A PILOT-STUDY OF STREPTOKINASE FOR ACUTE CEREBRAL INFARCTION

We evaluated intravenous streptokinase in the treatment of cerebral in farction. Following neurological assessment and cerebral computed tomo graphy (CT), patients aged 40-80 years with symptoms of anterior circu lation acute ischaemic stroke were given 1.5 M units streptokinase or saline placebo in a double-blind randomized study. Twenty patients (10 streptokinase, 10 placebo), 11 males, 9 females, aged 57-79 years, we re treated out of 512 consecutive admissions to the acute stroke unit over a 2-year period. Initial CT was normal in 11 (6 placebo, 5 strept okinase) and showed early signs of cerebral infarction in nine (4 plac ebo, 5 streptokinase). Median times from symptom onset to treatment we re 5.2 h (placebo) and 5.8 h (streptokinase), Streptokinase treatment was associated with symptomatic hypotension in one patient. Repeat CT at 72 h demonstrated intracerebral haematoma in two patients and haemo rrhagic infarction in one patient in the streptokinase group; the two cases of haematoma formation were associated with neurological deterio ration and death. One patient in the placebo group had evidence of hae morrhagic infarction at 72 h. There were three deaths in each treatmen t group, all within the first 14 days. Patients with acute stroke can be evaluated with CT and treated with streptokinase within 6 h, but th e opportunity for treatment is currently limited to few patients. Stre ptokinase treatment is not without risk, but potential clinical benefi t justifies ongoing multicentre randomized trials.