Thrombolytic therapy for stroke
Edited by Patrick D Lyden (Pp 398, US$125.00). Published by Humana Press, New Jersey, 2001. ISBN 0-896-03746-0
The end of the 20th century saw a transition in the approach to acute stroke from therapeutic nihilism to enthusiasm. Stroke is now seen as an emergency, warranting urgent assessment, investigation, and treatment. The positive results of the major randomised trial of thrombolysis in acute stroke have played a major part in stimulating this new approach, which is the topic of this publication. This is very much a hands on book, with much practical advice, ranging from detailed advice about the assessment and selection of patients for thrombolysis to how to set up and deliver an emergency service for stroke. The book ranges from a detailed description of the evidence from clinical trials to advice based on personal experience (for example, what questions to ask to determine the time of onset accurately).
The book starts with a review of the pharmacology and haematology of thrombolysis, the causes of ischaemic stroke, and a description of the ischaemic penumbra. The last is the holy grail of thrombolysis and refers to the concept that a portion of ischaemic brain can be salvaged before undergoing irreversible infarction if treatment can be started early. As becomes evident on reading further, the evidence from the thrombolysis trials suggests that ischaemic penumbra is rarely present for longer than 2 or 3 hours after the onset of stroke. The book then proceeds to an excellent account of the early …