Management of ischaemic stroke in the acute setting : review of the current status : review article

Abstract

Acute ischaemic stroke can be treated by clot busting and clot removal. Thrombolysis using intravenous recombinant-tissue plasminogen activator (IV r-TPA) is the current gold standard for the treatment of acute ischaemic stroke (AIS). The main failure of this type of treatment is the short time interval from stroke onset within which it has to be used for any benefit. The evidence is that IV r-TPA has to be used within 4.5 hours.Other modalities of treatment are not as effective and need more scrutiny and examination. The available modalities are intra-arterial thrombolysis and clot-retrieval devices. Not unexpectedly, recanalisation treatments have flourished at a rapid rate. Although vessel recanalisation is vital to increasing the possibility of significant tissue reperfusion, clinical trials need to emphasise functional outcomes rather than reperfusion/recanalisation rates to adequately assess success of these devices/techniques.Our view is that until these treatments become proven in large-scale studies, a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5-hour period following onset of stroke. The resources required are small with the main costs being a CT scan of the brain and the cost of r-tPA. This can easily be done in any emergency facility in any part of the world. What is needed is public awareness, and campaigns of ‘stroke attack’ should be revisited, especially in the resource-limited context. This approach at present will halt to some extent the stroke pandemic that we are facing.

CLEC14A deficiency exacerbates neuronal loss by increasing blood-brain barrier permeability and inflammation

“…Approximately 80% of strokes are ischemic [1,2]. The standard treatment for stroke is thrombolysis, which has rather limited efficacy [3,4]. Ischemic stroke induces bloodbrain barrier (BBB) breakdown that contributes to secondary brain injury by causing cerebral edema, increasing hemorrhage, and exacerbating the inflammatory response [5,6].…”

Providing full recovery with single‐dose intravenous reteplase in a patient presented to emergency department with acute ischemic stroke

“…Clinical trials with IV administration of reteplase in the setting of AIS is limited, and the results are conflicting. In a recent review , it was stated that no evidence is present showing benefit with reteplase for use in the setting of AIS. On the contrary, the Reopro Retevase Reperfusion of Stroke Safety Study (ROSIE) showed that in combination with Abciximab, intraarterial reteplase was revealed to have acceptable safety and efficacy in AIS patients within 3–24 h of symptom onset, with a disabling stroke, NIHSS score ≤16 points, and evidence of a perfusion deficit on PWI/MRI and MR angiography .…”

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

“…Antithrombolytic drugs are administered routinely in these stroke units hence; they have similar outcomes to the developed world [70]. These centres have gone further to institute multidisciplinary stroke care noting a reduction of inpatient mortality from 33% to 16% in one case [71]. The authors however decried the fact that the number of CT brain scans performed and referral to a tertiary hospital did not increase significantly [71].…”

“…These centres have gone further to institute multidisciplinary stroke care noting a reduction of inpatient mortality from 33% to 16% in one case [71]. The authors however decried the fact that the number of CT brain scans performed and referral to a tertiary hospital did not increase significantly [71]. One suggestion is that a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5 h period following onset of stroke.…”