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Statements

Subject Item
n2:RIV%2F00216208%3A11120%2F14%3A43907635%21RIV14-MSM-11120___
rdf:type
skos:Concept n5:Vysledek
dcterms:description
The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis-but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, starting acute stroke interventional programme requires a lot of learning, discipline, and humility. Randomized trials comparing different reperfusion strategies provided similar results in acute ischaemic stroke as in STEMI. Thus, it might be expected that also a future randomized trial comparing direct (primary) catheter-based thrombectomy vs. i.v. thrombolysis could show superiority of the mechanical intervention if it would be initiated without delay. Such randomized trial is needed to define the role of mechanical intervention alone in acute stroke treatment. The evolution of reperfusion therapy in acute myocardial infarction and acute ischaemic stroke has many similarities: thrombolysis is superior to placebo, intra-arterial thrombolysis is not superior to intravenous (i.v.), facilitated intervention is of questionable value, and direct mechanical recanalization without thrombolysis is proven (myocardial infarction) or promising (stroke) to be superior to thrombolysis-but only when started with no or minimal delay. However, there are also substantial differences. Direct catheter-based thrombectomy in acute ischaemic stroke is more difficult than primary angioplasty (in ST-elevation myocardial infarction [STEMI]) in many ways: complex pre-intervention diagnostic workup, shorter time window for clinically effective reperfusion, need for an emergent multidisciplinary approach from the first medical contact, vessel tortuosity, vessel fragility, no evidence available about dosage and combination of peri-procedural antithrombotic drugs, risk of intracranial bleeding, unclear respective roles of thrombolysis and mechanical intervention, lower number of suitable patients, and thus longer learning curves of the staff. Thus, starting acute stroke interventional programme requires a lot of learning, discipline, and humility. Randomized trials comparing different reperfusion strategies provided similar results in acute ischaemic stroke as in STEMI. Thus, it might be expected that also a future randomized trial comparing direct (primary) catheter-based thrombectomy vs. i.v. thrombolysis could show superiority of the mechanical intervention if it would be initiated without delay. Such randomized trial is needed to define the role of mechanical intervention alone in acute stroke treatment.
dcterms:title
Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences
skos:prefLabel
Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences
skos:notation
RIV/00216208:11120/14:43907635!RIV14-MSM-11120___
n5:predkladatel
n6:orjk%3A11120
n3:aktivita
n10:I
n3:aktivity
I
n3:cisloPeriodika
3
n3:dodaniDat
n15:2014
n3:domaciTvurceVysledku
n14:2228734
n3:druhVysledku
n12:J
n3:duvernostUdaju
n13:S
n3:entitaPredkladatele
n16:predkladatel
n3:idSjednocenehoVysledku
42208
n3:idVysledku
RIV/00216208:11120/14:43907635
n3:jazykVysledku
n19:eng
n3:klicovaSlova
Thrombolysis; Thrombectomy; Reperfusion; Primary angioplasty; Myocardial infarction; Catheter intervention; Acute stroke
n3:klicoveSlovo
n8:Acute%20stroke n8:Catheter%20intervention n8:Reperfusion n8:Thrombolysis n8:Primary%20angioplasty n8:Thrombectomy n8:Myocardial%20infarction
n3:kodStatuVydavatele
GB - Spojené království Velké Británie a Severního Irska
n3:kontrolniKodProRIV
[5E8F5CC089B0]
n3:nazevZdroje
European Heart Journal
n3:obor
n9:FA
n3:pocetDomacichTvurcuVysledku
1
n3:pocetTvurcuVysledku
3
n3:rokUplatneniVysledku
n15:2014
n3:svazekPeriodika
35
n3:tvurceVysledku
Widimský, Petr
n3:wos
000330441400013
s:issn
0195-668X
s:numberOfPages
11
n18:doi
10.1093/eurheartj/eht409
n17:organizacniJednotka
11120