Reperfusion Therapy, Cerebral

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

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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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