Patrick D. Lyden – författare

The world's leading experts detail the basic rationale, scientific evidence, and treatment protocol for thrombolytic therapy in acute stroke patients. Thoroughly revised and updated, these experienced clinicians show how promptly delivered thrombolysis can restore cerebral blood flow in time to salvage brain and neurologic functions. New chapters cover topics such as the newer thrombolytics (TNK, desmoteplase, and reteplase, MRI imaging to guide thrombolytics, new content on intr-arterial and comibed IV/IA therapies, as well as new clinical cases covering the real-life use of throbolytics. Their description of the treatment protocol discusses field triage and management, emergency department therapy, brain imaging, clinical decision making and patient selection, drug administration, post-thrombolysis management, and the treatment of complications. Comprehensive and highly practical, Thrombolytic Therapy for Stroke, 2nd ed., offers the practicing physician everything necessary - background, protocols, and case studies - for the safe and effective treatment of the emergency stroke patient today.

Thrombolytic Therapy for Stroke is intended for physicians who will be treating patients in the first few hours after stroke: neurologists, neurosurgeons, emergency medicine physicians, internists, and radiologists. In some areas, fam­ ily medicine general practice physicians may provide the majority of acute stroke care. We will provide the reader with all the data necessary to understand the utility and limitations of thrombolytic therapy. By reading the protocols, and working through the case tutorials, the reader will become sufficiently familiar with the indications and contraindications of thrombolytic therapy to begin evalu­ ating potential patients. Although nothing can replace direct instruction by more experienced physicians, we hope that by imparting our accumulated knowledge we may guide those physicians who cannot attend a "hands-on" workshop, or who, having heard the appropriate lectures, feel the need for further guidance. We will review the scientific rationale for thrombolysis: first, most ischemic stroke is caused by thrombo-emboli; second, a portion of brain, the penumbra, remains salvageable for a few hours after vascular occlusion; and third, promptly delivered thrombolysis can remove the offending occlusion and restore cerebral blood flow to the penumbra in time to salvage brain and neurologic function. Then we will review the preclinical development of thrombolytics for stroke pa­ tients and the early pilot trials. Next, we will present the pivotal clinical trials that demonstrated the efficacy and safety of thrombolysis.

It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become “vetted” by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of clinical research such as combining intravenous thr- bolysis with neuroprotective therapies or intra-arterial thrombolysis. A wealth of factual information is supplemented by chapters containing sage opinion from Drs. Lyden and Caplan concerning the logistical, economic, and procedural issues that have been generated since the advent of this technology. Importantly, diagnosis does not take a back seat to therapeutics as illustrated by sections devoted to eva- ation of the stroke patient, very useful illustrative cases and clinical comments, and chapters on the latest in imaging as applied to this field.

It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become “vetted” by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of clinical research such as combining intravenous thr- bolysis with neuroprotective therapies or intra-arterial thrombolysis. A wealth of factual information is supplemented by chapters containing sage opinion from Drs. Lyden and Caplan concerning the logistical, economic, and procedural issues that have been generated since the advent of this technology. Importantly, diagnosis does not take a back seat to therapeutics as illustrated by sections devoted to eva- ation of the stroke patient, very useful illustrative cases and clinical comments, and chapters on the latest in imaging as applied to this field.

This is a significant advancement since the 2nd edition to Thrombolytic Therapy for Acute Stroke published, creating a significant need for a 3rd edition. Thrombolytic Therapy for Acute Stroke, 3rd edition will be a practical and thorough reference to all those caring for acute stroke patients.

Thrombolytic therapy is finally starting to reach patients in a variety of settings all over the world. Formerly in the domain of sub-specialists, thrombolytic therapy now rests in the realm of Emergency Medicine, Intensive Care, Vascular, and Neuro hospital Medicine physicians. Increasingly, non-neurologists use thrombolytic therapy. This is a significant advancement since the 2nd edition to Thrombolytic Therapy for Acute Stroke published, creating a significant need for a 3rd edition. Thrombolytic Therapy for Acute Stroke, 3rd edition will be a practical and thorough reference to all those caring for acute stroke patients. Extensively updated from previous editions, new data and cases will provide guidance to this most effective stroke treatment. This text will be of great interest to physicians, residents and advanced practice nurses who treat acute stroke patients.