Thrombolytic therapy in stroke: possibilities and hazards.

AGENTS WHICH MEDIATE THE dissolution of thrombi are receiving increasingly wide therapeutic application. Urokinase or streptokinase have been employed in the treatment of acute thrombosis of coronary 1 " 23 and selected peripheral arteries, 15 ' 23 ~34 traumatic internal carotid artery occlusion, 35 as well as of pulmonary embolism 36 " 39 and peripheral deep venous thrombosis. 1340 " 39 The demonstration that acute stroke is typically an atherothrombotic or thromboembolic process 60 " 76 provides a theoretical basis for the use of thrombolytic therapy in the treatment of acute stroke. However, because of the possibility that intracerebral hemorrhage may develop during thrombolytic therapy, use of such agents in stroke treatment has generally been contraindicated. Nevertheless, limited recent experience indicates that careful infusion of thrombolytic agents may lead to thrombus dissolution and clinical improvement in selected patients presenting with acute stroke. 77 " 79 It is the purpose of this discussion to review the molecular basis for the thrombolytic state, clinical experience with systemic and local treatment of stroke