AGGRESSIVE THERAPEUTIC APPROACHES IN ACUT E ISCHEMIC STROKE

Background: Currently to an increasing extent aggressive therapeutic a pproaches in ischemic stroke are discussed. These approaches include i ntraarterial and systemic thrombolysis to reduce infarction size and a lso decompressive surgical measures to prevent from fatal consequences of elevated intracranial pressure. This report give an overview over these strategies. Their specific values are discussed. Strategies: In acute vertebrobasilar artery occlusion an attempt of intraarterial thr ombolysis is indicated because of the mostly poor prognosis of large b rainstem infarction. Acute artery occlusion in carotid territory has a better prognosis, so that the indication of intraarterial thrombolysi s has to be regarded more critically. In view of recent reports system ic rt-PA-thrombolysis seems to be justified in well defined cases inde pendently from site of occlusion. At present there is no longer doubt about the benefit of decompressive surgery in space occupying cerebell ar stroke. The value of surgery in malignant brain infarction in carot id territory is not clear to date. Further randomised studies are nece ssary to learn more about benefit, risks and required proceedings in s pace occupying supratentorial infarction. Conclusion: A well defined g roup of patients suffering from ischemic stroke seems to benefit from aggressive therapeutic approaches in ischemic stroke. Concerning the s election of patients and management of those approaches a close cooper ation with an experienced center is required.