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Until “Pre-hospital PCI” becomes a reality …this is not possible.

Dr. S. Venkatesan MD

Is primary PCI superior to thrombolysis in the first hour of STEMI ? The fact of the matter is, at best, pPCI fights for equipoise in the first hour, but thrombolysis is a clear winner in moral, scientifc & holistic perspective, as it can be administered very early, at a fraction of cost ,independent of expertise and infrastructure.

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Abstract WP179: Clinical Outcomes in Acute Stroke in Patients Undergoing Emergency Intracranial Stenting Receiving IV Thrombolysis

Stroke Journal

In cases of stent-retriever thrombectomy failure, rescue stent angioplasty might be the sole option for achieving permanent recanalization. Conclusions:The use of rescue stent angioplasty can be considered after unsuccessful stent-retriever thrombectomy, along with intravenous thrombolytic therapy. 10.43, p=0.0325).Conclusions:The

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Abstract 231: Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke:An Analysis of the SVIN Registry

Stroke: Vascular and Interventional Neurology

Rescue strategies options, including balloon angioplasty alone, rescue stenting (RS) alone, or stent with balloon angioplasty, have shown promise in observational studies and meta‐analyses [3, 4]. The patients were divided into two groups: those who received RS and those who only received MM.

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Abstract 225: Rescue Stenting for Posterior Circulation Strokes

Stroke: Vascular and Interventional Neurology

Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. IntroductionIntracranial atherosclerotic disease (ICAD) is associated with up to 32% of posterior circulation strokes.1

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An elderly male with shortness of breath

Dr. Smith's ECG Blog

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Wehrens XH, Doevendans PA, Ophuis TJ, Wellens HJ. Am Heart J. 2000 Mar;139(3):430-6. PubMed PMID: 10689257.

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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. (first authors are Wehrens and Doevendans, respectively) Wehrens XH, Doevendans PA, Ophuis TJ, Wellens HJ. Am Heart J. 2000;139:430–436.

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First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Wehrens X.H., Doevendans P.A., Ophuis T.J., Am Heart J (2000) 139 : pp 430-436.