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Does the use of IV tPA in the current era of rapid and predictable recanalization by mechanical embolectomy represent good value?
  1. Ronil V Chandra1,2,
  2. Thabele M Leslie-Mazwi3,
  3. Brijesh P Mehta4,
  4. Colin P Derdeyn5,
  5. Andrew M Demchuk6,7,
  6. Bijoy K Menon6,7,
  7. Mayank Goyal6,7,
  8. R Gilberto González8,
  9. Joshua A Hirsch3
  1. 1Department of Imaging, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
  2. 2Stroke and Ageing Research Centre, Department of Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Memorial Neuroscience Institute, Hollywood, Florida, USA
  5. 5Departments of Radiology, Neurology and Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  6. 6Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  7. 7Department of Radiology, University of Calgary, Calgary, Alberta, Canada
  8. 8Neuroradiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Joshua A Hirsch, NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Hirsch{at}snisonline.org

Abstract

As healthcare delivery in the USA transforms into a model that at its core requires value-based considerations, ischemic stroke is confronted by intersecting forces. Modern techniques allow rapid revascularization in the majority of patients with large vessel occlusions. Dramatic advances in the evidentiary basis for mechanical embolectomy are increasing the number of patients treated with this therapy. A key part of the therapeutic arsenal in many patients treated with interventional techniques has been concurrent intravenous thrombolysis. We consider whether this paradigm warrants change.

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