Regional Incomplete Ischaemia

The doses of prostacyclin used both by Hallenbeck and colleagues and Awad and colleagues are approximately 20 times the level that could be tolerated by awake humans without side-effects. Gryglewski et al. (1983) have recently reported the effects of prostacyclin in 10 patients admitted between 1 and 5 days after the onset of symptoms from carotid or intracranial artery occlusion. A dose of 2.5 to 5 ng/kg min i.v. was given in 6-hour courses (4-10) over 1 to 2.5 days. The authors describe a dramatic regression of neurological symptoms 6 patients were left without any deficit, 3 with minor residual deficit, and 1 patient died. 

Martin et al. (1985) have completed a double-blind controlled trial of intermittent infusions of prostacyclin (5 ng/kg-min for 6 hours—infusions over 65 hours) in 32 patients with acute cerebral infarction. There were no significant differences in neurological score or disability status between the two groups. Neither of these contradictory studies is of sufficient size to be statistically capable of revealing anything but the grossest difference. 

Tamura et al. (1979) have found that an imidazole derivative (Y9179) reduced the size of cerebral infarction produced by unilateral MCA occlusion in the cat, as determined at one week. However, in another study 

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This ACS with regional involvement is usually secondary to an incomplete coronary artery occlusion in patients frequently presenting with prior predominantly regional subendocardial ischaemia and single- or multivessel disease, but one culprit artery. Any coronary artery may be the culprit one and the occlusion often is not proximal (Table 8.2). 

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