Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
Research ArticleEDITORIAL

Intra-arterial Thrombolysis for the Treatment of Patients with Acute Ischemic Stroke

Charles M. Strother
American Journal of Neuroradiology October 1999, 20 (9) 1580;
Charles M. Strother
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • References
  • PDF
Loading

In this issue of the AJNR, Edwards and colleagues (page 1682) describe their experiences with the use of intra-arterial thrombolytic therapy for the treatment of patients with acute ischemic stroke. The report is noteworthy on at least two counts. First, it demonstrates unequivocally both the feasibility and practicality of implementing an aggressive and effective protocol for the treatment of acute ischemic stroke in a community hospital outside of a major urban area. It also serves as an excellent example of the type of important and innovative clinical research that can be conducted in medical facilities located outside of the walls of a university setting. In spite of increasingly convincing evidence that there is considerable benefit to be derived from the use of aggressive endovascular techniques in the management of properly selected patients with acute ischemic stroke, many institutions still either do not provide these treatment options or only offer them on what might be termed an ad hoc basis. Several explanations are commonly offered in defense of the inability to offer these services. Two of the most common are: 1) there are not enough interventional neuroradiologists to provide round-the-clock, 7-day-per-week coverage; and 2) the institution does not have adequate resources to make available either the necessary technology or the in-house staff (technician and physician) coverage required for such a service.

Although physicians with specialized training in interventional neuroradiology should, because of their special skills (technical and cognitive), enhance the function of a “stroke team,” it does not follow that “teams” without such members cannot also be effective. Using currently available microcatheters and guidewires, most physicians having significant experience performing diagnostic angiograms can be taught to perform catheterization on those intracranial arteries that are most commonly implicated in the etiology of ischemic stroke safely. It is much more difficult to provide training so that one understands issues such as when and when not to perform a particular intervention and what to do when things go wrong than it is to teach the technical skills required for the intervention itself. In my opinion, this hurdle may be quickly lowered and ultimately removed by establishment of “teams” such as the one described in the report by Edwards and colleagues. Unlike large academic centers where the personnel of stroke teams (technicians, residents, fellows, and staff) may be under considerable flux, the team described by Edwards was small, stable, and focused. Such an environment provides an ideal venue for each patient encounter to result in all members of the team expanding their understanding of “what went right and what went wrong” thereby “training” not only themselves but also the team for improved performance with each new experience. The reality is that if the vast numbers of patients who suffer an ischemic stroke each year in North America are to benefit from current and evolving therapeutic options, physicians other than formally trained interventional neuroradiologists and neurologists must be recruited to be members of stroke teams.

Recent studies provide some indication that the major reason for patients with ischemic stroke being ineligible for thrombolytic therapy is delay in obtaining treatment. While both access to rapid CT imaging and accurate interpretation of scan findings are critical if acute ischemic stroke intervention is to be safe and successful, neither issue need preclude offering such treatment in hospitals such as the one described by Edwards and colleagues. It seems certain that rapidly evolving MR techniques (diffusion and perfusion imaging) will greatly enhance the ability to distinguish between those patients having an “open therapeutic window” and those in whom the “window is closed.” The resulting improvement in stratifying individuals into appropriate treatment protocols ought to increase the number of patients who are potential candidates for thrombolytic therapy. A further increase in the patient population suitable for aggressive endovascular treatment likely will occur as a number of promising techniques for mechanical thrombolysis and nonpharmacologic methods of providing “brain protection,” ie, regional hypothermia, become available. As these techniques are commercialized, not only tertiary-care medical centers but also many community hospitals have adequate technology and personnel in place to implement them into their practice. As noted by Hill and Hachinski: “Nihilistic attitudes about stroke treatment are now archaic because the future holds much promise for stroke patients (1).” Edwards and colleagues have shown enthusiasm, dedication, and skill in carrying out the study reported in this issue of the Journal. This could serve as a model for implementing an interventional stroke service in other community hospital settings.

Reference

  1. ↵
    Hill M, Hachinski V. Stroke treatment: time is brain. Lancet 1998;352(suppl III):10-14
  • Copyright © American Society of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology
Vol. 20, Issue 9
1 Oct 1999
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Intra-arterial Thrombolysis for the Treatment of Patients with Acute Ischemic Stroke
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Intra-arterial Thrombolysis for the Treatment of Patients with Acute Ischemic Stroke
Charles M. Strother
American Journal of Neuroradiology Oct 1999, 20 (9) 1580;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Intra-arterial Thrombolysis for the Treatment of Patients with Acute Ischemic Stroke
Charles M. Strother
American Journal of Neuroradiology Oct 1999, 20 (9) 1580;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Reference
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • The No Surprises Act: What Neuroradiologists Should Know
  • Call to Action: Women in Neuroradiology’s Group (WINNERS)—Is There a Need?
  • The Z-Shift: A Need for Quality Management System Level Testing and Standardization in Neuroimaging Pipelines
Show more EDITORIAL

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire