THROMBOLYSIS IN ISCHEMIC STROKE - HOW FAR FROM A CLINICAL BREAKTHROUGH

Thromboembolic occlusions of the cerebral arteries often recanalize sp ontaneously, and patients with early recanalization have a better outc ome than patients who do not recanalize. Clinical as well as experimen tal data support the concept of a time window within which brain tissu e will profit from restoration of blood flow. In occlusion of middle c erebral artery, internal carotid artery, as well as vertebrobasilar ar teries, open studies of intra-arterial administration of thrombolytic agents have demonstrated recanalization within hours in 40-100% of pat ients in small series. In intravenous drug administration, recanalizat ion rate was obtained in 34-59% of patients. Favourable outcome was as sociated with recanalization. Intracerebral bleeding complications wit h clinical deterioration occurred in about 10% of patients. Three rand omized controlled trials comprising 156 patients with acute ischaemic stroke have reported favourable outcome in treated patients, with no d ifference of intracerebral haemorrhagic complications between treated and controls. Results of ongoing randomized placebo controlled trials are expected in 1995 to disclose whether a clinical breakthrough is ac hieved or whether haemorrhagic complications will outweigh a beneficia l effect of thrombolytic therapy in acute cerebral ischaemia.