PMID: 11898496Mar 20, 2002Paper

New insights on thrombolytic treatment of acute ischemic stroke

Current Neurology and Neuroscience Reports
J F Meschia, T G Brott

Abstract

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.

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Citations

Jul 29, 2009·Klinische Neuroradiologie·Bernd Eckert
Mar 14, 2009·Acta Neuropathologica·Yi Ping LiuRaghu Vemuganti
Dec 18, 2002·Journal of Pharmaceutical and Biomedical Analysis·Yoshio MachidaHiroyuki Nishi
Jan 11, 2005·Neurobiology of Aging·Claudio Napoli, Wulf Palinski
Feb 8, 2003·Stroke; a Journal of Cerebral Circulation·Marc Fisher, Thomas G Brott

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