Journal of vascular and interventional radiology : JVIR
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J Vasc Interv Radiol · Jan 2004
ReviewCritical care assessment and management of acute ischemic stroke.
The resuscitation and treatment of patients with an acute stroke has evolved measurably during the past 2 decades. Acute ischemic stroke represents a true emergency where time is crucial and, therefore, evaluation and treatment often proceed simultaneously. Advanced imaging techniques can provide information about the state of brain perfusion, metabolism, and the cerebrovascular anatomy to help identify patients with viable brain tissue who may derive the greatest benefit from available therapies. ⋯ In addition, newer agents such as ancrod and abciximab may be effective within the acute time period. Optimal care requires a multidisciplinary approach with attention to a wide variety of therapeutic issues while maintaining adequate brain perfusion to reverse or halt the ischemic process. Herein, the author examines the important therapeutic concerns in the critical care management of ischemic stroke, including the management of elevated intracranial pressure, elevated and low blood pressure, cardiac complications, and potential metabolic disturbances.
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J Vasc Interv Radiol · Jan 2004
Clinical TrialEfficacy and safety of reteplase for central venous catheter occlusion in patients with cancer.
To evaluate the efficacy and safety of reteplase for central venous catheter (CVC) occlusion in patients with cancer. ⋯ Reteplase at 0.4-U dosing per catheter lumen is an effective and safe alternative that rapidly restores the patency of occluded CVCs in patients with cancer.
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J Vasc Interv Radiol · Jan 2004
Multicenter Study Clinical TrialAlteplase for treatment of occluded peripherally inserted central catheters: safety and efficacy in 240 patients.
Peripherally inserted central catheters (PICCs) have dramatically improved intravenous therapy, but thrombotic occlusion remains a common problem. Despite the popularity of PICCs, there are few prospective data on the use of fibrinolytic agents to salvage these particular devices. The purpose of this study was to evaluate the efficacy and safety of alteplase treatment. ⋯ Treatment with use of a maximum of two doses of alteplase is safe and effective in restoring function to occluded PICCs.
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J Vasc Interv Radiol · Jan 2004
ReviewPhysiologic monitoring and anesthesia considerations in acute ischemic stroke.
Acute ischemic stroke is considered a neurologic emergency. The perioperative anesthesia management of acute ischemic stroke is challenging owing to the dynamic pathophysiology of the disease itself and the patients' comorbid factors and conditions. Herein, the authors review preoperative assessment, intraoperative and postoperative physiologic monitoring, and anesthesia management, with a focus on the control of the cerebrovascular and cardiovascular circulations. Issues specific to anesthesia monitoring and management in the radiology suite are emphasized.
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Intravenous recombinant tissue-type plasminogen activator (rtPA, alteplase) is the only drug approved for the treatment of acute ischemic stroke. It should be administered within 3 hours of stroke. There is additional evidence, however, that administration at later times, by means of other methods, is effective. Herein, is a broad review of the knowledge gained and insights created from studies in which thrombolytic treatment was used in patients with stroke.