Abstract
Thrombolysis is the first scientifically established treatment for acute ischemic stroke, but we now need to build on that success. One possible way this might be accomplished is by combining thrombolysis with neuroprotection (see Chapter 3). Such combination therapy might reduce complications of thrombolysis, especially hemorrhage, by protecting damaged endothelium or reducing the volume of tissue necrosis. It might also prevent secondary injury associated with reperfusion. Finally, it might augment the benefit of thrombolysis by extending the time window before irreversible damage occurs. This chapter explores the rationale behind combination therapy and describe laboratory and clinical results to date.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
DeGraba T, Ostrow P, Grotta J. Threshold of calcium disturbances after focal cerebral ischemia in rats: implications of the window of therapeutic opportunity. Stroke 1993;24:1212–1217.
Zhang RL, Zhang ZG, Chopp M. Increased therapeutic efficacy with rt-PA and anti-CD18 antibody treatment of stroke in the rat. Neurology 1999;52:273–279.
Tilley B, Marler J, Geller N, et al. for the NINDS rt-PA Stroke Trial Study Group. Use of a global test for multiple outcomes in stroke trials with application to the National Institute of Neurological Disorders and Stroke t-PA Trial. Stroke 1996;27:2136–2142.
Hosomi N, Lucero j, Heo JH, Koziol JA, Copeland BR, del Zoppo GJ. Rapid differential endogenous plasminogen activator expression after acute middle cerebral artery occlusion. Stroke 2001;32: 1341–1348.
Matsumoto K, Lo EH, Pierce AR, Halpern EF, Newcomb R. Secondary elevation of extracellular neurotransmitter amino acids in the reperfusion phase following focal cerebral ischemia. J Cereb Blood Flow Metab 1996; 16: 114–124.
Traystman RJ, Kirsch JR, Koehler RC. Oxygen radical mechanism of brain injury following ischemia and reperfusion. J Appl Physiol 1991;71:1185–1195.
Aronowski J, Strong R, Grotta J. Reperfusion injury: demonstration of brain damage produced by reperfusion after transient focal ischemia in rats. J Cereb Blood Flow Metab 1997;17: 1048–1056.
Uematsu D, Greenberg JH, Reivich M, Karp A. In vivo measurement of cytosolic free calcium during cerebral ischemia and reperfusion. Ann Neurol 1988;24:420–428.
Aronowski J, Strong R, Grotta JC. Combined neuroprotection and reperfusion therapy for stroke: the effect of lubeluzole and diaspirin crosslinked hemoglobin in experimental focal ischemia. Stroke 1996;27: 1571–1576.
Zivin JA, deGirolami U, Kochhar A, et al. A model for quantitative evaluation of embolic stroke therapy. Brain Res 1987;435:305–309.
Zivin JA, Mazzarella V. Tissue plasminogen activator plus glutamate antagonist improves outcome after embolic stroke. Arch Neurol 1991;48:1235–1238.
Bowes MP, Rothlein R, Fagan SC, et al. Monoclonal antibodies preventing leukocyte activation reduce experimental neurologic injury and enhance efficacy of thrombolytic therapy. Neurology 1995;45:815–819.
Grotta J. Combination therapy stroke trial: recombinant tissue-type plasminogen activator with/without lubeluzole. Cerebrovasc Dis 2001;12:258–263.
Lyden P, Jacoby M, Schim J, et al. The Clomethaizole Acute Stroke Study in tissue-type plasminogen activator-treated stroke (CLASS-T): final results. Neurology 2001;57(7): 1199–1205
Sacco RL, DeRosa JT, Haley C et al. for the GAIN Americas Investigators: Glycine antagonist in neuroprotection for patients with acute stroke: GAIN Americas: a randomized controlled trial. JAMA 2001;285: 1719–1728.
Aronowski JA, Strong R, Shrizadi A, Grotta JC. Ethanol plus caffeine (caffeinol) for treatment of ischemic stroke: preclinical experience. Stroke 2003; 34:1246–1251.
Piriyawat P, Labiche LA, Burgin WS, Aronowski JA, Grotta JC. A pilot dose-escalation study of caffeine plus ethanol (caffeinol)in acute ischemic stroke. Stroke 2003; 34:1242–1245.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Grotta, J.C., Labiche, L.A. (2005). Combination of Thrombolytic Therapy With Neuroprotectants. In: Lyden, P.D. (eds) Thrombolytic Therapy for Acute Stroke. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-933-8:77
Download citation
DOI: https://doi.org/10.1385/1-59259-933-8:77
Publisher Name: Humana Press
Print ISBN: 978-1-58829-398-5
Online ISBN: 978-1-59259-933-2
eBook Packages: MedicineMedicine (R0)