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. 2017 Apr;17(2):161-165.
doi: 10.7861/clinmedicine.17-2-161.

Thrombolysis and thrombectomy for acute ischaemic stroke

Salwa El Tawil  1 , Keith W Muir  2
Affiliations

Thrombolysis and thrombectomy for acute ischaemic stroke

Salwa El Tawil et al. Clin Med (Lond). 2017 Apr.

Abstract

The likelihood of disability-free recovery after acute ischemic stroke is significantly improved by reperfusion either by intravenous thrombolytic drug treatment or with endovascular mechanical thrombectomy in selected cases. The use of intravenous thrombolysis is limited by the short treatment window and you need to assess individual balance of benefit and risk of symptomatic intracranial haemorrhage. Benefit is greater for shorter onset-to-reperfusion time intervals, requiring optimisation of pre-hospital and in-hospital pathways. Symptomatic haemorrhage is more likely with more severe strokes, but a greater proportion of patients are left free of disability than suffer a treatment-related haemorrhage at all levels of severity. Extracranial haemorrhage and orolingual angioedema are less common complications. Endovascular mechanical thrombectomy can be used in selected patients with imaging-proven large artery occlusion. Successful therapy depends on well-organised services that can deliver treatment within a short time window at centres with adequate expertise to perform the procedure.

Keywords: Cerebrovascular disease; endovascular treatment; stroke; thrombectomy; thrombolysis.

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Figures

Fig 1.
Fig 1.
Indications and contraindications of thrombolysis. CT = computerised tomography; INR = international normalised ratio; IV rtPA = intravenous recombinant tissue plasminogen activator; NIHSS = National Institutes of Health Stroke Scale; PT = prothrombin time
Fig 2.
Fig 2.
Risk of symptomatic intracerebral haemorrhage (SICH) and absolute increase in proportion of patients with excellent functional outcome at 3–6 months after stroke by stroke severity (National Institutes of Health Stroke Scale (NIHSS)). These represent the difference in absolute outcomes between intravenous recombinant tissue plasminogen activator (IV rtPA)-treated patients and control groups adjusted for age and treatment delay. Modelled excess SICH risks for NIHSS strata were adjusted for age and treatment delay. Data derived from Whiteley et al.
Fig 3.
Fig 3.
Classification of post- thrombolysis haemorrhage.
See this image and copyright information in PMC

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