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Thrombolytic intervention in acute thrombotic and embolic stroke
G J del Zoppo1, M S Pessin, E Mori
1Department of Molecular and Experimental Medicine, Scripps Clinic, La Jolla, California.
Zeitschrift Fur Kardiologie
|January 1, 1993
Summary
Fibrinolytic therapy shows promise for acute stroke treatment, achieving reperfusion with acceptable safety and improved neurological outcomes. Further research aims to optimize patient selection and delivery methods for thrombolysis in cerebrovascular ischemia.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Stroke is a leading cause of death globally, with acute thrombosis frequently causing arterial occlusions.
- Currently, no definitive therapeutic strategy for acute stroke has been validated by controlled clinical trials.
- Thrombolytic therapy is being investigated to address acute thrombosis in stroke patients.
Purpose of the Study:
- To evaluate the efficacy and safety of fibrinolytic therapy in acute stroke.
- To assess the potential of thrombolysis in achieving rapid lysis of occluding thrombi.
- To explore the impact of thrombolysis on neurologic outcomes and hemorrhage risk.
Main Methods:
- Clinical investigations utilized various plasminogen activators (urokinase, streptokinase, tissue plasminogen activator).
- Administration routes included systemic delivery and local intra-arterial catheter delivery.
- Pivotal trials analyzed recanalization rates, safety profiles, and neurologic outcomes.
Main Results:
- Thrombolysis demonstrated a range of recanalization rates and acceptable safety.
- Encouraging effects on neurologic outcomes were observed in clinical investigations.
- Intracranial bleeding remains a risk, though hemorrhage incidence appears similar to untreated patients.
Conclusions:
- Fibrinolytic therapy offers a potential treatment for acute stroke, with ongoing research focusing on optimization.
- Future developments should enhance patient recruitment, noninvasive assessment, and advanced delivery techniques.
- Combined treatment strategies are under evaluation to improve thrombolysis effectiveness in acute stroke.