All this blathering and not one suggestion that maybe the way tPA is delivered could be changed. If you deliver it in magnetic nanoparticles you could use far less quantity and direct the bolus directly to the clot. But because they are enamored of shoehorning everything into tPA guidelines they fail to actually think of something better.
Stupidity prevails once again!!!
http://journal.frontiersin.org/Journal/10.3389/fneur.2014.00035/full?
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
About 25% of all strokes occur during sleep, i.e., without
knowledge of exact time of symptom onset. According to licensing
criteria, this large group of patients is excluded from treatment with
received tissue-plasminogen activator, the only specific stroke
treatment proven effective in large randomized trials. This paper
reviews clinical and imaging characteristics of wake-up stroke and gives
an update on treatment options for these patients. From clinical and
imaging studies, there is evidence suggesting that many wake-up strokes
occur close to awakening and thus, patients might be within the approved
time-window of thrombolysis when presenting to the emergency
department. Several imaging approaches are suggested to identify wake-up
stroke patients likely to benefit from thrombolysis, including
non-contrast CT, CT-perfusion, penumbral MRI, and the recent concept of
diffusion weighted imaging-fluid attenuated inversion recovery
(DWI-FLAIR). A number of small case series and observational studies
report results of thrombolysis in wake-up stroke, and no safety concerns
have occurred, while conclusions on efficacy cannot be drawn from these
studies. To this end, there are ongoing clinical trials enrolling
wake-up stroke patients based on imaging findings, i.e., the
DWI-FLAIR-mismatch (WAKE-UP) or penumbral imaging (EXTEND). The results
of these trials will provide evidence to guide thrombolysis in wake-up
stroke and thus, expand treatment options for this large group of stroke
patients.
Much more at link.
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