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RIWAYAT PEKERJAAN
– RSI Blitar
– RSI Muhammadiyah Moga Pemalang
– Concord Pasific Pty Ltd Papua
– PTT Depkes RI
– PTT Daerah Kab. Madiun
– RSUD. Dr. Soetomo
– RSUD Dr. Moewardi
Intravenous and Intra-arterial
Thrombolysis
in Acute Ischemic Stroke
MISTERI
Oligohaemic
Penumbra area
Penumbra
Ischaemic
Ischaemic core area
• Adapted from:
• Donnan et al. Lancet Neurol 2009;8:261-269;
• Moustafa & Baron. Br J Pharmacol 2008;153:S44-S54;
22-Oct-16 sympo Sunshine 2016 • Saver. Stroke 2006;37:263-266.
5
Management Stroke
• Supportif
• Neurorestorasi
• Neurorehabilitasi
• Neuroproteksi
• Revascularization Recanalization – Reperfusi
• Anticoagulan-Antiagregasi
secondary
< 4.5 hours <6 hours < 8 hours sub acute
Staff
prevention Patient
In-Service Outcomes
Time is Brain
22-Oct-16 sympo Sunshine 2016 8
(AHA/ASA, 2013) :
SPINAL
CEREBRAL
RETINA
Haemorrhagic
Other
12%
5%
Cryptogenic Atherosclerotic
30% cerebrovascular
disease
20%
Small vessel
Cardiac disease
embolism “lacunes”
20% 25%
Pra RS
―Ambulance
IGD
― Triase
― Tim Code Stroke Radiologi
― Laboratory
― CT Scan Kepala Polos
― rTPA IGD
― rTPA Unit
Stroke
• Approved in US in 1996
Tekanan Darah
Hipertensi: SBP >220 mmHg; DBP >120 mmHg => Nicardipin atau Nitrat IV
1. Ischemic Stroke
2. Patients of both sexes aged ≥ 18 years
3. Onset of symptoms within 4·5 hours (at administration of rt-PA)
Ischemic stroke
4. Patients (or family members) must have received treatment
information and have given consent to the use of their data and
to follow-up procedures
• A complex procedure
• Require of technique
• Not always available anywhere
• Time consuming preparation
• Costly procedure
Patient of dr. Bambang Tri Prasetyo, SpS, FINS. RS Pusat Otak Nasional, Jakarta
Digital Substraction Angiography
Patient of dr. Bambang Tri Prasetyo, SpS, FINS. RS Pusat Otak Nasional, Jakarta
Thank You
22-Oct-16 sympo Sunshine 2016 64