J Neurol Neurosurg Psychiatry 1998;65:1-9 ( July )

Editorial

Ischaemic damage of brain microvessels: inherent risks for thrombolytic treatment in stroke

The first 150 words of the full text of this article appear below.

Recent trials of plasminogen activators in acute ischaemic stroke underscore the delicate balance between promise of benefit and risk. Attempts to manage clinical outcome by systemic infusion of recombinant tissue plasminogen activator (rt-PA) have so far had mixed success.^1 2 The benefits seen in the National Institutes of Neurological Diseases and Stroke (NINDS) trial of rt-PA in acute ischaemic stroke were a significant absolute improvement in disability outcome.^2 3 However, the risks in that study and in the European Cooperative Acute Stroke Study (ECASS)¹ included further disability and mortality associated with haemorrhagic consequences of the plasminogen activator (PA).^1 2 Three recent studies of streptokinase in acute ischaemic stroke were terminated because of safety concerns.^4-9 In all five trials, the risk of symptomatic haemorrhage associated with the PA was significantly increased over placebo (table 1). In addition, approaches which effect recanalisation of documented cerebral arterial thrombotic occlusions by intravenous or intra-arterial PA infusion . . . [Full text of this article]

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