THE EFFICACY OF MAGNESIUM SULFATE BEFORE DELAYED THROMBOLYTIC TREATMENT IN EXPERIMENTAL MODEL OF ISCHEMIA REPERFUSION

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OBJECTIVE: The primary treatment of ischemic stroke is recanalization of occluded vascular structure. The treatment for that is tissue plasminogen activator (tPA). Since the indication period is limited to the first 4.5 hours, the majority of patients can not reach this intravenous treatment. Therefore an experimental study was planned to evaluate the efficacy of magnesium sulfate (MgSO_4) before delayed thrombolytic therapy. MATERIAL AND METHODS: 52 rats were randomly divided to six groups. Group 1 was the control group and no operation was performed. Group 2 was sham group and paratracheal muscles were dissected and carotid artery was reached. In group 3, carotid artery was occluded and tPA was started after 345 minutes. In group 4, tPA was started after 345 minutes and MgSO_4 was started after 120 minutes. In group 5, MgSO_4 was started after 300 minutes and tPA was started after 345 minutes. In group 6, MgSO_4 was started after 120 and 300 minutes; After 345 minutes, tPA was started. All groups were reperfused after 360 minutes. After 24 hours, neurological examinations of all rats were performed. Blood and brain tissue specimens were taken. Neuron specific enolase (NSE) and ischemia modified albumin (IMA) were analyzed from blood. Brain tissue was stained with Hematoxylin Eosin and cresyl violet. Degenerated pyramidal neurons were evaluated. RESULTS: The mortality rate was 40% in group 3, 22.2% in group 4, 30% in group 5 and 11.11% in group 6. Mortality reduction was detected 17.8% for group 4, 10% for group 5 and 28.9% for group 6. Functional disability and percentage of degenerated neurons was the least in group 6 (p=0.04). Decreased NSE level was associated with functional improvement and treatment efficacy (p=0.005; r=0.54). Functional disability correlated with increasing of IMA level (p=0.003; r=0.47). But there was no difference in IMA levels among MgSO_4-treated groups (p=0.06). CONCLUSIONS: Early onset and repetetive dose MgSO_4 have the best functional and histopathologic results in delayed thrombolytic treatment. NSE is a biomarker that is associated with treatment efficacy and disability.

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Reperfusion injury , Intravenous thrombolysis , Magnesium sulfate

Kocatepe Medical Journal

270

Kocatepe Medical Journal