Reocclusion and Hemorrhagic Transformation following Thrombolytic Therapy

J Korean Neurol Assoc > Volume 23(3); 2005 > Article

Journal of the Korean Neurological Association 2005;23(3): 295-302.

혈전용해술 후 재폐색과 뇌출혈

이종윤, 남효석 허지회

연세대학교 의과대학 신경과학교실, 뇌연구소

Reocclusion and Hemorrhagic Transformation following Thrombolytic Therapy

Jong Yun Lee

Department of Neurology, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea

Abstract

In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion to ischemic but still viable brain areas and to promote recovery of function. However, reocclusion and hemorrhagic transformation may occur after thrombolysis and these are major factors of no-improvement or deterioration despite the initial successful recanalization. Reocclusion occurs frequently during or immediately after successful recanalization, often silently. In the case of reocclusion, initial platelet-fibrin thrombi are converted into platelet-rich thrombi by platelet-mediated thrombotic mechanisms. Therefore, if can be effectively resolved by use of the platelet membrane glycoprotein Iib/IIIa receptor inhibitors such as abciximab. Hemorrhagic transformation (HT) is a well-known factor limiting the use of thrombolytics and negating the effect of the treatment. Recent studies demonstrate that loss of integrity of the blood-brain barrier in association with active proteolytic degradation of vascular extracellular matrix is a key molecular pathway leading to HT. Therapeutic strategies to prevent reocclusion and HT by use of agents that act against these mechanisms before or during thrombolysis are warranted to enhance the efficacy of reperfusion therapy in stroke. KeyWords:Thrombolytic therapy, Reocclusion, Hemorrhagic transformation, Cerebral infarction