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Intra-arterial Thrombolytics for Treatment of Acute Ischemic Stroke

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Acute Stroke Management in the Era of Thrombectomy

Abstract

Intra-arterial (IA) thrombolytic drugs were used as a primary therapy for recanalization of large vessel occlusions (LVO) with limited success. In recent years, endovascular interventions for the treatment of acute ischemic stroke (AIS) have rapidly evolved to include newer stentriever devices, which are now considered the standard of care for the treatment of AIS secondary to LVO. Although MT with stentriever technology has led to superior reperfusion rates, less than one third of patients achieve complete reperfusion. The role of thrombolytics in modern AIS endovascular therapy is undefined. However, new research suggests that IA thrombolytic use with MT may be beneficial in improving revascularization rates in AIS patients. Large series have shown that IA thrombolysis can be used as an adjunct/rescue therapy to MT, without increasing the risk of symptomatic intracerebral hemorrhage. In this chapter, we provide a brief history of IA thrombolytics, current approaches, and their potential role in modern endovascular therapy.

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Author information

Authors and Affiliations

  1. Department of Neurology, Research, University of Toledo, Toledo, OH, USA

    Alicia C. Castonguay

  2. Department of Neurology, Stroke Center, University of Toledo, Toledo, OH, USA

    Mouhammad A. Jumaa

  3. Department of Neurology, Neurointerventional and Vascular Neurology Program, University of Toledo, Toledo, OH, USA

    Syed F. Zaidi

Authors
  1. Alicia C. Castonguay
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  2. Mouhammad A. Jumaa
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  3. Syed F. Zaidi
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Corresponding author

Correspondence to Syed F. Zaidi .

Editor information

Editors and Affiliations

  1. Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Edgar A. Samaniego

  2. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    David Hasan

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Castonguay, A.C., Jumaa, M.A., Zaidi, S.F. (2019). Intra-arterial Thrombolytics for Treatment of Acute Ischemic Stroke. In: Samaniego, E., Hasan, D. (eds) Acute Stroke Management in the Era of Thrombectomy. Springer, Cham. https://doi.org/10.1007/978-3-030-17535-1_6

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  • DOI: https://doi.org/10.1007/978-3-030-17535-1_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17534-4

  • Online ISBN: 978-3-030-17535-1

  • eBook Packages: MedicineMedicine (R0)

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