@Article{Padma2010,
journal="Archives of Medical Science",
issn="1734-1922",
volume="6",
number="3",
year="2010",
title="Review paper Intra-arterial versus intra-venous thrombolysis within and after the first 3 hours of stroke onset",
abstract="The NINDS trial demonstrated for the first time the effectiveness of intravenous thrombolysis in improving outcome after acute ischemic stroke. The absolute benefit of this intervention was 11-13% greater chance of being normal or near normal (MRS \ 1) at 3 months. However, if patients with severe stroke were considered (NIHSS \ 20), the absolute benefit dropped to 5-6%, indicating that IV thrombolysis may not be as effective for large vessel occlusion. This observation was further supported by TCD studies that clearly demonstrated that large artery occlusions had a recanalization rate of 13-18% with IV rt-PA. Intra-arterial thrombolysis achieves recanalization rates of 60-70%. Since tissue viability is clearly important, it is time to stop defining rigid time windows and if there is a large penumbra (20-50%) and the occlusion is in a large artery, there exists a logic and a growing evidence to consider either bridge therapy or direct intra-arterial therapy.",
author="Padma, Srivastava
and Majaz, Moonis",
pages="303--315",
doi="10.5114/aoms.2010.14248",
url="http://dx.doi.org/10.5114/aoms.2010.14248"
}