Tissue-type plasminogen activator (t-PA), purified from the culture fluid of a stable human melanoma cell line, is a serine protease, different from urokinase, with a molecular weight of about 70,000. It is composed of one polypeptide chain, which is converted to a two-chain molecule by limited plasmic action. Activation of plasminogen to plasmin occurs by cleavage of the Arg 560-Val 561 peptid...

Arterial thrombosis and thrombus extension involve the overlapping systems of endothelial cell reactivity, platelet function, and coagulation. Thrombotic cerebrovascular occlusions arise secondary to thromboembolism from more proximal sites, e.g., the heart and proximal internal carotid artery, or from in situ thrombosis. Thrombus generation and extension involve thrombin-mediated fibrin format...

In contrast to myocardial infarction, stroke is a heterogeneous disease with multiple different causes. Determination of stroke mechanism is critical to choosing optimal therapy to prevent recurrence. This article reviews the diagnostic approach to stroke and prognostic and treatment implications of specific stroke mechanisms. Data on the role of antiplatelet and anticoagulant therapy in second...

The honorable editor-in-chief of the Journal of ARYA We read with interest the article of Dr. Maleki that has recently been published.1 We conducted a similar study in Birjand Vali-e-Asr Hospital in 20092010. This study was done on 125 patients with STEMI with a mean age of 59.2 ± 11.9 years. In this study, 65.6% of patients underwent thrombolytic therapy. This showed a crucial increase compare...

BACKGROUND AND PURPOSE It has been shown that thrombolytic therapy can improve clinical outcome in a subgroup of patients with acute cerebral ischemia. This subgroup was characterized by certain clinical and imaging findings (eg, moderate to severe neurological deficit for less than 3 to 6 hours, occlusion of the middle cerebral artery, lack of extended infarct signs on CT, and efficient leptom...

This study focuses on clinical effect of alteplase in the treatment acute cerebral infarction. 100 cases patients with infarction admitted to our hospital during 2014-2015 were randomly selected as objects and divided into groups according different therapeutic methods, 50 observation group control respectively. The received conventional non thrombolytic therapy. On this basis, therapy alteplas...

Pearls 1. Patient workup and evaluation is key to a successful intervention while limiting complications. In addition to physical exam and laboratory evaluation, review of prior imaging studies and surgical interventions is important to understanding the etiology of the occlusion and to guide therapy. 2. Use of arterial thrombolysis should be avoided in patients with evidence of irreversible li...

In the absence of significant symptoms and signs the diagnosis of pulmonary embolism remains difficult. Sensitivity and specificity of laboratory tests, chest x-ray, ECG, echocardiography and venous studies on their own is low. Ventilation-perfusion scanning establishes or excludes the diagnosis only in those patients with "high-probability" or "normal" scanning results. The diagnosis of pulmon...

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by ...

Several studies since 1998 have shown the efficacy of catheter-directed thrombolytic therapy with reteplase. Reteplase is a plasminogen activator that penetrates the thrombus and causes lysis. This catheter-directed approach has been used to treat both arterial and venous occlusions, with a success rate of 72% to 88%. The most serious complication associated with thrombolytic therapy is intracr...