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Thrombolysis in acute ischemic stroke
Vol. 65, Suppl. 1
ABSTRACTS OF 12TH INTNAT’L CONGRESS
S25
S46 THROMBOLYSIS IN MYOCARDIAL INFARCTION K.A. Fox Cardiovascular Research Unit, University of Edinburg, Scotland, UK ‘lhrombolytlc therapy represents the first major advance in the management of patients with acute myocardial infarction, since the development of coronary care units and defibrillation. Experimental studies have revealed the impact of myocardial reperfusion on restoration of blood supply to ischaemic myocardium, with recovery of intermediary metabolism and the sequential changes in contractile function. In consequence, successful thrombolysis is associated with diminished extent of infarction, reduced cardiac dilatation and lesser late deleterious effects of ventricular remodelling. However, the beneficial influences of thrombolytic therapy are critically dependent upon the time of administration, and practical strategies are required in order to minim& delays to thrombolysis and to ensure that all those eligible for thrombolytic treatment, receive it promptly. The GISSI-2 and ISIS-3 studies have revealed that no significant differences exist between thrombolytic agents, when outcome is measured as mortality benefit. Whether differences exist, and whether benefits outweigh risks with more aggressive heparinisation, and more aggressive anti-platelet and anti-thrombin activity, remains to be determined. However, the future advances in thrombolytic agents and the combination with more potent and specific antiplatelet and antithrombin agents may augment myocardial salvage and diminish the risk of reocclusion. Such advances will need to be measured against the current “gold standard” of streptokinase and aspirin.
s47
IN PULMONARYEMBOLISM: Samuel 2. Goldhaber, M.D.
THROMBOLYSIS
STATE
OF
THE
ART
State of the art thrombolysis for pulmonary embolism (PE) has become more straightforward, economical, and safer than PE thrombolysis undertaken several decades ago. The time window The diagnosis of PE can is now 14 days, rather than 5. occasionally be made with sufficient certainty utilizing lung scanning or echocardiography to obviate pulmonary angiography prior to thrombolysis. The optimal infusions are of short duration: 2 minutes to 2 hours, rather than 12-24 hours. Thrombolytic agents are administered via a peripheral vein, without the necessity of inserting a pulmonary artery catheter. No laboratory tests are required during the thrombolytic infusion. Finally, not all patients require Care Unit during the hospitalization in an Intensive thrombolytic infusion. S48 THROMBOLYSIS IN ACUTE ISCHEMIC STROKE M.L. Sacchetti, C. Cavalletti, M. Cao, C. Gori and C. Fieschi Department of Neurological Sciences, University of Rome “La Sapienza”, 1 Clinical data indicate that the majority of acute ischemic strokes are of thromboembolic origin. The level of residual cerebral blood flow (CBF) in the ischemic tissue is a major variable in determining the time interval towards the irreversible damage. The silent ischemic brain tissue (penumbra) surrounding the main infarcted area, remains potentially viable for a few hours if a residual “critical perfusion” exists. Lysis of the arterial occlusion in this time window, restoring the CBF in the ischemic area, might prevent the brain damage or reduce its extention. The clinical efficacy of pharmacological reperfusion, possible related hemorrhagic complications or reperfusional injuries and re-occlusion rate are currently being investigated.
ABSTRACTS OF 12TH INTNAT’L CONGRESS
S25
S46 THROMBOLYSIS IN MYOCARDIAL INFARCTION K.A. Fox Cardiovascular Research Unit, University of Edinburg, Scotland, UK ‘lhrombolytlc therapy represents the first major advance in the management of patients with acute myocardial infarction, since the development of coronary care units and defibrillation. Experimental studies have revealed the impact of myocardial reperfusion on restoration of blood supply to ischaemic myocardium, with recovery of intermediary metabolism and the sequential changes in contractile function. In consequence, successful thrombolysis is associated with diminished extent of infarction, reduced cardiac dilatation and lesser late deleterious effects of ventricular remodelling. However, the beneficial influences of thrombolytic therapy are critically dependent upon the time of administration, and practical strategies are required in order to minim& delays to thrombolysis and to ensure that all those eligible for thrombolytic treatment, receive it promptly. The GISSI-2 and ISIS-3 studies have revealed that no significant differences exist between thrombolytic agents, when outcome is measured as mortality benefit. Whether differences exist, and whether benefits outweigh risks with more aggressive heparinisation, and more aggressive anti-platelet and anti-thrombin activity, remains to be determined. However, the future advances in thrombolytic agents and the combination with more potent and specific antiplatelet and antithrombin agents may augment myocardial salvage and diminish the risk of reocclusion. Such advances will need to be measured against the current “gold standard” of streptokinase and aspirin.
s47
IN PULMONARYEMBOLISM: Samuel 2. Goldhaber, M.D.
THROMBOLYSIS
STATE
OF
THE
ART
State of the art thrombolysis for pulmonary embolism (PE) has become more straightforward, economical, and safer than PE thrombolysis undertaken several decades ago. The time window The diagnosis of PE can is now 14 days, rather than 5. occasionally be made with sufficient certainty utilizing lung scanning or echocardiography to obviate pulmonary angiography prior to thrombolysis. The optimal infusions are of short duration: 2 minutes to 2 hours, rather than 12-24 hours. Thrombolytic agents are administered via a peripheral vein, without the necessity of inserting a pulmonary artery catheter. No laboratory tests are required during the thrombolytic infusion. Finally, not all patients require Care Unit during the hospitalization in an Intensive thrombolytic infusion. S48 THROMBOLYSIS IN ACUTE ISCHEMIC STROKE M.L. Sacchetti, C. Cavalletti, M. Cao, C. Gori and C. Fieschi Department of Neurological Sciences, University of Rome “La Sapienza”, 1 Clinical data indicate that the majority of acute ischemic strokes are of thromboembolic origin. The level of residual cerebral blood flow (CBF) in the ischemic tissue is a major variable in determining the time interval towards the irreversible damage. The silent ischemic brain tissue (penumbra) surrounding the main infarcted area, remains potentially viable for a few hours if a residual “critical perfusion” exists. Lysis of the arterial occlusion in this time window, restoring the CBF in the ischemic area, might prevent the brain damage or reduce its extention. The clinical efficacy of pharmacological reperfusion, possible related hemorrhagic complications or reperfusional injuries and re-occlusion rate are currently being investigated.