Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke

Gregory J. Del Zoppo, Klaus Poeck, Michael S. Pessin, Samuel M. Wolpert, Anthony J. Furlan, Andreas Ferbert, Mark J. Alberts, Justin A. Zivin, Lawrence Wechsler, Otto Busse, Ralph Greenlee, Lawrence Brass, J. P. Mohr, Edward Feldmann, Werner Hacke, Carlos S. Kase, Jose Biller, Daryl Gress, Shirley M. Otis

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Abstract

An open angiography‐based, dose rate escalation study on the effect of intravenous infusion of recombinant tissue plasminogen activator(rt‐PA) on cerebral arterial recanalization in patients with acute focal cerebral ischemia was performed at 16 centers. Arterial occlusions consistent with acute ischemia in the carotid or vertebrobasilar territory in the absence of detectable intracerebal hemorrhage were prerequisites for treatment. After the 60‐minute rt‐PA infusion, arterial perfusion was assesed by repeat angiography and computed tomography scans were performed at 24 hours to assess hemorrhagic transformation, Of 139 patients with symptoms of focal ischemia, 80.6% (112) had complete occlusion of the primary vessel at a mean of 5.4 ± 1.7 hours after symptom onset. No dose rate response of cerebral arterial recanalization was observed in 93 patients who completed the rt‐PA infusion. Middle cerebral artery division (M2) and branch (M3) occlusions were more likely to undergo recanalization by 60 minutes than were internal carotid artery occlusions. Hemorrhagic infarction occured in 20.2% and parenchymatous hematoma in 10.6% of patients over all dose rates, while neurological worsening accompanied hemorrhagic transformation (hemorrhagic infarction and parenchymatous hematoma) in 9.6% of patients. All findings were within prospective safety guidelines. No dose rate correlation with hemorrhagic infarction, parenchymatous hematoma, or both was seen. Hemorrhagic transformation occured significantly more frequently in patients receiving treatment at least 6 hours after symptom onset. No relationship between hemorrhagic transformation and recanalization was observed. This study indicates that site of occlusion, time to recanalization, and time to treatment are important variables in acute stroke intervention with this agent.

Original languageEnglish (US)
Pages (from-to)78-86
Number of pages9
JournalAnnals of Neurology
Volume32
Issue number1
DOIs
StatePublished - Jul 1992

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Del Zoppo, G. J., Poeck, K., Pessin, M. S., Wolpert, S. M., Furlan, A. J., Ferbert, A., Alberts, M. J., Zivin, J. A., Wechsler, L., Busse, O., Greenlee, R., Brass, L., Mohr, J. P., Feldmann, E., Hacke, W., Kase, C. S., Biller, J., Gress, D., & Otis, S. M. (1992). Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Annals of Neurology, 32(1), 78-86. https://doi.org/10.1002/ana.410320113