SAQ 256 – Neurology – endovascular stroke therapy and thrombolysis reversal

Question 9. endovascular stroke therapy and thrombolysis reversal.

a. Interventional-radiology options

• Intra-arterial thrombolysis.
• Mechanical thrombectomy or clot retrieval.

b. Possible indications

• Large-vessel occlusion, particularly basilar, internal carotid, or M1 occlusion.
• Evidence of salvageable tissue on perfusion imaging.
• Functional independence before stroke, with appropriate modified Rankin and NIH Stroke Scale scores.
• Contraindication to systemic thrombolysis.

c. Reversal options

• Cryoprecipitate.
• Platelets.
• Fresh frozen plasma.
• Aminocaproic acid.
• Tranexamic acid.

d. Reasons not to reverse

• Patient wishes or the views of the medical power of attorney or next of kin.
• Very large haemorrhage with significant mass effect and poor prognosis.
• GCS 3.
• Cardiac arrest.