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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 -