Ischemic Stroke Therapeutics: A Comprehensive Guide PDF
Preview Ischemic Stroke Therapeutics: A Comprehensive Guide
Bruce Ovbiagele Tanya N. Turan Editors Ischemic Stroke Therapeutics A Comprehensive Guide 123 Ischemic Stroke Therapeutics Bruce Ovbiagele (cid:129) Tanya N. Turan Editors Ischemic Stroke Therapeutics A Comprehensive Guide Editors Bruce Ovbiagele, M.D., M.Sc., M.A.S. Tanya N. Turan, M.D., M.S.C.R. Admiral Pihl Professor and Chairman of Associate Professor of Neurology Neurology Stroke Neurology Division Director Medical University of South Carolina Medical University of South Carolina Charleston , SC , USA Department of Neurology MUSC Stroke Program Charleston , SC , USA ISBN 978-3-319-17749-6 ISBN 978-3-319-17750-2 (eBook) DOI 10.1007/978-3-319-17750-2 Library of Congress Control Number: 2015945656 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Foreword Fifteen years into the new millennium comes a truly contemporary and dynamic compendium for a new generation of physicians and care providers. Drs. Ovbiagele and Turan, and their contributors, bring forward a new book for a new era of stroke care. In a fi eld once character- ized by nihilism, minimalist therapy and long discussions over the dose of aspirin, these authors capture the emerging enthusiasm for stroke therapeutics at the infl ection point in its evolution where the care spectrum is expanding to encompass the prehospital space and extending well beyond the acute hospitalization into rehabilitation and recovery. Much has changed, not just the therapeutics we have to offer, but the ways and means of delivering that care within “s troke systems of care ” and using remote evaluation and treatment with telemedi- cine. There is a great deal to learn from this book as the fi eld of stroke care matures and expands into new areas such as aggressive endovascular therapy and brain stimulation to enhance recovery. The editors and contributors have accomplished an important task and the reader will be rewarded for engaging I schemic Stroke Therapeutics: A comprehensive Guide . Charleston, SC, USA Robert J. Adams, M.S., M.D. v Pref ace S troke exacts a huge toll throughout the world by way of its dreaded complications, death, disability, and dementia. Fortunately, the historic nihilism in stroke care has been replaced with a sense of optimism, due to a better understanding of its various underlying mechanisms, robust evidence to either support or discredit several interventions, and a measureable decline in the incidence of stroke over the last decade in many developed nations. Ischemic stroke, the more preponderant of the two main stroke types, has especially benefi tted from major thera- peutic strides forward in its acute management and secondary prevention. Just as thrilling is the prospect of future data from ongoing and planned clinical trials, testing a variety of treat- ments and strategies, aimed at improving stroke outcomes. Ischemic Stroke Therapeutics is a timely and consolidated resource for clinicians, which captures state-of-the-art strategies and the accelerated pace of discovery that is revolutionizing what we know about ischemic stroke and its treatment. Therapeutics for acute management, secondary prevention, recovery/rehabilitation, asymptomatic cerebral ischemia, and imple- mentation of stroke systems of care are all discussed in this comprehensive yet practical trea- tise. Leading academicians with extensive clinical practice experience from all over the world present the scientifi c evidence behind prevailing therapeutic strategies for managing ischemic cerebrovascular disease. Each section follows a similar format. An introductory general concepts subsection written by a senior academician provides an overview of the key issues pertinent to that area of stroke management and is followed by chapters covering important individual topics in that section that review currently available therapies in that area, describe unresolved major issues, and present promising future areas of therapeutic focus under investigation. M edicine is best taught case by case, so where applicable, chapters include a concise case vignette (emphasizing a key take-home point), followed by discussions of the relevant evidence- based treatments including results of clinical trials, meta-analyses of existing trial or cohort data, and “real-world” studies (hospital and community registries), along with user- friendly statistical concepts such as number needed to treat (NNT) and number needed to harm (NNH). Noteworthy differential effects of treatments in special populations (e.g., women, very elderly, race-ethnic minorities) and data on cost implications (where available) are also detailed. Where evidence is sparse or lacking, expert contributors acknowledge this and pres- ent their own management recommendations. Finally, select interventions in research develop- ment with a strong potential for transforming future care of the ischemic stroke patient are mentioned. Updated reference lists at the end of each chapter serve to direct readers to specifi c articles for more in-depth reading on a subject. Ischemic Stroke Therapeutics will be of value to Primary Care Physicians, Geriatricians, Emergency Care Physicians, Hospitalists, General Neurologists, Neuro-Hospitalists, Vascular- Neurologists-i n-training, and Vascular Neurology Board Re-certifi cation Candidates, because vii viii Preface it provides a comprehensive review of the most up-to-date evidence-based therapy for everyday management of ischemic stroke patients and a peek at promising future therapeutic strategies by world-renowned experts. W e are greatly indebted to our contributors, families, and especially our patients from whom we have been privileged to learn so much. Charleston, SC, USA Bruce Ovbiagele Tanya N. Turan Contents 1 General Concepts: Management of Acute Ischemic Stroke ................................. 1 Harold P. Adams, Jr. 2 Prehospital Stroke Treatment (EMS Stabilization Protocols) ............................. 7 Edward C. Jauch , David M. French , and Todd McGeorge 3 Intravenous Thrombolysis and Anti-thrombotics ................................................. 13 Mahesh P. Kate , Rajsrinivas Parthasarathy , and Ashfaq Shuaib 4 Intra-arterial Therapy for Acute Ischemic Stroke ................................................ 27 Osama O. Zaidat , Wled Wazni , Ahsan Sattar , and Jin Soo Lee 5 Hemicraniectomy ..................................................................................................... 45 Brian L. Hoh , Kyle M. Fargen , and Tim O’Connor 6 Supportive Care and Management of Inhospital Complications ........................ 53 Aimee M. Aysenne and S. Andrew Josephson 7 Post-discharge Complications of Stroke ................................................................ 69 Atif Zafar and Enrique C. Leira 8 General Concepts: Stroke Mechanisms, Subtyping, and Workup ...................... 77 Jong S. Kim 9 Traditional Stroke Risk Factor Treatment ............................................................ 93 Shelly Ozark and Bruce Ovbiagele 10 Heterogeneous Causes of Stroke: Antithrombotics .............................................. 99 Atul Ashok Kalanuria and Geoffrey Ling 11 Heterogeneous Causes of Stroke: Select Emerging Risk Factors ........................ 105 Kazunori Toyoda 12 Secondary Prevention After Cardioembolic Stroke .............................................. 111 Mark N. Rubin , W. David Freeman , and Maria I. Aguilar 13 Secondary Prevention After Ischemic Lacunar Stroke ........................................ 137 Raffaella Valenti and Leonardo Pantoni 14 Secondary Prevention After Symptomatic Large Artery Extracranial Disease ................................................................................................ 147 Chrysi Bogiatzi and J. David Spence 15 Secondary Prevention After Symptomatic Large Artery Intracranial Disease ................................................................................................. 161 Christine Anne Holmstedt , Alison P. Smock , and Tanya N. Turan 16 Secondary Prevention After Non- atherosclerotic Cerebral Vasculopathies ....... 169 Rima M. Dafer ix
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