A New Role for Thrombolytics? Some patients with acute ischaemic stroke respond favourably to urokinase

Previous work in Japan has indicated that thrombolytic therapy of stroke with urokinase is. both ineffective and hazardous. Improved diagnostic and clinical techniques may make thrombolytic therapy a feasible intervention in acute stroke. 22 patients with acute thromboembolic occlusion of the middle cerebral artery- were treated with intracaroiidurokinase infusion. Emergency cerebral angiograph¥ was performed and 180,000-1,320,000 units of urokinase were continuously infused into the internal carotid artery at a mean time of 4.5 hours after symptom onset.

Recanalisation of the middle cerebral artery occurred in 1 ° patients. Eight showed rapid improvement of symptoms following restoration of blood flow. Three of the 12 treatment failures, died of brain herniation. The mean infarction volume measured 3 days after symptom onset was significantly lower in the recanalisation group; 34 vs 174ml. Haemorrhagic transformation occurred in 1 patient with successful recanalisation and 3 without. Successful recanalisation was more common with thrombi presumed intra-arterial rather than cardiac in origin which is probably because of the increased size and reduced solubility of cardiac thrombi. The overall outcome was considerably better for successfully treated urokinase recipients than for those undergoing either conventional therapy or acute embolectomy.

'Intracarotld urokinase infusion appears to increase the chance of recanalisation occurring quickly enough to reduce the volume of infarction and the neurologic deficit after acute MeA [middle cerebral artery1 occlusion in selected patients.' Further trials and thrombolytic developments ' ... might make fibrinolytic therapy safe and effective in the treatment of acute Ischemic stroke'. Mori E, Tabuchi M, Yoshida T. Yamadori A. Stroke 19: 802·812, Jui 1988 1523

:0156-2703/ 88/0903·0013/ 0$01.00/ 0 © ADIS Press INPHARMA® 3 Sep 1988 13