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Over the last 15 years, IV thrombolysis in acute ischemic stroke has generally been done without knowledge of the status of an artery. Transcranial Doppler can demonstrate arterial occlusion and recanalization in real time. Early (during IV alteplase infusion) and late (within 24 hours) recanalization has been associated with better recovery.1,2 While some patients start improving before any therapy, persistent arterial occlusion in a patient with TIA, mild strokes, or improving stroke symptoms is associated with higher risk of subsequent stroke occurrence or symptom deterioration.3,4 Other patients we have assumed to be too late for therapy, despite symptoms.
More recently, endovascular therapies have targeted arterial occlusion per se in the acute stroke setting. The US Food and Drug Administration has approved the use of the MERCI and Penumbra catheters for the removal of clots from the cerebral circulation although the scientific evidence for efficacy of these therapies …
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