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    Reperfusion Therapy, Cerebral

    Reperfusion Therapy, Cerebral is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    Description

    • An ischemic cerebrovascular accident (CVA), or stroke, is an acute, sudden or gradual, interruption of regional cerebral blood supply
    • Cerebral reperfusion therapy involves:
      • Administration of an IV thrombolytic agent to rapidly dissolve a thromboembolic occlusion
      • Site-specific endovascular intra-arterial thrombolysis
      • Mechanical clot removal

    Etiology

    • Thrombotic CVA is from an in situ thrombosis:
      • At an ulcerated atherosclerotic plaque or other prothrombotic endothelial abnormality
      • From hypercoagulable states:
        • Antithrombin III, protein C or S deficiency
      • From sludging:
        • Sickle cell disease
        • Polycythemia vera
    • Embolic CVA is caused by acute obstruction by an embolus from:
      • Cardiac mural thrombus formed in:
        • Atrial fibrillation
        • Hypokinetic ventricle (MI, cardiomyopathy)
        • Ventricular aneurysm
      • An abnormal or prosthetic cardiac valve
      • Aortic, carotid, or cerebrovascular atherosclerotic plaques
    • Other occlusive events include:
      • Vascular dissection in aorta, cerebral, vertebral, carotid, or innominate arteries
      • Cerebral vasospasm induced by:
        • Subarachnoid hemorrhage (SAH)
        • Vasoconstrictive agents (e.g., cocaine)

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    Citation

    Rosen, Peter, et al., editors. "Reperfusion Therapy, Cerebral." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral.
    Reperfusion Therapy, Cerebral. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral. Accessed April 25, 2019.
    Reperfusion Therapy, Cerebral. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral
    Reperfusion Therapy, Cerebral [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Reperfusion Therapy, Cerebral ID - 307259 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -