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Emergency Nurse : the Journal of the... Feb 2006In this article Nick Castle explains that, with significant improvements being made to the emergency management of cardiac patients, emergency nurses should challenge... (Review)
Review
In this article Nick Castle explains that, with significant improvements being made to the emergency management of cardiac patients, emergency nurses should challenge and develop their clinical practice to ensure patients receive prompt and evidence based treatment.
Topics: Emergency Medical Services; Emergency Nursing; Fibrinolytic Agents; Humans; Models, Nursing; Myocardial Infarction; Myocardial Reperfusion; Nurse's Role; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic; Recombinant Proteins; Streptokinase; Tenecteplase; Thrombolytic Therapy; Tissue Plasminogen Activator; United Kingdom
PubMed: 16502632
DOI: 10.7748/en2006.02.13.9.25.c1206 -
Arquivos de Neuro-psiquiatria Dec 2023Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of... (Review)
Review
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
Topics: Humans; Ischemic Stroke; Brain Ischemia; Stroke; Thrombectomy; Thrombolytic Therapy; Reperfusion; Treatment Outcome
PubMed: 38157871
DOI: 10.1055/s-0043-1777721 -
BMC Neurology Jan 2018Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with... (Review)
Review
Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed. Both systemic thrombolysis and endovascular treatment have been incorporated into the standard of care in stroke therapy. Further research on advanced imaging-based approaches to select appropriate patients, may widen the time-window for patient selection and would contribute immensely to early thrombolytic strategies, better recanalization rates, and improved clinical outcomes.
Topics: Brain Ischemia; Endovascular Procedures; Fibrinolytic Agents; Humans; Patient Selection; Reperfusion; Stroke; Thrombolytic Therapy; Treatment Outcome
PubMed: 29338750
DOI: 10.1186/s12883-017-1007-y -
Archivos de Cardiologia de Mexico 2017Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation... (Review)
Review
Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction.
Topics: Cardiology; Combined Modality Therapy; Humans; Mexico; Myocardial Infarction; Myocardial Reperfusion
PubMed: 28169119
DOI: 10.1016/j.acmx.2016.12.007 -
Continuum (Minneapolis, Minn.) Apr 2020The article "Update on Treatment of Acute Ischemic Stroke" by Dr Rabinstein was first published in the February 2017 Cerebrovascular Disease issue of Continuum: Lifelong... (Review)
Review
EDITOR'S NOTE
The article "Update on Treatment of Acute Ischemic Stroke" by Dr Rabinstein was first published in the February 2017 Cerebrovascular Disease issue of Continuum: Lifelong Learning in Neurology as "Treatment of Acute Ischemic Stroke" and has been updated by Dr Rabinstein for this issue at the request of the Editor-in-Chief.
ABSTRACT
PURPOSE OF REVIEWThis article provides an update on the state of the art of the treatment of acute ischemic stroke with particular emphasis on the indications for reperfusion therapy.RECENT FINDINGSIn addition to the previously established indications for intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of stroke symptom onset and endovascular therapy with mechanical thrombectomy for patients with large artery occlusion who can be treated within 6 hours of symptom onset, recent randomized controlled trials have now established new indications for emergency reperfusion in patients with wake-up stroke or delayed presentation (up to 24 hours from last known well in the case of mechanical thrombectomy). Identification of patients who may benefit from acute reperfusion therapy within this extended time window requires screening with perfusion brain imaging or, in the case of IV thrombolysis for wake-up strokes, emergency brain MRI. Collateral status and time to reperfusion remain the primary determinants of outcome.SUMMARYTimely successful reperfusion is the most effective treatment for patients with acute ischemic stroke. Recent evidence supports the expansion of the time window for reperfusion treatment in carefully selected patients.
Topics: Fibrinolytic Agents; Humans; Ischemic Stroke; Mechanical Thrombolysis; Outcome and Process Assessment, Health Care; Reperfusion; Thrombolytic Therapy
PubMed: 32224752
DOI: 10.1212/CON.0000000000000840 -
Stroke Oct 2021Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for... (Review)
Review
Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the "outer limits" of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy. The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.
Topics: Animals; Endovascular Procedures; Humans; Ischemic Stroke; Reperfusion; Thrombolytic Therapy; Treatment Outcome
PubMed: 34470484
DOI: 10.1161/STROKEAHA.121.035022 -
American Heart Journal Nov 2015More than 20 years of misconceptions derailed acceptance of reperfusion therapy for acute myocardial infarction (AMI). Cardiologists abandoned reperfusion for AMI using... (Review)
Review
More than 20 years of misconceptions derailed acceptance of reperfusion therapy for acute myocardial infarction (AMI). Cardiologists abandoned reperfusion for AMI using fibrinolytic therapy, explored in 1958, because they no longer attributed myocardial infarction to coronary thrombosis. Emergent aortocoronary bypass surgery, pioneered in 1968, remained controversial because of the misconception that hemorrhage into reperfused myocardium would result in infarct extension. Attempts to limit infarct size by pharmacotherapy without reperfusion dominated research in the 1970s. Myocardial necrosis was assumed to progress slowly, in a lateral direction. At least 18 hours was believed to be available for myocardial salvage. Afterload reduction and improvement of the microcirculation, but not reperfusion, were thought to provide the benefit of streptokinase therapy. Finally, coronary vasospasm was hypothesized to be the central mechanism in the pathogenesis of AMI. These misconceptions unraveled in the late 1970s. Myocardial necrosis was shown to progress in a transmural direction, as a "wave front," beginning with the subendocardium. Reperfusion within 6 hours salvaged a subepicardial ischemic zone in experimental animals. Acute angiography provided in vivo evidence of the high incidence of total coronary occlusion in the first hours of AMI. In 1978, early reperfusion by transluminal recanalization was shown to be feasible. The pathogenetic role of coronary thrombosis was definitively established in 1979 by demonstrating that intracoronary streptokinase rapidly restored flow in occluded infarct-related arteries, in contrast to intracoronary nitroglycerine which rarely did. The modern reperfusion era had dawned.
Topics: Humans; Myocardial Infarction; Myocardial Reperfusion
PubMed: 26542507
DOI: 10.1016/j.ahj.2015.08.005 -
Cardiology Clinics Feb 2015Reperfusion, or restoration of blood flow, is an effective means of reducing disability in the setting of acute stroke. Reperfusion therapies, such as intravenous... (Review)
Review
Reperfusion, or restoration of blood flow, is an effective means of reducing disability in the setting of acute stroke. Reperfusion therapies, such as intravenous thrombolysis or endovascular and interventional procedures, fit within the existing stroke system of care. There are currently 4 devices cleared by the Food and Drug Administration for recanalization of arterial occlusion in patients with ischemic stroke. Endovascular device technology and advanced imaging technology continue to evolve with newer devices suggesting greater recanalization success. A new paradigm using advanced imaging to select patients in combination with newer devices is being tested and may lead to great improvements in care.
Topics: Adult; Aged; Aged, 80 and over; Brain; Cause of Death; Cerebral Infarction; Cooperative Behavior; Diagnostic Imaging; Disability Evaluation; Emergency Medical Services; Endovascular Procedures; Equipment Design; Humans; Interdisciplinary Communication; Middle Aged; Reperfusion; Thrombolytic Therapy; United States
PubMed: 25439334
DOI: 10.1016/j.ccl.2014.09.009 -
Journal of the American Heart... Oct 2014
Comparative Study Review
Topics: Angioplasty, Balloon, Coronary; Electrocardiography; Female; Heart Rupture, Post-Infarction; Humans; Male; Myocardial Infarction; Myocardial Reperfusion; Prognosis; Risk Assessment; Survival Analysis; Thrombolytic Therapy; Treatment Outcome
PubMed: 25332182
DOI: 10.1161/JAHA.114.001368 -
CNS Neuroscience & Therapeutics Feb 2024In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete... (Review)
Review
In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete microcirculatory reperfusion failure after the achievement of full patency of a former obstructed large vessel, known as the "no-reflow phenomenon" or "microvascular obstruction," was first reported in the 1960s and was later detected in both experimental models and patients with stroke. The no-reflow phenomenon (NRP) was reported to result from intraluminal occlusions formed by blood components and extraluminal constriction exerted by the surrounding structures of the vessel wall. More recently, an emerging number of clinical studies have estimated the prevalence of the NRP in stroke patients following reperfusion therapy, ranging from 3.3% to 63% depending on its evaluation methods or study population. Studies also demonstrated its detrimental effects on infarction progress and neurological outcomes. In this review, we discuss the research advances, underlying pathogenesis, diagnostic techniques, and management approaches concerning the no-reflow phenomenon in the stroke population to provide a comprehensive understanding of this phenomenon and offer references for future investigations.
Topics: Humans; No-Reflow Phenomenon; Microcirculation; Stroke; Thrombectomy; Reperfusion; Treatment Outcome
PubMed: 38358074
DOI: 10.1111/cns.14631