Progressive ischaemic stroke: the difficulty in choosing antithrombotic therapy

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Progressive ischaemic stroke is a clinical form of unfavourable progression of an acute cerebrovascular accident, found in around 20% of cases during the acute period. The strategy and approach to managing patients with an apparent deterioration during the acute period of stroke have not been fully established. Various types of antithrombotic therapy are discussed in the literature, with the use of antiplatelet drugs considered the most promising.

The authors analyse all types of antithrombotic therapy for progressive ischaemic stroke and examine in detail the only known case of late thrombolysis, which was performed in 1968.

About the authors

Evgenii A. Shirokov

S.M. Kirov Military Medical Academy (Moscow branch)

Author for correspondence.
Russian Federation, Moscow

Nikita V. Lomakin

Central Clinical Hospital, Presidential Affairs Department

Russian Federation, Moscow

Luydmila I. Buryachkovskaya

National Medical Cardiology Center

Russian Federation, Moscow


  1. Chimowitz M.I. The Feinberg award lecture 2013: treatment of intracranial atherosclerosis: leaning from the past and planning for the future. Stroke 2013; 44: 2664–2669. doi: 10.1161/STROKEAHA.113.001290. PMID: 23821232.
  2. Amarenco P., Lavallee P.C., Tavares L.M. et al. Five-year risk of stroke af- ter TIA or minor ischemic stroke. N Engl J Med 2018; 378: 2182–2190. doi: 10.1056/NEJMoa1802712. PMID: 29766771.
  3. Yang W., Wong K., Chen X. Intracranial atherosclerosis: from microscopy to high-resolution Magnetic Resonance Imaging. J Stroke 2017; 19: 249–260. doi: 10.5853/jos.2016.01956. PMID: 28877564.
  4. Kernan W.N., Obliagele B., Black H.R. et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for health- care professionals from the American Heart Association/American Stroke Asso- ciation. Stroke 2014; 45: 2160–2236. doi: 10.1161/STR.0000000000000024. PMID: 24788967.
  5. Powers W.J., Rabinstein A.A., Ackerson T. et al. Guidelines for the early man- agement of patients with acute ischemic stroke: a guideline for healthcare pro- fessionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110. DOI: 10.1161/ STR.0000000000000158. PMID: 29367334.
  6. Campbell B.C.V., Meretoja A., Donnan G.A., Davis S.M. Twenty-year his- tory of the evolution of stroke thrombolysis with intravenous alteplase to reduce long-term disability. Stroke 2015; 46: 2341–2346. doi: 10.1161/STROKEA- HA.114.007564. PMID: 26152294.
  7. Muruet W., Rudd A., Wolfe C.D.A., Douiri A. Long-term survival after in- travenous thrombolysis for ischemic stroke. A propensity score-matched co- hort with up to 10-year follow-up. Stroke 2018; 49: 607–613. DOI: 10.1161/ STROKEAHA.117.019889. PMID: 29440582.
  8. Ali L.K., Saver J.L. The ischemic stroke patient who worsens: new assessment and management approaches. Rev Neurol Dis 2007; 4: 85–91. PMID: 17609640.
  9. Lesser T., Venth S., Lesser K. Progressive stroke in cases of common carotid occlusion — indication for revascularization. Zentralbl Chir 2008; 133: 374–375. doi: 10.1055/s-2008-1076905. PMID: 18702024.
  10. Birschel P., Ellul J., Barer D. Progressing stroke: towards an internationally agreed definition. Cerebrovasc Dis 2004; 17: 242–252. doi: 10.1159/000076161. PMID: 14718754.
  11. Emberson J., Lees K.R., Lyden P. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384: 1929–1935. doi: 10.1016/S0140-6736(14)60584-5. PMID: 25106063.
  12. Fiehler J., Cognard C., Gallitelli M. et al. European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS). Int J Stroke 2016; 11: 701–716. doi: 10.1177/1747493016647735. PMID: 27462090.
  13. Nakase T., Sasaki M., Ikeda Y., Suzuki A. Progressing small vessel pontine infarction includes different etiologies. Ann Clin Transl Neurol 2014; 1: 75–79. doi: 10.1002/acn3.25. PMID: 25356386.
  14. Cho Y.J., Koo J.S., Park J.M. et al. Factors associated with stroke progression in acute cerebral infarction. Int J Stroke 2008; 3: 405.
  15. Castillo J., Noya M. Mechanisms of progression of cerebral infarction. Neu- rologia 1999; 14: 2–12. PMID: 10379155.
  16. Milstone H. A factor in human normal blood which participates in strepto- coccal fibrinolysis. J Immunology 1941; 42: 109–115.
  17. Kline D.L. The purification and crystallization of plasminogen (profibrino- lysin). J Biol Chem 1953; 204: 949–955. PMID: 13117872.
  18. Sussman B.J., Fitch T.S. Thrombolysis with fibrinolysin in cere- bral arterial occlusion. JAMA 1958; 167: 1705–1709. DOI: 10.1001/ jama.1958.02990310011002. PMID: 13563167.
  19. Meyer J.S., Gilroy J., Barnhart M.I., Johnson J.F. Anticoagulants plus strep- tokinase therapy in progressive stroke. JAMA 1964; 189: 373. DOI: 10.1001/ jama.1964.03070050039011. PMID: 14163124.
  20. Schefer D.G., Chorjakov G.I. [The first experience of using fibrinolysin in an ambulance]. Vsesoyuznyy simpozium “Preduprezhdeniye i lecheniye mozgovykh insul’tov” Moscow, 1965: 34–35. (In Russ.)
  21. Chazov E.I., Andreyenko G.V. [The first experience of thrombosis therapy with domestic fibrinolysin]. Kardiologiya 1962; 4: 59–64. (In Russ.)
  22. Andreyenko G.V. [Fibrinolysis]. Moscow, 1967. 248 p. (In Russ.)
  23. Mustard J.F., Murphy E.A., Downie H.G., Rowsell H.C. Heparin and thrombus formation: early suppression and late enhancement. Brit J Haematol 1963; 9: 548–551. doi: 10.1111/j.1365-2141.1963.tb05479.x. PMID: 14076136.
  24. Kudrjashov B.A. [Biological problems of regulation of the liquid state of blood and its coagulation]. Moscow, 1975. 488 p. (In Russ.)
  25. Rödén-Jüllig A., Britton M. Effectiveness of heparin treatment for progress- ing ischemic stroke: before and after study. J Intern Med 2000; 248: 287–291. doi: 10.1046/j.1365-2796.2000.00727.x. PMID: 11086638.
  26. Ma H., Campbell H., Parsons M. et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med 2019; 380: 1795–1803. doi: 10.1056/NEJMoa1813046. PMID: 31067369.
  27. Kate M., Wannamaker R., Kamble H. et al. Penumbral imaging-based thrombolysis with tenecteplase is feasible up to 24 hours after symptom onset. J Stroke 2018; 20: 122–130. doi: 10.5853/jos.2017.00178. PMID: 29402060.
  28. Hart R.G., Sharma M., Mundl H. et al. Rivaroxaban for stroke prevention af- ter embolic stroke of undetermined source. N Engl J Med 2018; 378: 2191–2201. doi: 10.1056/NEJMoa1802686. PMID: 29766772.
  29. Berberich A., Schneider C., Reiff T. et al. Dual antiplatelet therapy improves functional outcome in patients with progressive lacunar strokes. Stroke 2019; 50: 1007–1009. doi: 10.1161/STROKEAHA.118.023789. PMID: 30841818.

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Copyright (c) 2020 Shirokov E.A., Lomakin N.V., Buryachkovskaya L.I.

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