Available treatments for stroke

The medicines used for the treatment of ischemic stroke at the moment are alteplase, aspirin, heparin and other anticoagulants and mechanical thrombectomy.

Thrombolysis medication, recombinant tissue plasminogen activators(rt-PA), such as alteplase, work by binding to the fibrin rich clots via the fibronectin finger-like domain and the Kringle 2 domain. Plasminogen is the inactive precursor of plasmin and is activated by rt-PA. The protease domain in rt-PA then cleaves the Arg561 - Val562 peptide bond in plasminogen to form plasmin. Plasmin is a serine protease and can cleave the haemostatic clot, consisting of polymerized fibrin and platelets by proteolytic digestion. Therefore, rt-PA mediates recanalization of the congested vessels. Yet, not all patients are suitable for thrombolysis treatment, as it can cause an increase in cerebral haemorrhage.

Thrombectomy is the surgical removal of the blood clot, mechanically recanalising the obstructed vessels. It can be proximal and distal. In proximal thrombectomy manual suction is performed by placing an aspiration catheter at the proximal surface of the thrombus. Manual aspiration is then applied and the aspiration catheter is retrieved under constant negative pressure. Distal thrombectomy is more challenging technically. To deliver the device distally to the thrombus, a microcatheter is passed at the occlusion site. To avoid thromboembolic problems, placing a balloon guide catheter in the cervical internal cerebral artery and aspiration during device retrieval is recommended for most devices. Several distal thrombectomy devices have been introduced into clinical practice, such as Merci, Catch, BALT. (Mordasini et al., 2012)

Дата добавления: 2015-08-18