New insights on thrombolytic treatment of acute ischemic stroke.
In 1995, a two-part randomized trial showed the efficacy of intravenous tissue plasminogen activator (tPA) when given within 3 hours of onset of symptoms of acute ischemic stroke. Two subsequent trials were unable to extend the therapeutic window of intravenous tPA beyond 3 hours. A phase IV study performed by experienced stroke centers showed an acceptably low symptomatic intracerebral hemorrhage rate for intravenous tPA of only 3%, whereas a review of the Cleveland area experience showed a disturbingly high rate of symptomatic intracerebral hemorrhage of 15.7%. The Prolyse in Acute Cerebral Thromboembolism (PROACT) II study showed efficacy of intra-arterial pro-urokinase and intravenous heparin over intravenous heparin alone when given within 6 hours of onset of symptoms to patients with thrombotic occlusion of the proximal middle cerebral artery. Additional controlled investigations of intra-arterial thrombolytic therapy are needed. Neuroprotectants in combination with intravenous tPA have yet to show improved efficacy over the use of tPA alone.
Meschia
J F
JF
Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. meschia.james@mayo.edu
Brott
T G
TG
D000208:Acute Disease; D000818:Animals; D002545:Brain Ischemia / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D013300:Streptokinase / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents; D013300:Streptokinase