Safety and Effect of Continuous Intravenous Urokinase Therapy in Acute Ischemic Stroke ( Open Clinical Trial )

BACKGROUND: Early thrombolysis with intra-arterial urokinase(UK) or intravenous(IV) t-PA may be beneficial for patients with acute ischemic stroke, but this therapy is unavailable in some circumstances and cannot be applied in the cases of late admission. Thus, continuous IV UK infusion has been applied empirically in many hospitals of our country. However, the therapeutic efficacy of this therapy is not known yet. In this study, we investigated the safety and the clinical effect of continuous IV UK infusion. METHOD: 68 patients with acute supratentorial ischemic stroke within 3 days of onset received 6 x 105units of UK daily by continuous infusion for 5 days without loading dose. We estimated European stroke scale (ESS) and Barthel index score (BIS) prior to therapy, on day 1, 3 and 7 after the start of UK, and on the day of discharge. RESULTS: The ESS and BIS were improved in most patients after the therapy. There are no differences in therapeutic effects among the various stroke subtypes and the starting times of therapy after onset. Out of 10 TIA patients, 9 patients did not undergo further TIA and only one patient had complete infarction during UK infusion. Complications were noted in 7(10.3%) patients. But these complications were all minimal. CONCLUSION: As this study was just an open clinical trial, we could not conclude about definite efficacy of continuous IV UK infusion in acute ischemic stroke. However, this therapy might be at least acceptable safe regimen and deserves to be performed in multicenter double-blind controlled trials to clarify the efficacy.

Clinical Significance of Mixed Stroke: in non-Embolic Ischemic Stroke

BACKGROUND & OBJECTIVES: After introduction of MRI with excellent capability of diagnosis In intracerebral hemorrhage (ICH), old ICH is more readily detected in patients with ischemic stroke. However, very few studies have addressed the identification of clinical significance of mixed stroke. The aims of the study are to elucidate the incidence and the location of the coexisting ICH in non-embolic ischemic stroke. Also we tried to seek the difference of the vascular risk factors between ischemic strokes combined with and without ICH. MEHTODS: Having 222 patients with non-embolic ischemic stroke as subjects, we reviewed the clinical data and MRIs of them retrospectively. We have defined mixed stroke as ischemic stroke combined with MR evidence of coexisting old ICH. The diagnosis of old ICH was made on the basis of the following findings; T2 weighted image showing a low signal intensity lesion with or without a hyperintesity area within it, and Tl weighted image revealing a low intensity lesion in the corresponding area. The frequency of vascular risk factors in the patients with mixed stroke was compared to that of those with pure ischemic stroke. RESULTS: MRI examinations showed old coexisting ICH in 10.4% (23) of 222 non-embolic ischemic stroke patients. Of 23 patients, nineteen patients had old ICH associated with multiple lacunar infarction and others were cortical infarction. The anatomic distribution of the hemorrhage was as follows; basal ganglia and internal capsule 19(78.3%), thalamus 3(13.1%), corona radiata 1 (4.3%), cerebellum 1 (4.3%). Analyzing the vascular risk factors, no significant difference was noted between lacunar infarctions and mixed stroke. CONCLUSION: The results of the study support that lacunar infarction and hypertensive ICH are bases on similar vascular pathophysiology. Therefore, old intracerebral hemorrhage may have a similar significance as a risk factor like previous ischemic stroke and inadvertent anti-thrombotic therapy might be avoided in certain stroke subtypes, which must be defined in future study.