Dis 2007 |
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Sonothrombolysis is a promising additional approach for recanalisation of occluded arteries
Alexandrov A etal.,Stroke 2000; 31: 610-614 |
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Alexandrov A etal., NEJM 2004,351(21): 2170-2178 |
Haemorrhage and oedema in and around the infarct may be serious complications to thrombolysis
•tPA may cause increased cerebrovascular permeability, which may be related to formation of oedema
and haemorrhage in and around the infarct area, both potentially severe complications to thrombolysis
•New experimental evidence suggest that this effect
is mediated by platelet-derived growth factor (PDGF-CC) and may be blocked by specific antibodies against the PDGF-alpha receptor on perivascular astrocytes
Su EJ et al., Nat Med, in press |
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The screen versions of these slides have full details of copyright and acknowledgements |
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
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Delashaw et al.,Stroke 1990; |
21:874-881 |
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Results on modified Rankin scale (mRS) at follow up in pooled study
(Vahedi et al.)
Vahedi K etal.,Lancet Neurol 2007;6:215-222 |
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The screen versions of these slides have full details of copyright and acknowledgements |
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
Vahedi K etal.,Lancet Neurology 2007;6:215-222 |
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Vahedi K etal.,Lancet Neurology 2007;6:215-222 |
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Vahedi K etal.,Lancet Neurology 2007;6:215-222 |
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The screen versions of these slides have full details of copyright and acknowledgements |
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
Thrombolysis is also evaluated
as a treatment for intracerebral haemorrhage
Barret RJ et al., Neurocrit Care 2005; 3(3):237-245 |
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Thrombolysis and highly specialised interventions require new standards for organised stroke care
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Multidisciplinary teams; |
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Stroke units |
Assessment procedures; Early management; |
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Ongoing rehabilitation |
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Langhorne P et al, Age Ageing 2002 31(5): 365-371 |
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Stroke unit + intrav enous rt-PA protocols 24/7; |
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Primary stroke |
Computer tomography av ailability 24/7 |
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centres |
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Leys D et al., Stroke 2007; 38: 2985-2991 |
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Primary stroke centre + intraarterial |
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Comprehensive |
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interv entions; Neurosurgery ; Vascular surgery |
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stroke centres |
Leys D et al., Stroke 2007; 38: 2985-2991 |
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Summary
•Intrav enous thromboly sis within 3 hours af ter onset of ischemic
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stroke is now approv ed treatment in most countries |
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I.v. thromboly sis can be considered ev en af ter 3 hours |
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in selected cases af ter ev aluation of extension of blood f low |
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reduction and inf arct |
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Thrombectomy and sonothromboly sis are new strategies |
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f or recanalisation of occluded arteries which may |
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be complementary to i.v. thrombolysis |
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Oedema dev elopment in y ounger patients (<60 y ears) |
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may be particularly aggressiv e – recent statistical ov erv iews |
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are in f av our of decompressiv e surgery in some of these patients |
•New therapeutic strategies require new standards
f or organisation of stroke care |
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The screen versions of these slides have full details of copyright and acknowledgements |
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The Treatment of Stroke:
Specific Management – Thrombolysis Plus
Prof. Nils Wahlgren
Stockholm, old town
Thanks for your attention!
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The screen versions of these slides have full details of copyright and acknowledgements |
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