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Timing of thrombolysis for acute ischemic stroke: “timing is everything” or “everyone is different”
Author(s) -
Grotta James
Publication year - 2012
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2012.06690.x
Subject(s) - thrombolysis , medicine , cardiology , duration (music) , stroke (engine) , consistency (knowledge bases) , occlusion , ischemic stroke , clinical practice , ischemia , computer science , myocardial infarction , artificial intelligence , art , mechanical engineering , literature , engineering , family medicine
It is indisputable that in the first 2 to 3 hours of an acute ischemic, the best strategy to maximize recovery is robustly time‐based and depends on getting the artery open as soon as possible. The second law of thermodynamics and the underappreciated effect of clot consistency and size must be accounted for in our efforts to minimize time to recanalization within the first 2 to 3 hours. It is also clear that at later time intervals, beyond 4.5 hours, few patients completely recover even with sustained complete recanalization, and that the ability to recover depends more on physiologic tissue issues than on the duration of the occlusion. Clinical factors as well as imaging should be used to select patients who may benefit from delayed attempts at reperfusion.