Thrombolytic Therapy in Acute Ischemic Stroke

272 Pages·1991·7.64 MB·English

by  A. J. Furlan (auth.)

Werner Hacke Gregory J. del Zoppo
Matthias Hirschberg (Eds.)
Thrombolytic Therapy
in Acute Ischemic Stroke
With 35 Figures and 54 Tables
Springer -Vedag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Prof. Dr. WERNER HACKE
Klinikum der Universitat Heidelberg
Neurologische Klinik
Im Neuenheimer Feld 400
W-6900 Heidelberg, FRG
GREGORY J. DEL Zoppo, MD
Department of Molecular and Experimental Medicine
and Division of Hematology/Medical Oncology
Scripps Clinic and Research Foundation
10666 North Torrey Pines Road
La Jolla, CA 92037, USA
Dr. MATTHIAS HIRSCHBERG
Klinikum der Universitat Heidelberg
Neurologische Klinik
Im Neuenheimer Feld 400
W-6900 Heidelberg, FRG
ISBN-13: 978-3-540-53680-2 e-ISBN-13: 978-3-642-76439-4
DOl: 10.1007/978-3-642-76439-4
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Preface
During the last decade scientists in both basic and clinical research have renew
ed their interest in the potential role of thrombolytic therapy in the treatment
of acute ischemic stroke. The reevaluation of this approach was kindled by our
growing knowledge of the pathogenesis of thrombotic and embolic stroke and
by the development of new thrombolytic agents. With no proven therapy for
acute ischemic stroke available, the potential value of early pharmacologic
recanalization of occluded vessels in the management of acute stroke patients
- an approach that has been supported by animal experiments and a limited
number of uncontrolled clinical pilot studies - is again under scrutiny. A sym
posium on "Thrombolysis in Acute Cerebral Ischemia" was held in Heidel
berg, Germany, in May 1990 to summarize and discuss the pathophysiological
background for thrombolysis in acute ischemic stroke and the recent ex
perimental and clinical experience with the new generation of thrombolytic
agents.
The editors are fortunate to be able to include authoritative manuscripts
from almost all the speakers at the symposium. These include reports of work
by the most active investigators in this challenging field. The editors wish to
express their gratitude to all the contributors for the additional work they have
undertaken. Additionally, we would like to thank Springer-Verlag, Heidelberg,
for its generous assistance in the preparation and rapid publication of this
volume.
Heidelberg, August 1990 WERNER HACKE
GREGORY J. DEL ZopPO
MATTHIAS HIRSCHBERG
Contents
I. Acute Cerebral Ischemia and Thrombolysis
Natural History of Atherothromboembolic Occlusion
of Cerebral Arteries: Carotid Versus Vertebrobasilar Territories
A. J. FURLAN 3
0 0 0 0 0 •• 0 0 •• 0 0 0 • 0 0 0 •• 0 •• 0 0 • 0 0 ••••• 0 0 0 • 0 0 0 •• 0 0 0 0 0 0 •
Fibrinolysis: Thrombolytic Agents, Mechanisms,
and New Developments
D. COLLEN and H. R. LIJNEN 9
0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 •• 0 0 0 0 0 0 0 0 0
Fibrinolysis in Myocardial Infarction:
Lessons for Cerebrovascular Disease
J. MEYER . 24
0 0 0 0 0 0 0 •• 00 •• 000000.0000000. 0 0 0.0.0000.00000000000.
Reperfusion of Ischemic Brain: Why and Why Not!
L. R. CAPLAN o. 36
0 0 • 0 ••• 0 • 0 •• 0 0 0 0 0 • 0 0 •• 0 0 0 0 0 0 0 0 ••• 0 0 0 0 • 0 0 0 0 0 0 0 0
Thrombolysis in Stroke: Timing of Recanalization
and Its Clinical Consequences
K. ASPLUND and B. CARLBERG 46
0 0 0 0 0 0 0 0 0 0 • 0 0 ••••• 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
The Ischemic Penumbra: Fact or Fiction?
B. K. SIESJO and H. MEMEZAWA 60
0 0 0 0 0 0 0 0 0 0 0 •• 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hemorrhagic 1fansformation in the Natural History
of Acute Embolic Stroke
M. S. PES SIN 67
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 ••• 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0
Intracranial Hemorrhage After Coronary Thrombolysis
with Tissue Plasminogen Activator
C. S. KASE 75
000 •• 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 000
Predictive Factors for the Effective Treatment of Acute Stroke
with Intravenous Thrombolytic Agents
SoM. WOLPERT o. o. 87
000000.0000 •• 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000000
Invasive Imaging Techniques in the Evaluation of Patient Selection
and Cerebrovascular Recanalization
H. ZEUMER, G. SIEPMANN, M. MULLER-JENSEN,
and Ho GOOSSENS-MERKT 91
0000.000000000000000000000000000000000
VIII Contents
The Role of Noninvasive Imaging Techniques
in Cerebrovascular Recanalization
S. M. OTIS ................................................... 98
D. Thrombolysis and Stroke Models
Thrombolytic Therapy in Ischemic Stroke:
Relevance and Limitations of Animal Models
G. F. MOLINARI ............................................... 105
Update on Animal Model Experience
with Recombinant Tissue Plasminogen Activator
M. HIRSCHBERG .............................................. 114
DI. Clinical Trials
Clinical Trials: Some General Considerations
L.R. CAPLAN ................................................ 129
Intraarterial Urokinase Plasminogen Activator and Streptokinase
in Carotid and Vertebrobasilar Territory Stroke:
Clinical Outcome
W. HACKE ................................................... 131
Fibrinolytic Recanalization Therapy
in Acute Cerebrovascular Thromboembolism
E. MORI ..................................................... 137
Intravenous Recombinant Tissue Plasminogen Activator
in Acute Thrombotic Stroke:
Study Design, Recanalization, and Clinical Outcome
G. J. DEL ZopPO and A. FERBERT ............................... 147
Evaluation of Tissue Plasminogen Activator
Early in the Course of Acute Ischemic Stroke
J. R. MARLER, T. BROTT, E. C. HALEY, and D. LEVY 152
Intravenous Recombinant Tissue Plasminogen Activator
in Acute Stroke
R. VON KUMMER, M. FORSTING, K. SARTOR, and W. HACKE 161
Thrombolytic Therapy
in Embolic and Thrombotic Cerebral Infarction:
A Cooperative Study
T. Y AMAGUCHI, T. HAYAKAWA, H. KIKUCHI, and T. ABE 168
Contents IX
IV. Future Directious
Problems in Formulating Therapeutic Trials
J.P. MOHR ................................................... 177
Invasive and Noninvasive Vascular Imaging Techniques
and Their Role in Clinical Stroke Trials
W.J. HUK ................................................... 186
Strategies for Early Treatment of Acute Cerebral Infarction
T. BROTT, E. C. HALEY, D. LEVY, W. BARSAN, J. BRODERICK,
and J. R. MARLER ............................................ 196
V. Open Communications
Topical Intraarterial Urokinase Infusion for Acute Stroke
K. MATSUMOTO and K. SATOH ...................... . . . . . . . . . .. 207
Local Thrombolytic Therapy in Acute Basilar Artery Occlusion:
Experience with 18 Patients
E. MOBIUS, E. BERG-DAMMER, D. KDHNE, and H. C. NAHSER 213
Vertebrobasilar Occlusion:
Outcome With and Without Local Intraarterial Fibrinolysis
G. PFEIFFER, G. THAYSSEN, A. ARLT, G. SIEPMANN, H. ZEUMER,
and K. KUNZE ............................................... 216
Recanalization of Acute Middle Cerebral Artery Occlusion Monitored
by Transcranial Doppler Sonography
R. BINIEK, E. B. RINGELSTEIN, H. BRDcKMANN, G. LEONHARDT,
B. AMMELING, and P. NOLTE .................................. 221
Neuropathological Findings After Thrombolytic Therapy
in Acute Ischemic Stroke
P. PILZ, G. LADURNER, and E. GRIEBNITZ ...................... 224
How Many Stroke Patients Are Candidates for Thrombolysis?
M. KAps, C. R. HORNIG, M. NDcKEL, and I. SINGER ............. 228
Spontaneous Recanalization in Middle Cerebral Artery Occlusion
M. KAps and U. TESCHENDORF ................................ 231
In Vitro Thrombus Lysis by Urokinase
in Preparation for Patient Studies
K. MATSUMOTO and K. SATOH ........... . . . . . . . . . . . . . . . . . . . . .. 236
Local Intraarterial Fibrinolysis
in Acute Middle Cerebral Artery Occlusion
G. SIEPMANN, M. MDLLER-JENSEN, H. GOOSSENS-MERKT,
L. LACHENMAYER, and H. ZEUMER ............................. 240
x Contents
Treatment of Acute Ischemic Stroke with Recombinant Tissue
Plasminogen Activator: Evaluation with Regional Cerebral Blood
Flow Single Photon Emission Computed Tomography
D. HERDERSCHEE, M. LIMBURG, A. HUDRA, E.A. VAN ROYEN,
and P. A. KOSTER ............................................. 244
Thrombolytic Therapy in Acute Ischemic Stroke:
The Copenhagen Multicenter Study
K. OVERGAARD, H. PEDERSEN, and G. BOYSEN 247
Thrombolytic Therapy in Cerebral Sinus Thrombosis: A Case Report
K. SPITZER, J. FREITAG, A. THIE, L. LACHENMAYER,
and G. SIEPMANN ............................................ 251
Basilar Artery Occlusion Associated with Protein C Deficiency:
Successful Treatment Using Recombinant Tissue Plasminogen
Activator Infusion
B. WILDEMANN, R. VON KUMMER, M. HUTSCHENREUTER,
D. KRIEGER, and W. HACKE ................................... 255
Intracerebral Hemorrhage and Infarction Volume
Following Recombinant Tissue Plasminogen Activator
in an Acute Stroke Model
G. J. DEL ZopPO, K. E. ANDERCHEK, J. A. KOZIOL, B. R. COPELAND,
and W. HACKE ............................................... 259
ProUrokinase Therapy in Stroke
G. HAMANN, A. HAASS, G. PINDUR, E. WENZEL, and
K. SCHIMRIGK ................................................ 263
Subject Index ................................................ 267
List of Contributors
Addresses are given at the beginning of the respective contribution.
Abe, T. 168 Kikuchi, H. 168
Ammeling, B. 221 Koster, P. A. 244
Anderchek, K. E. 259 Koziol, J. A. 259
Arlt, A. 216 Krieger, D. 255
Asplund, K. 46 Kuhne, D. 213
Barsan, W. 196 Kunze, K. 216
Berg-Dammer, E. 213 Lachenmayer, L. 240
Biniek, R. 221 Ladurner, O. 224
Boysen, O. 247 Leonhardt, O. 221
Broderick, J. 196 Levy, D. 152, 196
Brott, T. 152, 196 Lijnen, H. R. 9
Bruckmann, H. 221 Limburg, M. 244
Caplan, L. R. 36, 129 Marler, J.R. 152, 196
Carlberg, B. 46 Matsumoto, K. 207, 236
Collen, D. 9 Memezawa, H. 60
Copeland, B. R. 259 Meyer, J. 24
del Zoppo, O. J. 147, 259 Mobius, E. 213
Ferbert, A. 147 Mohr, J. P. 177
Forsting, M. 161 Molinari, O. F. 105
Freitag, J. 251 Mori, E. 137
Furlan, A. J. 3 Mfiller-Jensen, M. 91, 240
Ooossens-Merkt, H. 91, 240 Nahser, H. C. 213
Oriebnitz, E. 224 Nolte, P. 221
Haass, A. 263 Nuckel, M. 228
Hacke, W. 131, 161, 255, 259 Otis, S. M. 98
Haley, E. C. 152, 196 Overgaard, K. 247
Hamann, O. 263 Pedersen, H. 247
Hayakawa, T. 168 Pessin, M. S. 67
Herderschee, D. 244 Pfeiffer, O. 216
Hijdra, A. 244 Pilz, P. 224
Hirschberg, M. 114 Pindur, O. 263
Hornig, C. R. 228 Ringeistein, E. B. 221
Huk, W. J. 186 Sartor, K. 161
Hutschenreuter, M. 255 Satoh, K. 207, 236
Kaps, M. 228, 231 Schirnrigk, K. 263
Kase, C. S. 75 Siepmann, O. 91, 216, 240, 251
XII List of Contributors
Siesjo, B.K. 60 von Kummer, R. 161, 255
Singer, 1. 228 Wenzel, E. 263
Spitzer, K. 251 Wildemann, B. 255
Teschendorf, U. 231 Wolpert, S. M. 87
Thayssen, G. 216 Yamaguchi, T. 168
Thie, A. 251 Zeumer, H. 91, 216, 240
van Royen, E. A. 244