Evidence-Based Use of IV and IA Thrombolytics in Acute Ischemic Stroke

Jin Moo Lee, M.D., PhD -- Department of Neurology
Washington University School of Medicine -- Presented July 25, 2006


Introduction: Evidence-Based Treatment of Cerebrovascular Disease

The following lecture is part of an ongoing series of lectures that discuss the current state of evidence supporting different treatments for the most common types of cerebrovascular disease.

Thrombolysis in Acute Ischemic Stroke

This lecture will examine the available data supporting the use of thrombolytic therapy for the treatment of acute ischemic stroke; critically evaluating levels of evidence.

The lecture will cover the balance of efficacy vs. morbidity of IV tPA and streptokinase, intra-arterial pro-Urokinase for MCA strokes, and the limited evidence supporting intra-arterial thrombolysis for the treatment of posterior circulation infarcts.
Table of Contents


1. Evidence Based-Practice:Thrombolysis in Acute Ischemic Stroke
2. Disclosure Policy
3. Overview
4. Levels of Evidence
5. IV Thrombolysis
6. NINDS rt-PA Study Design I
7. NINDS rt-PA Study Design II
8. NINDS rt-PA Study: Inclusion Criteria
9. NINDS rt-PA Study: Exclusion Criteria
10. NINDS rt-PA Study: Outcome Scales
11. NINDS rt-PA Study: Part 1 Primary Outcome
12. NINDS rt-PA Study: Part 2 Primary Outcome
13. NINDS rt-PA Study: Time to Treatment
14. NINDS rt-PA Study: ICH within 36 hours of RX
15. NINDS rt-PA Study: Who Developed Hemorrhage?
16. NINDS rt-PA Study: Mortality
17. NINDS rt-PA Study: Summary
18. NINDS rt-PA Study: Questions
19. NINDS rt-PA Study: Post-hoc and subgroup analysis
20. NINDS rt-PA Study: Post-hoc Analysis: Early Recovery I
21. NINDS rt-PA Study: Post-hoc Analysis: Early Recovery II
22. NINDS rt-PA Study: Post-hoc Analysis: Time to Treatment I
23. NINDS rt-PA Study: Post-hoc Analysis: Time to Treatment II
24. NINDS rt-PA Study: Hemorrhage
25. NINDS rt-PA Study: Sub-group analysis
26. NINDS rt-PA Study: Predictors of hemorrhage: Multivariate analysis
27.Major early infarct signs
28. Major early infarct signs II
29. NINDS rt-PA Study: Outcome
30. NINDS rt-PA Study Subgroup analysis: NIHSS
31. NINDS rt-PA Study Subgroup analysis: Early CT signs
32. NINDS rt-PA Study Subgroup analysis: Stroke Subtypes
33.NINDS rt-PA Study Subgroup analysis: Age
34. NINDS rt-PA Study Post-hoc analysis: Disposition Outcome
35. NINDS rt-PA Study: Long-term Outcome (1 year)
36. NINDS rt-PA Study: Long-term Mortality (1 year)
37. NINDS rt-PA Study Summary: Post-hoc and subgroup analysis
38. Dose and therapeutic window: ECASS I
39. Dose and therapeutic window: ECASS I
40. Dose and therapeutic window: ECASS II
41. Dose and therapeutic window: ATLANTIS
42. tPA: Summary
43. Are all thrombolytics the same?
44. Streptokinase
45.Intra-arterial thrombolysis I
46. Intra-arterial thrombolysis II
47. Intra-arterial thrombolysis: anterior circulation
48. Intra-arterial thrombolysis: PROACT II Study Design
49. PROACT II Study Design
50. PROACT II: Primary Outcome
51. PROACT II: Secondary and Other Outcomes
52. PROACT II: Hermorrhagic Conversions
53. PROACT II: Summary
54. PROACT II: Questions
55. Intra-arterial thrombolysis: posterior circulation
56. IA Thrombolysis for Acute Vertebrobasilar Occlusion
57. IA Thrombolysis for Acute VB Occlusion (Hacke et al.)
58. Baseline Characteristics (Hacke et al.)
59. Clinical Outcome (Hacke et al.)
60. Caveats (Hacke et al.)
61: Evidence Supporting IA Thrombolysis for Acute VB Occlusion
62. MERCI Trial I
63.MERCI Trial II
64. MERCI Results
65. MERCI Complications
66. Levels of Evidence
67. MERCI Summary
68. Summary

 

 

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