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This book provides detailed practical guidance on the management of acute ischemic stroke in the clinical settings encountered in daily practice. Real-life cases are used to depict a wide range of clinical scenarios and to highlight significant aspects of management of ischemic stroke. In addition, diagnostic and therapeutic protocols are presented and helpful decision-making algorithms are provided that are specific to the different professionals involved in delivery of acute stroke care and to differing types of hospital facility. The coverage is completed by the inclusion of up-to-date scientific background information relevant to diagnosis and therapy. Throughout, the approach adopted is both practical and multidisciplinary. The book will be of value for all practitioners involved in the provision of acute stroke care, and also for medical students.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.
It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become “vetted” by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of clinical research such as combining intravenous thr- bolysis with neuroprotective therapies or intra-arterial thrombolysis. A wealth of factual information is supplemented by chapters containing sage opinion from Drs. Lyden and Caplan concerning the logistical, economic, and procedural issues that have been generated since the advent of this technology. Importantly, diagnosis does not take a back seat to therapeutics as illustrated by sections devoted to eva- ation of the stroke patient, very useful illustrative cases and clinical comments, and chapters on the latest in imaging as applied to this field.
During the last decade scientists in both basic and clinical research have renew ed their interest in the potential role of thrombolytic therapy in the treatment of acute ischemic stroke. The reevaluation of this approach was kindled by our growing knowledge of the pathogenesis of thrombotic and embolic stroke and by the development of new thrombolytic agents. With no proven therapy for acute ischemic stroke available, the potential value of early pharmacologic recanalization of occluded vessels in the management of acute stroke patients - an approach that has been supported by animal experiments and a limited number of uncontrolled clinical pilot studies - is again under scrutiny. A sym posium on "Thrombolysis in Acute Cerebral Ischemia" was held in Heidel berg, Germany, in May 1990 to summarize and discuss the pathophysiological background for thrombolysis in acute ischemic stroke and the recent ex perimental and clinical experience with the new generation of thrombolytic agents. The editors are fortunate to be able to include authoritative manuscripts from almost all the speakers at the symposium. These include reports of work by the most active investigators in this challenging field. The editors wish to express their gratitude to all the contributors for the additional work they have undertaken. Additionally, we would like to thank Springer-Verlag, Heidelberg, for its generous assistance in the preparation and rapid publication of this volume. Heidelberg, August 1990 WERNER HACKE GREGORY J. DEL ZopPO MATTHIAS HIRSCHBERG Contents I.
A critical and comprehensive look at current state-of-the-art scientific and translational research being conducted internationally, in academia and industry, to address new ways to provide effective treatment to victims of ischemic and hemorrhagic stroke and other ischemic diseases. Currently stroke can be successfully treated through the administration of a thrombolytic, but the therapeutic window is short and many patients are not able to receive treatment. Only about 30% of patients are "cured" by available treatments. In 5 sections, the proposed volume will explore historical and novel neuroprotection mechanisms and targets, new and combination therapies, as well as clinical trial design for some of the recent bench-side research.