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- Perspective and Pathogenesis
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1. Expanding frontiers of cerebrovascular disease
- Prof. Vladimir Hachinski
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2. Basic anatomy, physiology and pathophysiology of the cerebral circulation for the physician
- Prof. Jean-Claude Baron
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3. Pathophysiology of cerebral ischemia
- Prof. Wolf-Dieter Heiss
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4. Intracerebral hemorrhages: causes and clinical findings
- Prof. Louis Caplan
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5. Subarachnoid hemorrhage (SAH)
- Prof. R. Loch Macdonald
- Diagnosis
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6. Clinical diagnosis of stroke and subtypes
- Prof. Louis Caplan
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7. The investigation of stroke
- Dr. Bart Demaerschalk
- Treatment
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8. Acute therapy of stroke and reperfusion treatments
- Prof. Brian Silver
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9. Subarachnoid hemorrhage diagnosis and management
- Prof. Gary K. Steinberg
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10. Stroke-induced heart injury
- Dr. Luciano A. Sposato
- Rehabilitation
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11. Stroke rehabilitation: principles of stroke
- Prof. Robert Teasell
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12. Stroke rehabilitation: therapies and treatments
- Prof. Robert Teasell
- Prevention
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13. Lifestyle and nutrition in stroke prevention
- Prof. J. David Spence
- Special Topics
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15. Pediatric stroke: cerebrovascular injury in the developing brain
- Prof. Adam Kirton
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16. Stroke in women: epidemiology, risk and prevention
- Prof. Cheryl Bushnell
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17. Transient ischemic attack and cognition
- Dr. Jennifer Mandzia
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18. Vascular cognitive impairment
- Prof. Eric E. Smith
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19. Atrial fibrillation, anticoagulation and vitamins for homocysteine
- Prof. J. David Spence
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20. Stroke in the young adult
- Prof. Jeffrey Saver
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21. Stroke in the young
- Dr. Gyan Kumar
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22. Convergence and joint prevention of stroke and dementia
- Prof. Vladimir Hachinski
- Archived Lectures *These may not cover the latest advances in the field
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23. Vascular cognitive impairment
- Dr. John Bowler
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24. Pediatric stroke
- Dr. Gabrielle deVeber
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25. The deteriorating stroke
- Prof. Werner Hacke
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26. General management
- Prof. Bo Norrving
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27. The treatment of stroke: specific management - thrombolysis plus
- Prof. Nils Wahlgren
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28. Rehabilitation: the chronic phase
- Prof. Lalit Kalra
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29. Prevention: management of risk and protective factors
- Prof. Graeme Hankey
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30. Medical therapy for secondary prevention of ischemic stroke
- Prof. Larry Goldstein
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31. Subarachnoid haemorrhage
- Prof. Jan van Gijn
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32. Controversies in stroke
- Prof. Stephen Davies
- Prof. Geoffrey Donnan
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33. Medical and surgical stroke
- Prof. Carlos Kase
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34. The urgency of stroke prevention after TIA
- Prof. S. Claiborne Johnston
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35. Carotid endarterectomy, angioplasty and stenting
- Prof. Martin Brown
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36. The clinical diagnosis of stroke and stroke subtypes
- Prof. Louis Caplan
Printable Handouts
Navigable Slide Index
- Introduction
- Overview
- Timeline
- tPA (alteplase)
- Benefits of thrombolysis within 4.5 hours of stroke onset
- Time dependency of a good outcome with intravenous thrombolysis
- Intravenous thrombolysis beyond 4.5 hours with MRI based imaging
- Diffusion (DWI) FLAIR mismatch on MRI
- Intravenous thrombolysis up to 9 hours after symptom onset
- Principles of CT perfusion mismatch
- CT perfusion mismatch
- Mechanical thrombectomy
- Devices
- Devices (ARTS technique)
- Mechanical thrombectomy within 12 hours of symptom onset
- Mechanical thrombectomy up to 24 hours with patient selection
- Time dependency of a good outcome with mechanical thrombectomy
- Individual differences in ischemic stroke progression
- Prevalence of fast and slow progressors
- Case study 1: 94-year-old woman
- Case study 1: Left M2 occlusion
- Case study 1: Recanalization
- Case study 1: Outcome
- Case study 2: 44-year-old woman
- Case study 2: Right M1 occlusion
- Case study 2: Angiogram of right M1 occlusion
- Case study 2: Recanalization
- Case study 2: Outcome
- Case study 2: Surgery to relieve swelling
- Case study 3: 76-year-old woman
- Case study 3: No asymmetry between hemispheres
- Case study 3: Left M1 occlusion
- Case study 3: Recanalization
- Case study 3: Outcome
- Complexity of decision making
- Future directions
Topics Covered
- Acute ischemic stroke
- Thrombolysis
- CT perfusion mismatch
- Thrombectomy
- Devices used to treat large vessel occlusion
- Imaged-Guided Patient Selection
Links
Series:
Categories:
Therapeutic Areas:
External Links
Talk Citation
Silver, B. (2021, April 27). Acute therapy of stroke and reperfusion treatments [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 7, 2024, from https://doi.org/10.69645/FLJO7558.Export Citation (RIS)
Publication History
Financial Disclosures
- There are no commercial/financial matters to disclose.
A selection of talks on Neuroscience
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Brian Silver.
I'm from the Department of Neurology at
the University of Massachusetts Medical School
in Worcester, Massachusetts, United States.
I'll be talking on acute therapy of stroke and reperfusion treatments.
Particularly changes that have occurred over the last decade.
0:19
In terms of the overview,
I'll be reviewing the reperfusion therapies including tPA and mechanical thrombectomy.
I'll then describe individual differences in ischemic stroke progression.
Finally, I'll discuss some future directions on how therapies can improve.
0:37
So in terms of the timeline on how reperfusion therapies have evolved since 1995,
the first positive trial occurred in 1995,
showing that tPA was effective for the treatment of ischemic stroke up to three hours.
Then it took 13 years to show that the same treatment was effective up to 4.5 hours.
Then it was not for another seven years in 2015 before thrombectomy,
which is where a device is inserted
into the clot in order to remove it from the blood vessel,
was shown to be effective up until six hours.
Then right after that, very rapidly,
we saw a number of studies showing the benefit of
thrombectomy and tPA using advanced imaging or artificial intelligence,
if you will, to benefit patients in an extended time window.
In 2018, there were positive thrombectomy trials up to
24 hours. Then there was a tPA trial beyond 4.5 hours with
an MRI mismatch. And there was a positive tPA trial between 4.5 and 9 hours
using CT perfusion, and a mismatch on that sequence, showing benefit as well.
What is not shown on this slide are the series of negative trials
that informed the development of these positive trials and lessons learned.
So this is a brief timeline of how the evolution of tPA and thrombectomy have occurred since 1995.
So, tPA is established, up to 4.5 hours currently, with plain CT scan of the head.