Main description:

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.

Contents:

Part I: Background and Basic Investigations

Mechanisms of Thrombolysis
Gregory J. del Zoppo and Naohisa Hosomi

Pathology of Cervico-Cranial Artery Occlusion
Louis R. Caplan

The Ischemic Penumbra and Neuronal Salvage
Patrick D. Lyden

Part II: Scientific Rationale and Clinical Trials

Pre-Clinical Testing of Thrombolytic Therapy for Acute Ischemic Stroke
Steven R. Levine

Combination of Thrombolytic Therapy With Neuroprotectants
James C. Grotta and Lise A. Labiche

Pilot and Preliminary Studies of Thrombolytic Therapy for Stroke
Steven R. Levine, E. Clarke Haley, and Patrick D. Lyden

Intravenous Thrombolytic Therapy for Acute Ischemic Stroke: Results of Large Randomized Clinical Trials
Matthew L. Flaherty, Edward C. Jauch, Rashmi U. Kothari, and Joseph P. Broderick

Further Analysis of NINDS Study: Long-Term Outcome, Subgroups, and Cost Effectiveness
Susan C. Fagan, Thomas D. Kwiatkowski, and Patrick D. Lyden

Community Experience With Intravenous Thrombolysis for Acute Stroke
Lama Al-Khoury and Christy M. Jackson

Intra-Arterial Thrombolysis in Acute Ischemic Stroke
Anthony J. Furlan, Randall Higashida, Irene Katzan, Alex Abou-Chebl, and Andrew N. Russman

Combinations of Intravenous and Intra-Arterial Thrombolysis
Matthew L. Flaherty and Joseph Broderick

Part III: Using Thrombolysis for Acute Stroke

Thrombolysis in Vertebrobasilar Occulsive Disease
Louis R. Caplan

Thrombolytic Therapy in Stroke Patients
Patrick D. Lyden

Stroke Thrombolysis: The Present Guidelines and Policies for Clinical Use Should Be Changed
Louis R. Caplan

How to Run a Stroke Code
Askiel Bruno

The Impact of Computed Tomography on Acute Stroke Treatment
Rudiger von Kummer

Using Magnetic Resonance Imaging to Select andManage Patients for Treatment
Peter D. Schellinger, Chelsea S. Kidwell, and Steven Warach

The rt-PA for Acute Stroke Protocol
John Marler and Patrick D. Lyden

Part IV: Illustrative Cases

Illustrative Cases

Index