Ultrasound Enhanced Thrombolysis: Applications in Acute Cerebral Ischemia

Intravenous tissue plasminogen activator (TPA) improves patient chances to recover from stroke by inducing mostly partial recanalization of large intracranial thrombi. TPA activity can be enhanced with ultrasound including 2 MHz transcranial Doppler (TCD). TCD identifies residual blood flow signals around thrombi, and, by delivering mechanical pressure waves, exposes more thrombus surface to circulating TPA. The international multi-center CLOTBUST trial showed that ultrasound enhances thrombolytic activity of a drug in humans thereby confirming multi-disciplinary experimental research conducted worldwide for the past 30 years

Lysophosphatidic acid LPA1 and LPA3 receptors play roles in the maintenance of late tissue plasminogen activator-induced central poststroke pain in mice

We developed a mouse model for central post-stroke pain (CPSP), a centrally-originated neuropathic pain (NeuP). In this mode, mice were first injected with Rose Bengal, followed by photo-irradiation of left middlecerebral artery (MCA) to generate thrombosis. Although the MCA thrombosis was soon dissolved, the reducedblood flow remained for more than 24 h due to subsequent occlusion of microvessels. This photochemicallyinduced thrombosis (PIT) model showed a hypersensitivity to the electrical stimulation of both sides of paw, butdid not show any abnormal pain in popular thermal or mechanical nociception tests. When tissue-type plas-minogen activator (tPA) was injected 6h after the PIT stress, tPA-dependent hypersensitivity to the electricalpaw stimulation and stable thermal and mechanical hyperalgesia on both sides for more than 17 or 18 days afterthe PIT treatment. These hyperalgesic effects were abolished in lysophosphatidic acid receptor 1 (LPA1)- andlysophosphatidic acid receptor 3 (LPA3)-deficient mice. When Ki-16425, an LPA1and LPA3antagonist wastreated twice daily for 6days consecutively, the thermal and mechanical hyperalgesia at day 17 and 18 weresignificantly reversed. The liquid chromatography?mass spectrometry (LC?MS/MS) analysis revealed that thereis a significant increase in several species of LPA molecules in somatosensory S-I and medial dorsal thalamus (MD), but not in striatum or ventroposterior thalamus. All these results suggest that LPA1and LPA3signalingplay key roles in the development and maintenance of CPSP

Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation