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Thrombolytic Therapy for Stroke
edited by Patrick D. Lyden, MD,
410 pp., Totowa, NJ, Humana Press, 2001, $125
With the publication in 1995 of the National Institutes of Neurological Disorders and Stroke (NINDS) recombinant tissue-plasminogen activator (rtPA) Stroke Study, in 1996 the US Food and Drug Administration approved the use of rtPA as an effective treatment for acute stroke. For selected patients, the medical community now had its first tool to potentially reverse the course of a frequently devastating illness. With this new therapy came controversies, including concerns about the risks for intracerebral hemorrhage, appropriate selection criteria for patients, and which physicians and centers had the expertise to provide these services. Physicians on the front lines of stroke care had to become rapidly familiar with a novel (not to mention controversial) therapeutic modality, often without much clinical experience to fall back on.
Co-authored by many leaders in the field of acute stroke therapy, this book represents a thorough yet concise primer on stroke thrombolysis. It is intended to provide clinicians with the background necessary to develop their own informed opinions on the relative risks and benefits of cerebral thrombolysis, along with practical information on how to rapidly and safely evaluate patients for treatment.
This book consists of 18 chapters, logically organized into sections that methodically expose the reader to the history and science of thrombolysis, including both its successes and failures. The first section reviews the mechanisms of thrombolysis, the pathogenesis of vascular occlusion, and the principles of ischemic penumbra and neuronal salvage. The second section examines the history of stroke thrombolysis, from the early pilot studies in the 1960s through the post hoc analyses of the NINDS trial results. Additional chapters review the current state of thrombolysis research, including reviews of recent developments in intra-arterial …
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