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(Circulation. 1996;93:1604.)
© 1996 American Heart Association, Inc.

Articles

New Treatments for Acute Ischemic Stroke

James J. Ferguson, MD

From the Texas Heart Institute, Houston.

Correspondence to James J. Ferguson, MD, Clinical Cardiology Research, Texas Heart Institute, 6720 Bertner, Box 20345, Houston, TX 77030.

	Introduction

 
Two recently published studies have investigated new modalities for the treatment of acute ischemic stroke.

The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group¹ recently reported the results of a randomized, double-blind trial of intravenous recombinant tissue plasminogen activator (TPA) for acute ischemic stroke. There were two parts to the overall study; a total of 624 patients were randomized in both parts. To qualify for inclusion in either of the two parts, patients had to (1) have had an ischemic stroke with a clearly defined time of onset; (2) have a deficit that was measurable according to the National Institutes of Health Stroke Scale (NIHSS), a 42-point serial measure of neurological deficit; and (3) have a baseline computed tomographic brain scan that showed no evidence of intracranial hemorrhage. Patients had to have treatment with study drug initiated within 3 hours of symptom onset. Exclusion criteria included another stroke or head trauma within the past 3 months, major surgery within the past 2 weeks, any history of intracranial hemorrhage, blood pressure either >185 mm Hg systolic or >110 mm Hg diastolic, rapidly improving or minor symptoms, symptoms suggestive of subarachnoid hemorrhage, and seizures at the onset of stroke. Other exclusion criteria included a recent history of gastrointestinal or genitourinary bleeding. Recombinant TPA was administered intravenously; the dose was 0.9 mg/kg (up to a maximum of 90 mg). Ten percent of the drug was given as a bolus, followed by a 60-minute infusion of the remaining 90% of the . . . [Full Text of this Article]