The utility of intravenous tissue plasminogen activator (IV t-PA) in improving the clinical outcomes after acute ischemic stroke has been well demonstrated in past clinical trials. Though multiple initial small series of endovascular stroke therapy had shown good outcomes as compared to IV t-PA, a similar beneficial effect had not been translated in multiple randomized clinical trials of endovascular stroke therapy. Over the same time, there have been parallel advances in imaging technology and better understanding and utility of the imaging in therapy of acute stroke. In this review, we will discuss the evolution of endovascular stroke therapy followed by a discussion of the key factors that have to be considered during endovascular stroke therapy and directions for future endovascular stroke trials.
Stroke* ; Tissue Plasminogen Activator

No abstract available.
Blood Coagulation* ; Pulmonary Embolism* ; Tissue Plasminogen Activator*

No abstract available.
Embolism ; Hyaluronic Acid ; Stroke ; Tissue Plasminogen Activator

We report removing a large subretinal hemorrhage by means of vitrectomy combined with the use of tissue plasminogen activator(tPA) to facilitate clot removal. A 25-year-old man had a 4 days history of visual loss in the right eye after blunt trauma. The right fundus had a large subretinal hemorrhage involving macula. Surgery was performed the following day. A small retinotomy was made, through which tPA was injected into the subretinal space and through which the dissolved clot was removed. The use of tPA minimizes surgical manipulation of the retina and greatly reduces the size of the retinotomy reguired for evacuation of subretinal bood. Although the long-term prognosis is guarded, this case does suggest that tPA may be a useful adjunct in managing of subretinal hemorrhage.
Adult ; Hemorrhage* ; Humans ; Plasminogen ; Prognosis ; Retina ; Tissue Plasminogen Activator* ; Vitrectomy

Thromboembolism is a crucial part of the global disease burden. It has high incidence, high mortality and disability rates, and the mechanism of occurrence and development is extremely complex. It is difficult to detect the disease in the early stage so that we have trouble with clinical prevention and treatment in general. At present, four items of blood coagulation and D-dimer have been widely used in the evaluation and auxiliary diagnosis of thromboembolism, the monitoring of effect for antithrombotic drugs and other fields. The thrombus biomarkers including thrombin-antithrombin complex (TAT), thrombomodulin (TM), tissue plasminogen activator-inhibitor complex (t-PAIC) and α2-plasmin inhibitor-plasmin complex (PIC) fill the gap of laboratory diagnosis before clinical symptoms appear in some degree. This article aims to explain the current application status of TAT, TM, t-PAIC and PIC in thromboembolism and explore their potential application value, so as to provide a reference for selecting appropriate early monitoring indicators for high-risk population of thromboembolism.
Humans ; Tissue Plasminogen Activator ; Plasminogen Inactivators ; Thrombomodulin ; Thromboembolism ; Biomarkers

Thromboembolism is a crucial part of the global disease burden. It has high incidence, high mortality and disability rates, and the mechanism of occurrence and development is extremely complex. It is difficult to detect the disease in the early stage so that we have trouble with clinical prevention and treatment in general. At present, four items of blood coagulation and D-dimer have been widely used in the evaluation and auxiliary diagnosis of thromboembolism, the monitoring of effect for antithrombotic drugs and other fields. The thrombus biomarkers including thrombin-antithrombin complex (TAT), thrombomodulin (TM), tissue plasminogen activator-inhibitor complex (t-PAIC) and α2-plasmin inhibitor-plasmin complex (PIC) fill the gap of laboratory diagnosis before clinical symptoms appear in some degree. This article aims to explain the current application status of TAT, TM, t-PAIC and PIC in thromboembolism and explore their potential application value, so as to provide a reference for selecting appropriate early monitoring indicators for high-risk population of thromboembolism.
Humans ; Tissue Plasminogen Activator ; Plasminogen Inactivators ; Thrombomodulin ; Thromboembolism ; Biomarkers

Many case series showed local intraarterial thrombolysis using urokinase was effective treatment for acute ischemic stroke, but it was performed in the limited area because its outcome largely depends upon the manpower and facility of the each stroke center. Thrombolysis has not been in use world-wide, until a large randomized control study revealed intravenous thrombolysis using tissue plasminogen activator (t-PA) is a safe and effective treatment for ischemic stroke. The clinical trial also showed that thrombolysis significantly increases the incidence of fatal hemorrhage and the development of effective methods for selection of proper candidates is warranted. New advanced MR technology including diffusion and perfusion weighted images may be able to identify ideal candidates for thrombolytic therapy. Here the author review data from clinical trials and current treatment options for patients with acute ischemic stroke.
Diffusion ; Hemorrhage ; Humans ; Incidence ; Perfusion ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

OBJECTIVE: Recent clinical studies have demonstrated that intracisternal administration of recombinant tissue plasminogen activator(rt-PA) can facilitate the normal clearing of blood from the subarachnoid space. Urokinase, a first generation fibrinolytic agent, has been used to liquify such clots with some success. Therefore, recombinant tissue plasminogen activator, a second generation fibrinolytic drug that may be safer and more effective, is studied to evaluate its dosage to lyse clots in vitro and reactivity in the brain parenchyme. METHODS: Intracerebral hematomas were created by stereotactically injecting 2ml of clotted autogenous blood into the brain parenchyme of total 28 anesthetized adult cats (weighting 3.8 to 4.1kg). The control animals (group A) received 1ml of normal saline injected into the clots and the experimental animals received each 0.1mg of rt-PA (group B), 0.5mg of rt-PA (group C) and 1mg of rt-PA (group D) at 6 hours after the clot injection. RESULTS: 1. The amount of remained clots after lysing the hematomas were as follows: 1.80+/-0.17ml in group A, 1.65+/-0.23ml in group B, 0.61+/-0.37ml in group C and 0.52+/-0.34 in group D. The result indicated that hematomas in rt-PA treated groups (C & D) were lysed better than the control group. 2. At least 0.5mg of rt-PA should be required for the lysis of 2ml of hematomas. 3. Light microscopic examination revealed no histological evidence of hemorrhage in tissue sections from each brain. CONCLUSION: Recombinant tissue plasminogen activator may be safely and effectively employed for the lysis of intracerebral hematomas in animal model.
Adult ; Animals ; Brain ; Cats* ; Hematoma* ; Hemorrhage ; Humans ; Models, Animal ; Plasminogen ; Subarachnoid Space ; Tissue Plasminogen Activator* ; Urokinase-Type Plasminogen Activator

No abstract available.
Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Tissue Plasminogen Activator*

For the patients suffering from acute ischemic infarct from abrupt occlusion of vessels, prompt reperfusion is necessary to save the ischemic penumbra, eventually leading to a good prognosis. Regarding this, intravenous (IV) recombinant tissue plasminogen activator (rt-PA) thrombolysis as a reperfusion therapy is the only approved method. The IV rt-PA therapy gives us a clinical benefit of 30% or more likelihood of favorable outcome compared to the placebo. However, there is about 6% symptomatic intracranial hemorrhagic risk. Therefore, prudent decision-making by selecting of indicated patients is the role of neurologists. Besides intravenous rt-PA thrombolysis, application of intra-arterial therapy or bridging concept of intra-arterial combined with IV rt-PA is promising. They showed better recanalization rate than that of IV therapy according to the controlled studies. Although the clinical evidence is lacking, they have been performed occasionally in well-facilitated institutions. The results of ongoing trials to support the clinical benefit of these active therapies are expected. In this article, we reviewed the major clinical trials for thrombolytic treatment of acute ischemic stroke and various trials which are under investigation for the extension of the time window for thrombolysis.
Humans ; Prognosis ; Reperfusion ; Stress, Psychological ; Stroke ; Tissue Plasminogen Activator