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Evidence-based Management of Stroke (Hardcover)
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Evidence-based Management of Stroke (Hardcover)
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Over five million people die from stroke each year. Stroke is also
the leading cause of adult disability, affecting over 20 million
people world-wide, with two-thirds of stroke victims left
permanently disabled. We now know that speed of intervention is
critical and patient outcomes are determined by a very narrow
therapeutic window, during which physicians need to be able to make
their choice of treatment rapidly, based on the best evidence
available. The purpose of this book is to review that evidence, for
both medical and surgical therapies as well as preventative
strategies, drawing on the expertise of leading international
authorities to distinguish the issues for which there is a
consensus on best practice from those for which the evidence
remains inconclusive. For example, for patients with acute ischemic
stroke the first choice is intravenous thrombolytic therapy, but
does a treatment window of 0-3 hours deliver outcomes significantly
better than one of 3-4.5 hours? Arterial hypertension is the single
most important modifiable risk factor for ischemic stroke, but what
are the effects of blood pressure reduction among acute stroke
patients? How effective is blood pressure lowering in primary
intracerebral hemorrhage? What are the arguments in favour of
continuation versus temporary discontinuation of anti-hypertensive
therapy immediately after acute ischemic stroke? Endovascular
procedures (carotid angioplasty/stenting) are increasingly
important but what do the data tell us about their safety? Or
durability? How do they compare with carotid endarterectomy? The
management of unruptured intracranial aneurysms is rife with
controversies; clip, coil, wait and watch? The authors examine the
evidence for and against. Other sections examine the impact of
various risk factors, and special populations. A section on stroke
after cardiovascular surgeries reviews the incidence and management
of stroke following a whole range of procedures including coronary
artery bypass grafting, valve replacement surgery, congenital heart
disease treatment, aortic surgery, cardiac transplantation and
post-carotid endarterectomy. Another examines special risks during
pregnancy. Lastly, the book reviews our understanding of childhood
stroke -- perinatal, infants and older children, adolescents and
young adults - and presents current best practice recommendations
for this most challenging group of patients.
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