Plasminogen Activator and Cerebral Infarction

Cranston, Robert E.; Wolfson, Mark A.; Buchsbaum, Harvey W.; Feinberg, William M.; Barreuther, Alan

doi:10.7326/0003-4819-108-5-766_1

Cited by 12 publications

(5 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 We suspected reocclusion in only one of our patients (see above). Thrombolytic fragmentation of a preexisting thrombus with embolization to the brain is another possible neurological complication 12 and may have occurred in one of our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Another patient with cardiomyopathy and atrial fibrillation may have had fragmentation of a preexisting thrombus. 12 He had a sudden MCA distribution infarction (incomplete parietal branch occlusion by arteriography), demonstrated major neurological improvement during and after rt-PA therapy, but then sustained a posterior cerebral artery distribution infarction on the fourth hospital day. His transthoracic echocardiogram was normal.…”

Section: Table 1 Selected Methods For Urgent Evaluation and Treatmentmentioning

confidence: 99%

“…The neurological examination performed just before treatment showed 24 patients with a decreased level of consciousness (32%, none in coma), 37 with forced eye deviation (50%), and 30 with hemiplegia (40%, face-arm-leg score 2:8); 16 patients (22%) had two or more of these examination findings. The median pretreatment Stroke Scale score for all patients was 12 (interquartile range [8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Table 1 Selected Methods For Urgent Evaluation and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes.

Brott

Haley

Levy

et al. 1992

Stroke

473

228

View full text Add to dashboard Cite

Thrombolytic agents hold theoretical promise as therapy for cerebral infarction. This study was designed to evaluate the safety of tissue plasminogen activator, to accomplish urgent patient treatment, and to estimate potential efficacy of tissue plasminogen activator. Following neurological evaluation and computed tomography of the brain, patients with acute ischemic stroke were evaluated and treated with intravenous tissue plasminogen activator under an open-label, dose-escalation design within 90 minutes from symptom onset. End points examined included symptomatic and asymptomatic intracranial hematoma, systemic hemorrhage, and neurological outcome at 2 hours, 24 hours, and 3 months. Seventy-four patients were treated within 90 minutes of symptom onset over seven dose tiers of tissue plasminogen activator, ranging from 0.35 mg/kg to 1.08 mg/kg. Intracranial hematoma with associated neurological deterioration occurred in three patients and was related to increasing doses of tissue plasminogen activator (p = 0.045). Intracranial hematoma did not occur in any of the 58 patients treated with less than or equal to 0.85 mg/kg. Major neurological improvement occurred in 22 patients (30%) at 2 hours from the initiation of tissue plasminogen activator and in a total of 34 patients (46%) at 24 hours, but major neurological improvement was not related to increasing doses of tissue plasminogen activator or to stroke type. Patients with acute stroke can be evaluated and treated within 90 minutes. Tissue plasminogen activator for acute ischemic infarction is not without risk, but the potential for clinical benefit justifies a randomized clinical trial. To date, differences in hemorrhagic risk or neurological benefit of tissue plasminogen activator for particular ischemic stroke types are not apparent.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Table 1 Selected Methods For Urgent Evaluation and Treatmentmentioning

confidence: 99%

Section: Table 1 Selected Methods For Urgent Evaluation and Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes.

Brott

Haley

Levy

et al. 1992

Stroke

473

228

View full text Add to dashboard Cite

show abstract

“…4,5 However, thromboembolism following such therapy is extremely rare, with only a few case reports in the literature. [1][2][3] In the case presented, the patient suffered an ischemic stroke 2 hours after treatment with tPA for acute myocardial infarction. Our patient had no history of previous heart disease, arrhythmias (such as atrial brillation), or pulmonary hypertension, nor had he undergone interventions such as cardiac catheterization or surgery.…”

Section: Discussionmentioning

confidence: 94%

“…While intracranial hemorrhages are the major neurologic complication, a few case reports described the uncommon occurrence of embolic strokes shortly after thrombolytic therapy, [1][2][3] which are presumably caused by the rapid fragmentation and subsequent dislodging of a preexisting cardiac thrombus. However, these reports lacked con rmatory evidence, and the assumptions were made in retrospect.…”

mentioning

confidence: 99%

Embolic Cerebral Infarction and Gastrointestinal Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction

et al. 2002

View full text Add to dashboard Cite

We report an unusual case of cerebral embolization that occurred after intravenous thrombolytic therapy for myocardial infarction. Direct observation by serial echocardiograms in this patient confirmed that the thrombolytic treatment induced lysis and fragmentation of thrombus, and the subsequent dislodging and embolization of preexisting cardiac thrombi, which caused the cerebral infarction. It is suggested that an echocardiogram, if instantly available, be performed before considering thrombolytic therapy whenever acute anterior wall myocardial infarction is impressed.

show abstract

Ischemic stroke and intracranial hemorrhage following thrombolytic therapy for acute myocardial infarction: A risk-benefit analysis

Sloan

Gore

1992

The American Journal of Cardiology

View full text Add to dashboard Cite

Plasminogen Activator and Cerebral Infarction

Cited by 12 publications

References 1 publication

Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes.

Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes.

Embolic Cerebral Infarction and Gastrointestinal Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction

Ischemic stroke and intracranial hemorrhage following thrombolytic therapy for acute myocardial infarction: A risk-benefit analysis

Contact Info

Product

Resources

About