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BrainWaves


May 25, 2017

With the advent of mechanical thrombectomy, some have argued that using intravenous tissue plasminogen activator for stroke is futile. But is it really? Dr. Sheryl Martin-Schild of Dr. Brain, Inc. joins us for today's episode to discuss if the thrombectomy has killed tPA.

 

The content in this episode was vetted and approved by Sheryl Martin-Schild. Produced by James E. Siegler. Music by Lee Rosevere, Josh Woodward, Kevin McLeod and Little Glass Men. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making.

 

REFERENCES

  1. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The european cooperative acute stroke study (ecass). JAMA : the journal of the American Medical Association. 1995;274:1017-1025
  2. Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-pa stroke study group. The New England journal of medicine. 1995;333:1581-1587
  3. Saver JL, Gornbein J, Grotta J, Liebeskind D, Lutsep H, Schwamm L, et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: Joint outcome table analysis of the ecass 3 trial. Stroke; a journal of cerebral circulation. 2009;40:2433-2437
  4. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731
  5. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the american heart association/american stroke association. Stroke; a journal of cerebral circulation. 2016;47:581-641
  6. Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Davalos A, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the swift and star studies. JAMA Neurol. 2017;74:268-274
  7. Rai AT, Boo S, Buseman C, Adcock AK, Tarabishy AR, Miller MM, et al. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J Neurointerv Surg. 2017