title: Does the use of IV tPA in the current era of rapid and predictable recanalization by mechanical embolectomy represent good value?
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.
authors.affiliation: Department of Imaging, Monash Imaging, Monash Health, Melbourne, Victoria, Australia Stroke and Ageing Research Centre, Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Ronil V
authors.identifier: http://orcid.org/0000-0001-7555-2297
authors.initials: RV
authors.lastname: Chandra
authors.affiliation: NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thabele M
authors.initials: TM
authors.lastname: Leslie-Mazwi
authors.affiliation: Memorial Neuroscience Institute, Hollywood, Florida, USA.
authors.forename: Brijesh P
authors.initials: BP
authors.lastname: Mehta
authors.affiliation: Departments of Radiology, Neurology and Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Bijoy K
authors.identifier: http://orcid.org/0000-0002-3466-496X
authors.initials: BK
authors.lastname: Menon
authors.affiliation: Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Neuroradiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: R Gilberto
authors.initials: RG
authors.lastname: González
authors.affiliation: NeuroEndovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017128:Embolectomy / Q000379:methods* / Q000639:trends; D005544:Forecasting; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000191:economics
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Stroke