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To tPA or Not to tPA, That Is the Question

To tPA or Not to tPA, That Is the Question EDITORIAL with 87% of the control population. From the thrombectomy To tPA or Not to tPA, That Is the group, 108 patients were ineligible for IV tPA of 188 total. Question There was no treatment-effect heterogeneity across a range of prespecified variables; the administration of tPA caused nei- X T.M. Leslie-Mazwi, X R.V. Chandra, and X J.A. Hirsch ther benefit nor harm. The authors concluded that endovascu- lar therapy should be pursued irrespective of tPA eligibility or or decades, the acute treatment of stroke has centered on status. Fdelivery of intravenous recombinant tissue plasminogen These are specific trial populations, and even in aggregate, activator. Endovascular stroke therapy was historically dogged there are reasons that generalizing to patients in everyday practice by a dearth of high-level evidence supporting its application. requires caution. However, several recent publications have ex- Refinements in imaging selection, improved treatment logis- plored this in typical clinical scenarios. tics, and increased reperfusion rates came together in 2015 Weber et al retrospectively analyzed patients treated with with the publication of multiple randomized trials that changed that, unequivocally identifying the benefit of endo- combination therapy with IV tPA and thrombectomy (n  105) vascular therapy combined with medical management http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

To tPA or Not to tPA, That Is the Question

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5263
Publisher site
See Article on Publisher Site

Abstract

EDITORIAL with 87% of the control population. From the thrombectomy To tPA or Not to tPA, That Is the group, 108 patients were ineligible for IV tPA of 188 total. Question There was no treatment-effect heterogeneity across a range of prespecified variables; the administration of tPA caused nei- X T.M. Leslie-Mazwi, X R.V. Chandra, and X J.A. Hirsch ther benefit nor harm. The authors concluded that endovascu- lar therapy should be pursued irrespective of tPA eligibility or or decades, the acute treatment of stroke has centered on status. Fdelivery of intravenous recombinant tissue plasminogen These are specific trial populations, and even in aggregate, activator. Endovascular stroke therapy was historically dogged there are reasons that generalizing to patients in everyday practice by a dearth of high-level evidence supporting its application. requires caution. However, several recent publications have ex- Refinements in imaging selection, improved treatment logis- plored this in typical clinical scenarios. tics, and increased reperfusion rates came together in 2015 Weber et al retrospectively analyzed patients treated with with the publication of multiple randomized trials that changed that, unequivocally identifying the benefit of endo- combination therapy with IV tPA and thrombectomy (n  105) vascular therapy combined with medical management

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Aug 1, 2017

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