[Thrombolytic therapy].
Favorable outcome by hyperacute rt-PA (recombinant tissue-type plasminogen activator) therapy was suggested firstly by randomized controlled trials (RCT) in Japan, and confirmed by the NINDS trial (1995) using alteplase within the initial 3 hours. A phase III clinical trial using open-labeled, single-dose alteplase was carried out in Japan (Japan Alteplase Clinical Trial, J-ACT). The study protocol was almost compatible to that of the NINDS study, except for several modifications including lower dose administration of alteplase (0.6 mg/kg) in the J-ACT than that in the NINDS study (0.9 mg/kg). The clinical backgrounds were almost similar, and frequencies of very favorable outcome at 3-months and symptomatic intracranial hemorrhage were comparable between the studies. The Japanese Government approved the use of intravenous alteplase therapy in October 11, 2005. The Japan Stroke Society published a guideline and gave more than 130 courses for appropriate alteplase therapy immediately after the approval. Clinical results of this therapy were excellent in the initial 21 cases of our hospital. New approaches will open the door to an exciting new era for stroke management. They include MR-based delayed thrombolysis up to 9 hours after stroke onset and ultrasound-enhanced systemic thrombolysis.
Minematsu
Kazuo
K
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center.
D002544:Cerebral Infarction / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator