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Semin Thromb Hemost 2013; 39(04): 406-425
DOI: 10.1055/s-0033-1338126
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Plasminogen Activators and Ischemic Stroke: Conditions for Acute Delivery

Gregory J. del Zoppo
1   Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
2   Department of Neurology, University of Washington School of Medicine, Seattle, Washington
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Publication History

Publication Date:
28 March 2013 (online)

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Abstract

Appropriate acute treatment with plasminogen activators (PAs) can significantly increase the probability of minimal or no disability in selected ischemic stroke patients. There is a great deal of evidence showing that intravenous recombinant tissue PAs (rt-PA) infusion accomplishes this goal, recanalization with other PAs has also been demonstrated in the development of this treatment. Recanalization of symptomatic, documented carotid or vertebrobasilar arterial territory occlusions have also been achieved by local intra-arterial PA delivery, although only a single prospective double-blinded randomized placebo-controlled study has been reported. The increase in intracerebral hemorrhage with these agents by either delivery approach underscores the need for careful patient selection, dose-appropriate safety and efficacy, proper clinical trial design, and an understanding of the evolution of cerebral tissue injury due to focal ischemia. Principles underlying the evolution of focal ischemia have been expanded by experience with acute PA intervention. Several questions remain open that concern the manner in which PAs can be applied acutely in ischemic stroke and how injury development can be limited.

Keywords

stroke - plasminogen activators - acute intervention - thrombolysis - hemorrhage - intra-arterial - intravenous - thrombosis
 

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