CURRENT REPERFUSION THERAPY POSSIBILITIES IN MYOCARDIAL INFARCTION AND ISCHEMIC STROKE

Myocardial infarction and ischemic stroke remain to be of the greatest medical and social importance because of their high prevalence, disability, and mortality rates. Intractable thrombotic occlusion of the respective artery leads to the formation of an ischemic lesion focus in the tissue of the heart or brain. Emergency reperfusion serves to decrease a necrotic focus, makes its formation reversible, and reduces patient death rates. The paper considers main reperfusion therapy lines: medical (with thrombolytic drugs) and mechanical (with primary interventions) one and their combination in treating patients with acute myocardial and cerebral ischemia. Each reperfusion procedure is discussed in view of its advantages, disadvantages, available guidelines, and possibilities of real clinical practice. Tenecteplase is assessed in terms of its efficacy, safety, and capacities for bolus administration, which allows its use at any hospital and at the pre-hospital stage. Prehospital thrombolysis permits reperfusion therapy to bring much closer to the patient and therefore aids in reducing time to reperfusion and in salvaging as much the myocardial volume as possible. The rapidest recovery of myocardial and cerebral perfusion results in a decreased necrotic area and both improved immediate and late prognosis. The results of randomized clinical trials studying the possibilities of the medical and mechanical methods to restore blood flow are analyzed in the context of evidence-based medicine. The reason why despite the available contraindications, limited efficiency, and the risk of hemorrhagic complications, thrombolytic therapy remains the method of choice for prehospital reperfusion, an alternative to primary percutaneous coronary intervention (PCI) if it cannot be carried out in patients with myocardial infarction at the stated time, and the only treatment ischemic stroke treatment that has proven its efficiency and safety in clinical trials is under discussion. The benefits of a novel pharmacoinvasive approach to treating patients with acute coronary syndrome, as well as possible promises for its use to manage patients with ischemic stroke are depicted. The main results of a large STREAM trial, showing that early prehospital thrombolysis in conjunction with tenecteplase administration and subsequent PCI enables effective myocardial reperfusion in patients with ECG ST-segment elevation acute coronary syndrome within 3 hours after the occurrence of the first symptoms of the disease and in the absence of a chance of doing primary PCI within one hour after the first medical contact, are given and discussed. Reperfusion therapy for ischemic stroke now implies the preference of systemic thrombolytic therapy with recombinant tissue plasminogen activator. The established inadequate efficiency and safety of this technique lend impetus to a search for new approaches and novel fibrinolytic agents. Tenecteplase is a probable alternative to alteplase in treating patients with ischemic stroke. 

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