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(Stroke. 2004;35:2746.)
© 2004 American Heart Association, Inc.

Articles

Current Status of Hemorrhagic Stroke and Acute Nonthrombolytic Ischemic Stroke Treatment

From Oregon Stroke Center, Oregon Health & Science University, Portland, Ore.

Correspondence to Dr Helmi L. Lutsep, Oregon Stroke Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR 131, Portland, OR 97239. E-mail lutseph@ohsu.edu

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

	Introduction

 
Strokes still cause death every 3.3 minutes in the United States and are a leading cause of disability. Although the thrombolytic tissue plasminogen activator has been available for the treatment of ischemic stroke since 1996, no neuroprotectant acute stroke treatment strategy to preserve dysfunctional neurons in the ischemic penumbra has shown efficacy in clinical trials. New approaches for the treatment of hemorrhagic stroke and changes in the design of acute ischemic stroke trials provide a more optimistic picture for future stroke treatments.

Hemorrhagic Stroke
Hemorrhagic stroke has received far less attention than ischemic stroke. Hemorrhagic stroke offers >1 potential approach for treatment, some of which are only now being assessed in clinical trials. These include preventing hematoma expansion, reducing any perihemorrhage oligemia, and preventing hemorrhage recurrence.

The International Surgical Trial in Intracerebral Hemorrhage (STICH) was the first multicenter trial to assess the efficacy of early surgical evacuation of hemorrhage. This trial, reported in February 2004, required that patients be randomized to surgery or conservative treatment by 96 hours after the ictus.¹ Perhaps because the trial allowed both superficial and deep hemorrhage locations to be included, it showed a neutral effect for surgery.

Although seemingly counterintuitive to the treatment of hemorrhage, the use of a lytic was also reported in February 2004. In an early safety trial in patients with intraventricular hemorrhage, low-dose tissue plasminogen activator was injected into the ventricles to reduce clot burden.² Although high adverse event rates will require careful planning of future trials, encouraging trends toward improved functional outcomes . . . [Full Text of this Article]

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