You really don't want your doctor questioning what to do when you present at the ER with stroke symptoms. You want EXACT DIAGNOSIS PROTOCOLS LEADING TO EXACT TREATMENT PROTOCOLS AND THEN FIRST WEEK INTERVENTION PROTOCOLS THAT STOP THE NEURONAL CASCADE OF DEATH. FOLLOWED BY EXACT REHAB PROTOCOLS LEADING TO 100% RECOVERY. Yes, this is pie in the sky but until this occurs all persons with stroke are screwed. Looking forward to being told where my analysis is wrong without excuses about brains being hard to treat and the research is not there yet, or the tyranny of low expectations. Leaders solve problems, they don't make excuses. Are you a leader or not? If you don't soften up the clot with tPA does endovascular treatment still work? Maybe reduce the size of the bolus substantially by directing tPA there in magnetic nanoparticles.
Or maybe this solution from March, 2015
Magnetic nanoparticles could stop blood clot-caused strokes
The objection to this here:
Potentially Toxic Magnetic Nanoparticle Pollution Found in Human Brains
Or this from May, 2012
Future of med devices: Nanorobots in your blood stream
Use them to deliver tPA or drill thru the clot.
The fucking answers are out there, they just need to be researched and implemented.
The latest here:
IV tPA is associated with increase in rates of intracerebral hemorrhage and length of stay in patients with acute stroke treated with endovascular treatment within 4.5 hours: should we bypass IV tPA in large vessel occlusion?
- Ameer E Hassan1,2,3,
- Victor M Ringheanu2,
- Laurie Preston2,3,
- Wondwossen Tekle1,3,
- Adnan I Qureshi4,5
Author affiliations
Abstract
Background
Endovascular treatment (EVT) is a widely proved method to treat
patients diagnosed with intracranial large vessel occlusions (LVOs);
however, there has been controversy about the safety and efficacy of
incorporating intravenous tissue plasminogen activator (IV tPA) as
pretreatment for EVT.
Objective To compare the outcomes of all patients with LVO treated with IV tPA +EVT versus EVT alone within 4.5 hours of stroke onset.
Methods
A prospectively collected endovascular database at a comprehensive
stroke center between 2012 and 2019 was used to examine variables such
as demographics, comorbid conditions, symptomatic/asymptomatic
intracerebral hemorrhage (ICH), mortality rate, and good/poor outcomes
as shown by the modified Thrombolysis in Cerebral Infarction score and
modified Rankin Scale (mRS) assessment at discharge. The outcomes
between patients receiving IV tPA+EVT on admission and patients who
underwent EVT alone were compared.
Results
Of 588 patients with acute ischemic stroke treated with EVT, a total of
189 met the criteria for the study (average age 70.44±12.90 years,
42.9% women). Analysis of 109 patients from the group receiving
EVT+IV tPA (average age 68.17±14.28 years, 41.3% women), and 80 patients
from the EVT alone group was performed (average age 73.54±9.84 years,
45.0% women). Four patients (5.0%) in the EVT alone group experienced
symptomatic ICH versus 15 patients (13.8%) in the IV tPA+EVT group
(p=0.0478); significant increases were also noted in the length of stay
for patients treated with IV tPA (8.2 days vs 11.0 days; p=0.0056).
Conclusion
IV tPA in addition to EVT was associated with an increase in the rate
of ICH in patients with LVO treated within 4.5 hours and in patients’
length of stay. Further research is required to determine whether EVT
treatment alone in patients with LVO treated within 4.5 hours is a more
effective option.
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