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(Stroke. 2003;34:820.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Early Major Ischemic Changes on Computed Tomography Should Preclude Use of Tissue Plasminogen Activator

From the Department of Neuroradiology, University of Technology, Dresden, Germany.

Correspondence to Rüdiger von Kummer, MD, Technische Universität, Department of Neuroradiology, Fetscherstr 74, Dresden D-01307, Germany. E-mail kummer-r@rcs.urz.tu-dresden.de

Key Words: brain ischemia • computed tomography • tissue plasminogen activator

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The rationale of tissue plasminogen activator (tPA) treatment is the restoration of blood supply to ischemic brain areas by clot lysis and subsequent arterial recanalization. With view to the high vulnerability of brain tissue, early restoration of blood supply will have a better chance of regaining neurological function than delayed restoration. Brain tissue survival is, however, clearly not guaranteed for 3 hours, the currently accepted time window for thrombolysis, if cerebral blood flow falls below 10 mL per 100 g x min. Under such conditions, it survives for not more than 15 to 30 minutes.¹ Time is only one condition among others for the success of thrombolysis. This treatment will work if the clot is dissolvable by tPA, (containing fibrin, not calcified, small), if reperfusion is accelerated compared with the spontaneous course, and if reperfusion of the ischemic brain tissue will result in recovery of neurological function. Fortunately, stroke can have a beneficial spontaneous course, and no treatment is necessary. Conversely, stroke in others may be caused by conditions that cannot be treated with tPA. These conditions are arterial wall dissection or inflammation, arteriosclerotic stenosis, and long-standing extracranial carotid occlusion in combination with a drop in arterial blood pressure. Again, time may play a crucial role: arterial recanalization by 0.9 mg/kg tPA may be too slow and too late. Under unfortunate circumstances (eg, embolic occlusion of the distal internal carotid artery), the major portion of the affected arterial territory is already dead, when tPA treatment is initiated and when the . . . [Full Text of this Article]

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