Hemorrhagic Transformation of Cerebral Infarction – Possible Mechanisms

Gerhard F. Hamann; Gregory J. del Zoppo; Rüdiger von Kummer

doi:10.1055/s-0037-1615562

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1999; 82(S 01): 92-94
DOI: 10.1055/s-0037-1615562

Commentaries

Schattauer GmbH

Hemorrhagic Transformation of Cerebral Infarction – Possible Mechanisms

Gerhard F. Hamann

³From the Department of Neurology, Ludwig-Maximilians University, Klinikum Großhadern, Munich, Germany

,

Gregory J. del Zoppo

¹Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, Ca, USA

,

Rüdiger von Kummer

²Department of Neuroradiology, Technische Universität Dresden, Dresden, Germany

› Author Affiliations

Abstract

Summary

To analyse the risk/benefit of cerebral thrombolysis the role of hemorrhagic transformation, either as clinically silent hemorrhagic infarction or disastreous parenchymal hemorrhage, is crucial. Thrombolysis in acute ischemic stroke increases the risk of severe, life-threatening hemorrhagic complications by up to 10 times compared to controls. In this paper, previous proposed concepts for the development of intracerebral hemorrhage and hemorrhagic transformation are presented. The role of the cerebral microvasculature will be emphasized. In experimental focal cerebral ischemia a significant loss of basal lamina components of the cerebral microvessels has been demonstrated. This loss in vessel wall integrity is associated with the development of petechial hemorrhage. The mechanisms for this microvascular damage may include plasmin-generated laminin degradation, matrix metalloproteinases activation, transmigration of leukocytes through the vessel wall, and other processes. We propose that attenuation of the microvascular integrity loss with subsequent reduction in hemorrhage is theoretically possible 1) by an improvement in the definition of an individual time window of therapy (by means of imaging techniques), 2) by a biochemical quantification of the basal lamina damage to avoid dangerous interventions, and 3) by pharmacological strategies to protect the basal lamina during thrombolysis.

Key words

Hemorrhagic transformation - intracerebral hemorrhage - cerebral infarction - thrombolysis - microvasculature

Full Text

References

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