Thrombolytic Therapy in Acute Ischemic Stroke by A. J. Furlan (auth.), Prof. Dr. Werner Hacke, Gregory J. del

By A. J. Furlan (auth.), Prof. Dr. Werner Hacke, Gregory J. del Zoppo MD, Dr. Matthias Hirschberg (eds.)

During the decade scientists in either uncomplicated and scientific examine have renew­ ed their curiosity within the strength position of thrombolytic remedy within the remedy of acute ischemic stroke. The reevaluation of this method was once kindled by means of our starting to be wisdom of the pathogenesis of thrombotic and embolic stroke and via the advance of latest thrombolytic brokers. with out confirmed treatment for acute ischemic stroke on hand, the capability worth of early pharmacologic recanalization of occluded vessels within the administration of acute stroke sufferers - an technique that has been supported via animal experiments and a constrained variety of out of control scientific pilot stories - is back less than scrutiny. A sym­ posium on "Thrombolysis in Acute Cerebral Ischemia" used to be held in Heidel­ berg, Germany, in could 1990 to summarize and speak about the pathophysiological history for thrombolysis in acute ischemic stroke and the new ex­ perimental and scientific adventure with the hot iteration of thrombolytic brokers. The editors are lucky so as to comprise authoritative manuscripts from just about all the audio system on the symposium. those contain reviews of labor by means of the main energetic investigators during this not easy box. The editors desire to exhibit their gratitude to all of the members for the extra paintings they've got undertaken. also, we want to thank Springer-Verlag, Heidelberg, for its beneficiant suggestions within the training and swift ebook of this quantity. Heidelberg, August 1990 WERNER HACKE GREGORY J. DEL ZopPO MATTHIAS HIRSCHBERG Contents I.

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3. 4. 5. 6. 7. 8. 9. 27 Definition of patency Recanalization versus patency Thrombolytic agent Time to treatment start Time to angiography Repetitive coronary injections Severity of underlying stenosis Platelet-rich thrombi Anterior > inferior infarctions We also have to differentiate between patency and recanalization. Patency is the demonstration of an open vessel, be it spontaneous or caused by the thrombolytic agent. Recanalization, on the other hand, requires the reopening of a previously occluded vessel to be recorded.

The title I was given for today was why reperfuse the brain? The material presented so far should stimulate the intelligent listener to turn the question. Surely why not reperfuse the ischemic brain seems an eminently more sensible and practical query. I will devote the rest of my time to the issue of why not reperfuse? Delayed Neurological Deterioration After Hypoxia and Ischemia: Reperfusion Injury The first clinical clue that bringing fuel to a previously deprived brain might not always be beneficial was the report by Plum et al.

Special features of thrombolytic drugs Fibrin enhancement Plasma proteolytic state Simultaneous heparin Bleedings Allergic reactions Pressure drop Expense SK APSAC UK rt-PA Saruplase + +++ + +++ ++ ++ +++ + +++ + No No No Yes Yes Yes Yes Yes Yes No No No No No No Not yet defined ++ + ++ ++ ++ ++ + +++ + SK, streptokinase; UK, urokinase; rt-PA, recombinant tissue-type plasminogen activator. need additional treatment with heparin, others do not. Not only the rate of bleedings, but also the rate of allergic reactions and of decrease in arterial pressure are of importance.

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