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On the threshold of an exciting new era for acute stroke diagnosis
and treatment, the Third International Symposium on Thrombolytic
Therapy in Acute Ischemic Stroke was held in Nara, Japan, in April
1994. The symposium brought together some 200 basic and clinical
scientists for presentations and discussions of issues vital to the
understanding of thrombolytic therapy. This volume compiles the
major presentations of the symposium, with attention to
applications of new diagnostic measures such as diffusion and
perfusion MRI, contrast-enhanced transcranial Doppler and
angioscopy. Other presentations examine the mechanisms of
ischemia/reperfusion injury, hemorrhagic transformation, and
reocclusion, with reviews of recent developments in thrombolytic
agents. The proceedings of the symposium will be of special
interest to researchers, physicians, and students in the fields of
neurology, neurosurgery, and nuclear medicine, as well as those in
pharmacology, critical care medicine, and related fields.
Over the last decade, interest in treatment of ischemic stroke has
increased significantly. Perhaps the single most important feature
of attempts to improve the outcome of stroke patients has been that
the interventions be applied within the very early hours of stroke
symptoms. This has spawned efforts to understand the vascular and
neuronal responses to cerebral artery reperfusion experimentally.
Important prospective clinical studies of thrombolysis in acute
ischemic stroke have been completed, and large placebo-controlled,
symptom-based studies are now underway worldwide. Here, we consider
the central features of those studies, their experimental basis,
and the future importance of adjunctive therapies to recanalization
in focal brain ischemia acutely. Risks and benefits are discussed.
This collection benefits from the opinions of experts and workers
in this rapidly evolving and exciting field.
During the last decade scientists in both basic and clinical
research have renew ed their interest in the potential role of
thrombolytic therapy in the treatment of acute ischemic stroke. The
reevaluation of this approach was kindled by our growing knowledge
of the pathogenesis of thrombotic and embolic stroke and by the
development of new thrombolytic agents. With no proven therapy for
acute ischemic stroke available, the potential value of early
pharmacologic recanalization of occluded vessels in the management
of acute stroke patients - an approach that has been supported by
animal experiments and a limited number of uncontrolled clinical
pilot studies - is again under scrutiny. A sym posium on
"Thrombolysis in Acute Cerebral Ischemia" was held in Heidel berg,
Germany, in May 1990 to summarize and discuss the
pathophysiological background for thrombolysis in acute ischemic
stroke and the recent ex perimental and clinical experience with
the new generation of thrombolytic agents. The editors are
fortunate to be able to include authoritative manuscripts from
almost all the speakers at the symposium. These include reports of
work by the most active investigators in this challenging field.
The editors wish to express their gratitude to all the contributors
for the additional work they have undertaken. Additionally, we
would like to thank Springer-Verlag, Heidelberg, for its generous
assistance in the preparation and rapid publication of this volume.
Heidelberg, August 1990 WERNER HACKE GREGORY J. DEL ZopPO MATTHIAS
HIRSCHBERG Contents I."
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