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Review
. 2018 Jan 16;18(1):8.
doi: 10.1186/s12883-017-1007-y.

Reperfusion therapy in acute ischemic stroke: dawn of a new era?

Sonu Bhaskar  1   2   3   4   5   6 , Peter Stanwell  7 , Dennis Cordato  8   9   10 , John Attia  7   11 , Christopher Levi  12   13   14   15   16   17
Affiliations
Review

Reperfusion therapy in acute ischemic stroke: dawn of a new era?

Sonu Bhaskar et al. BMC Neurol. .

Abstract

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.

Keywords: Endovascular treatment; Neurointervention; Prognosis; Reperfusion therapy; Stroke.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
The illustration of the fibrinolytic mechanisms: (a) tissue plasminogen activator (tPA) causes breakdown of the clot, and (b) detailed mechanism of fibrinolysis. Green arrow denotes activation/stimulation, and the red arrow indicates inhibition. tPA = tissue plasminogen activator; UK = Urokinase; PAI = plasminogen activator inhibitor
Fig. 2
Fig. 2
Workflow diagram detailing the algorithm to select AIS patients with or without large artery occlusion for IV-tPA, MT, or IV-tPA followed by MT. CT = computed tomography; MRI = magnetic resonance imaging; IV-tPA = intravenous trans-plasminogen activator; ICU = intensive care unit; CTA = CT angiography; MRA = MR angiography; LVO = large vessel occlusion; NIHSS = National Institutes of Health Stroke Scale; ICA = internal carotid artery
See this image and copyright information in PMC

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