Factors influencing the efficiency and safety of systemic thrombolysis in patients with ischemic stroke
https://doi.org/10.14412/2074-2711-2014-3-61-68
Abstract
Systemic thrombolysis using recombinant tissue plasminogen activator is the most effective and safe therapy option for ischemic stroke (IS) in the first 4.5 hours after onset of the disease. The safety and efficiency (or inefficiency) of perfusion therapy in patients with IS may be affected by a multitude of factors associated with the time of the therapy, patient age, the presence and size of a brain region with potentially reversible changes, the location of a cerebral lesion region, the specific features of systemic and local hemodynamics, and the degree of blood-brain barrier impairment. The hemorrhagic transformation of a brain lesion focus in IS is a serious complication of thrombolytic therapy (TT). The analysis and detection of predictors for hemorrhagic complications, TT in terms of the clinical and pathogenetic features of the disease, the location of a lesion focus and the degree of early neuroimaging signs, and data of additional studies will contribute to the safer and more effective
use of this treatment in patients with IS.
About the Authors
N. A. Shamalov
Research Institute of Cerebrovascular Pathology and Stroke N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia
Department of Fundamental and Clinical Neurology and Neurosurgery, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
1, Ostrovityanov St., Moscow 117997
1, Ostrovityanov St., Moscow 117997
K. V. Anisimov
Research Institute of Cerebrovascular Pathology and Stroke N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997
Russian Federation
1, Ostrovityanov St., Moscow 117997
M. A. Kustova
Department of Fundamental and Clinical Neurology and Neurosurgery, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997
Russian Federation
1, Ostrovityanov St., Moscow 117997
A. P. Tolmachev
Department of Fundamental and Clinical Neurology and Neurosurgery, N.I. Pirogov Russian National Research Medical University,
Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997
Russian Federation
1, Ostrovityanov St., Moscow 117997
References
1. Available from: http://www.eso-stroke.org
2. Jauch EC, Saver JL, Adams HP Jr, et al.; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947. DOI: http://dx.doi.org/10.1161/STR.0b013e318284056a.
3. Tillet WS, Garner RL. The fibrinolytic activity of hemolytic streptococci. J Exp Med. 1933;58:485–520. DOI: http://dx.doi.org/10.1084/jem.58.4.485.
4. Fletcher AP, Alkjaersig N, Smyrniotis FE, Sherry S. The treatment of patients suffering from early myocardial infarction with massive and prolonged streptokinase therapy. Trans Assoc Am Phys. 1958;71:287–96.
5. Del Zoppo GJ, Zeumer H, Harker LA. Thrombolytic therapy in acute stroke: Possibilities and hazards. Stroke. 1986;17:595–607. DOI: http://dx.doi.org/10.1161/01.STR.17.4.595.
6. Ringelstein EB, Zeumer H. The role of continuous-wave Doppler sonography in the diagnosis and management of basilar and vertebral artery occlusions, with special reference to its application during local fibrinolysis. J Neurol. 1982;228:161–70. DOI: http://dx.doi.org/10.1007/BF00313728.
7. Zeumer H, Hacke W, Ringelstein EB. Local intraarterial thrombolysis in vertebrobasilar thromboembolic disease. Am J Neuroradiol. 1983;4(3):401–4.
8. Solis OJ, Roberson GR, Taveras JM, et al. Cerebral angiography in acute cerebral infarction. Rev Interam Radiol. 1977;2(1):19–25.
9. Matsuo O, Kosugi T, Mihara H, et al. Retrospective study on the efficacy of using urokinase therapy. Acta Haem Jap. 1979;42:684–8.
10. Multicentre Acute Stroke Trial – Italy (Mast-I) Group. Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet. 1995 Dec 9;346(8989):1509–14. DOI: http://dx.doi.org/10.1016/S0140- 6736(95)92049-8.
11. Multicentre Acute Stroke Trial – Europe tudy Group. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med. 1996 Jul 18;335(3):145–50. DOI: http://dx.doi.org/10.1056/NEJM199607183350301.
12. Yasaka M, Chambers BR, Davis SM, Donnan GA. Streptokinase in acute stroke: effect on reperfusion and recanalization. Australian Streptokinase Trial Study Group. Neurology. 1998 Mar;50(3):626–32. DOI: http://dx.doi.org/10.1212/WNL.50.3.626.
13. Seifried E, Tanswell P, Ellbrü ck D, et al. Pharmacokinetics and haemostatic status during consecutive infusions of recombinant tissuetype plasminogen activator in patients with acute myocardial infarction. Thromb Haemostas. 1989;61(3):497–501.
14. Tanswell P, Tebbe U, Neuhaus K-L, et al. Pharmacokinetics and fibrin specificity of Alteplase during accelerated infusions in acute myocardial infarction. J Am Coll Cardiol. 1992;19:1071–5. DOI: http://dx.doi.org/10.1016/0735-1097(92)90297-Z.
15. Brott TG, Haley EC Jr, Levy DE, et al. Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes. Stroke. 1992;23:632–40. DOI: http://dx.doi.org/10.1161/01.STR.23.5.632.
16. Haley EC Jr, Levy DE, Brott TG, et al. Urgent therapy for stroke. Part II. Pilot study of tissue plasminogen activator administered 91–180 minutes from onset. Stroke. 1992;23:641–5. DOI: http://dx.doi.org/10.1161/01.STR.23.5.641.
17. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. New Engl J Med. 1995;333(24):1581–7.
18. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke the european cooperative acute stroke study (ECASS). JAMA. 1995;274(13):1017–25.
19. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet. 1998;352(9136):1245–51.DOI: http://dx.doi.org/10.1016/S0140-6736(98)08020-9.
20. Clark WM, Wissman S, Albers GW, et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282:2019–26. DOI: http://dx.doi.org/ 10.1001/jama.282.21.2019.
21. Hacke W, Kaste M, Bluhmki E, et al.; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29. DOI: 10.1056/NEJMoa0804656.
22. Sandercock P, Wardlaw JM, Lindley RI, et al.; IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63. DOI: http://dx.doi.org/10.1016/S0140- 6736(12)60768-5.
23. Indyk JA, Chen ZL, Tsirka SE, Strickland S. Laminin chain expression suggests that laminin-10 is a major isoform in the mouse hippocampus and is degraded by the tissue plasminogen activator/plasmin protease cascade during excitotoxic injury. Neuroscience. 2003;116:359–71. DOI: http://dx.doi.org/10.1016/S0306-4522(02)00704-2.
24. Lo EH, Broderick JP, Moscowitz MA. tPA and proteolysis in the neurovascular unit. Stroke. 2004;35(2):354–6. DOI: http://dx.doi.org/10.1161/01.STR.0000115164.80010.8A.
25. Furlan AJ, Eyding D, Albers GW, et al.; DEDAS Investigators. Dose escalation of desmoteplase for acute ischemic stroke (dedas): evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke. 2006;37:1227–31. DOI: http://dx.doi.org/10.1161/ 01.STR.0000217403.66996.6d.
26. Hacke W, Albers G, Al-Rawi Y., et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS). A phase II MRI – based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke. 2005;36:66–73. DOI: http://dx.doi.org/10.1161/01.STR. 0000149938.08731.2c.
27. Hacke W, Furlan AJ, Al-Rawi Y, et al. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusiondiffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, doubleblind, placebo-controlled study. Lancet Neurol. 2009;8(2):141–50. DOI: http://dx.doi.org/10.1016/S1474-4422(08)70267-9.
28. Kratzschmar J, Haendler B, Langer G, et al. The plasminogen activator family from the salivary gland of the vampire bat Desmodus rotundus: cloning and expression. Gene. 1991;105:229–37. DOI: http://dx.doi.org/10.1016/0378-1119(91)90155-5.
29. Lopez-Atalaya JP, Roussel BD, Ali C, et al. Recombinant desmodus rotundus salivary plasminogen activator crosses the blood-brain barrier through a low-density lipoprotein receptorrelated protein-dependent mechanism without exerting neurotoxic effects. Stroke. 2007;38:1036–43. DOI: http://dx.doi.org/10.1161/01. STR.0000258100.04923.84.
30. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768–74. DOI: http://dx.doi.org/10.1016/S0140-6736(04)15692-4.
31. Bray BD, Campbell J, Cloud GC, et al.; Intercollegiate Stroke Working Party Group. Bigger, Faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke. Stroke. 2013;44:3129–35. DOI: http://dx.doi.org/10.1161/ STROKEAHA.113.001981.
32. Carlson MD, Leber S, Deveikis J, Silverstein FS. Successful use of rt-PA in pediatric stroke. Neurology. 2001;57:157–8. DOI: http://dx.doi.org/10.1212/WNL.57.1.157.
33. Engelter ST, Bonati LH, Lyrer PA. Intravenous thrombolysis in stroke patients of 80 versus 80 years of age – a systematic review across cohort studies. Age Ageing. 2006;35:572–80. DOI: http://dx.doi.org/10.1093/ageing/afl104.
34. Mateen FJ, Buchan AM, Hill MD; CASES Investigators. Outcomes of thrombolysis for acute ischemic stroke in octogenarians versus nonagenarians. Stroke. 2010;41:1833–5. DOI: http://dx.doi.org/10.1161/STROKEAHA. 110.586438.
35. Khaw KT, Barrett-Connor E, Suarez L, Criqui MH. Predictors of stroke associated mortality in the elderly. Stroke. 1984;15:244–8. DOI: http://dx.doi.org/10.1161/ 01.STR.15.2.244.
36. Wardlaw JM, Murray V, Berge E, Del Zoppo GJ. Thrombolysis for acute ischemic stroke. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD000213. DOI: 10.1002/14651858.CD000213.pub2.
37. Anzini A, Niaz A, Durastanti L, et al. Thrombolysis in young patients: the SITSMOST data. Cerebrovasc Dis. 2008;25 (Suppl 2):3.
38. Putaala J, Metso TM, Metso AJ, et al. Thrombolysis in young adults with ischemic stroke. Stroke. 2009;40:2085–91. DOI: http://dx.doi.org/10.1161/ STROKEAHA.108.541185.
39. Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke. Stroke. 2000;31:1833–7. DOI: http://dx.doi.org/10.1161/01.STR.31.8.1833.
40. Kapral MK, Fang J, Hill MD, et al.; Investigators of the Registry of the Canadian Stroke Network. Sex differences in stroke care and outcomes: results from the registry of the canadian stroke network. Stroke. 2005;36:809–14. DOI: http://dx.doi.org/10.1161/01.STR. 0000157662.09551.e5.
41. Meseguer E, Mazighi M, Labreuche J, et al. Outcomes of intravenous recombinant tissue plasminogen activator therapy according to gender: a clinical registry study and systematic review. Stroke. 2009;40:2104–10. DOI: http://dx.doi.org/10.1161/STROKEAHA. 108.546325.
42. Savitz SI1, Schlaug G, Caplan L, Selim M. Arterial occlusive lesions recanalize more frequently in women than in men after intravenous tissue plasminogen activator administration for acute stroke. Stroke. 2005;36:1447–51. DOI: http://dx.doi.org/10.1161/01.STR. 0000170647.42126.a8.
43. Kent DM, Price LL, Ringleb P, et al. Sex-based differences in response to recombinant tissue plasminogen activator in acute ischemic stroke: a pooled analysis of randomized clinical trials. Stroke. 2005;36:62–5. DOI: http://dx.doi.org/10.1161/01.STR. 0000150515.15576.29.
44. Fö rster A, Gass A, Kern R, et al. Gender differences in acute ischemic stroke: etiology, stroke patterns and response to thrombolysis. Stroke. 2009;40:2428–32. DOI: http://dx.doi.org/10.1161/STROKEAHA.109.548750.
45. Tafreshi GM, Raman R, Ernstrom K, et al. Gender differences in acute stroke treatment: the University of California San Diego experience. Stroke. 2010;41:1755–7. DOI: http://dx.doi.org/10.1161/STROKEAHA. 110.584136.
46. Pessin M, del Zoppo GJ, Estol C. Thtombolytic agents in the treatment of stroke. Clin Neuropharmacol. 1990;13:271–89. DOI: http://dx.doi.org/10.1097/00002826- 199008000-00001.
47. Okada Y, Yamaguchi T, Minematsu K, et al. Hemorrhagic transformation in cerebral embolism. Stroke. 1989;20:598–603. DOI: http://dx.doi.org/10.1161/01.STR.20.5.598.
48. Lodder J, Krijne-Kubat B, Broekman J. Cerebral hemorrhagic infarction at autopsy: cardiac embolic cause and the relationship to the cause of death. Stroke. 1986;17:626–9. DOI: http://dx.doi.org/10.1161/01.STR.17.4.626.
49. Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke. 1997;28:2119–25. DOI: http://dx.doi.org/10.1161/01.STR.28.11.2119.
50. Fiorelly M, Bastianello S, von Kummer R, et al.; ECASS I Study Group. Hemorrhagic transformation within 36 hours of a cerebral infarct. Relationship with early clinical deterioration and 3-month outcome in the ECASS I cohort. Stroke. 1999;30:2280–4. DOI: http://dx.doi.org/10.1161/01.STR.30.11.2280.
51. Molina CA, Alvarez-Sabin J, Montaner J, et al. Thrombolysis-related hemorragic infarction: a marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke. 2002;33;1551–6. DOI: http://dx.doi.org/10.1161/01. STR.0000016323.13456.E5.
52. Neumann-Haefelin T, Hoelig S, Berkefeld J, et al. Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute Stroke. Stroke. 2006;37:2463–6. DOI: http://dx.doi.org/10.1161/01.STR.0000239321.53203.ea.
53. Dubey N, Bakshi R, Wasay M, Dmochowski J. Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging. 2001;11:184–8. DOI: http://dx.doi.org/10.1111/j.1552- 6569.2001.tb00031.x.
54. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group. Stroke. 1997;28:2109–18. DOI: http://dx.doi.org/10.1161/01.STR.28. 11.2109.
55. Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355:1670–4. DOI: http://dx.doi.org/10.1016/S0140- 6736(00)02237-6.
56. Dzialowski I, Hill MD, Coutts SB, et al. Extent of early ischemic changes on computed tomography (ct) before thrombolysis: prognostic value of the Alberta Stroke Program Eearly CT Score in ECASS II. Stroke. 2006;37:973–8. DOI: http://dx.doi.org/10.1161/01. STR.0000206215.62441.56.
57. Lindsberg PJ, Hä ppö lä O, Kallela M, et al. Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment. Neurology. 2006;67:334–6. DOI: http://dx.doi.org/10.1212/01.wnl. 0000224759.44743.7d.
58. Martin-Schild S, Morales MM, Khaja AM, et al. Is the drip-and-ship approach to delivering thrombolysis for acute ischemic stroke safe? J Emerg Med. 2011 Aug;41(2):135–41. DOI: 10.1016/j.jemermed.2008.10.018. Epub 2009 Mar 9
59. Mayer TE, Hamann GF, Brueckmann HJ. Treatment of basilar artery embolism with a mechanical extraction device: necessity of flow reversal. Stroke. 2002;33:2232–5. DOI: http://dx.doi.org/10.1161/01.STR. 0000024524.71680.C6.
60. Hacke W, Zeumer H, Ferbert A, et al. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988;19:1216–22. DOI: http://dx.doi.org/10.1161/01. STR.19.10.1216.
61. Brandt T, von Kummer R, Muller-Kuppers M, Hacke W. Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke. 1996;27:875–81. DOI: http://dx.doi.org/10.1161/01. STR.27.5.875.
62. Schonewille WJ, Wijman CA, Michel P, et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol. 2009;8:724–30. DOI: http://dx.doi.org/10.1016/S1474- 4422(09)70173-5.
63. Martin-Schild S, Morales MM, Khaja AM, et al. Is the drip-and-ship approach to delivering thrombolysis for acute ischemic stroke safe? J Emerg Med. 2009.
64. Silverman IE, Beland DK, Chhabra J, McCullough LD. The «Drip-and-ship» approach: starting IV t-Pa for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center. Conn Med. 2005;69:613–20.
65. Pfefferkorn T, Mayer TE, Opherk C, et al. Staged escalation therapy in acute basilar artery occlusion: Intravenous thrombolysis and ondemand consecutive endovascular mechanical thrombectomy: Preliminary experience in 16 patients. Stroke. 2008;39:1496–500. DOI: http://dx.doi.org/10.1161/STROKEAHA. 107.505123.
66. Pfefferkorn T, Holtmannspotter M, Schmidt C, et al. Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke. 2010;41:722–6. DOI: http://dx.doi.org/10.1161/STROKEAHA. 109.567552.
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For citations:
Shamalov N.A., Anisimov K.V., Kustova M.A., Tolmachev A.P. Factors influencing the efficiency and safety of systemic thrombolysis in patients with ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):61-68. (In Russ.) https://doi.org/10.14412/2074-2711-2014-3-61-68
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