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Past and Future

Michael A. Sloan, MD

Arch Neurol. 1987;44(7):748-768.

Abstract
• Investigators have tried to limit ischemic cerebral infarct size by pharmacologic and surgical means with mixed results. Thrombolytic (fibrinolytic) therapy has been used in the past with unfavorable outcome. With advances in clinical and radiologic assessment and new knowledge of the pathophysiology of brain ischemia, thrombolytic therapy has now become a feasible pharmacologic intervention in acute stroke. Central nervous system hemorrhage, the most dread complication of fibrinolytic therapy, is rare in patients with acute myocardial infarction favorably treated with these agents. Risk of hemorrhagic transformation of ischemic cerebral infarcts is related to size, location, and age of patient. Anticoagulation therapy may increase its size, but not its likelihood. The development of clot-specific agents, such as tissue-type plasminogen activator, and careful patient selection make fibrinolytic therapy safe and potentially effective in acute stroke.

Author Affiliations
From the Department of Neurology, Tufts New England Medical Center, Boston. Dr Sloan is now with the Department of Neurology, University of Virginia Medical Center, Charlottesville.

Footnotes
Accepted for publication March 5, 1987.

Reprint requests to Department of Neurology, University of Virginia Medical Center, Box 394, Charlottesville, VA 22908 (Dr Sloan).

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