3. The Power of Observation

  1. Andrei V Alexandrov

Published Online: 1 JUL 2013

DOI: 10.1002/9781118583906.ch3

Neurovascular Examination: The Rapid Evaluation of Stroke Patients Using Ultrasound Waveform Interpretation

Neurovascular Examination: The Rapid Evaluation of Stroke Patients Using Ultrasound Waveform Interpretation

How to Cite

Alexandrov, A. V. (ed) (2013) The Power of Observation, in Neurovascular Examination: The Rapid Evaluation of Stroke Patients Using Ultrasound Waveform Interpretation, John Wiley & Sons Ltd, Oxford, UK. doi: 10.1002/9781118583906.ch3

Editor Information

  1. University of Alabama at Birmingham, Birmingham, Alabama, United States

Publication History

  1. Published Online: 1 JUL 2013
  2. Published Print: 22 JUL 2013

ISBN Information

Print ISBN: 9781405185301

Online ISBN: 9781118583906

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Keywords:

  • stroke;
  • thrombolysis;
  • tissue plasminogen activator;
  • transcranial Doppler;
  • carotid duplex;
  • occlusion;
  • outcome

Summary

The pivotal clinical trials of systemic tPA, such as the NINDS-rt-PA Stroke Study and ECASS 3 trials, showed that tPA helped more patients recover at 3 month after ischemic stroke but did not show the so-called Lazarus effect during and shortly after treatment. The debate about how and if tPA works prompted the departure from snap-shot assessments of parenchyma and perfusion to real-time monitoring of the residual flow around thrombus and changes in cerebral hemodynamics. Case presentations illustrate sudden recanalization, hyperemic reperfusion, arterial re-occlusion after systemic tPA and endovascular procedures, and blood flow steal. These observations lead to subsequent clinical studies of sonothrombolysis and exploration of various combined reperfusion strategies.