[Thrombolytic therapy of cerebrovascular disorders]

To analyze the available scientific evidence regarding treatment with thrombolytic agents in patients with cerebrovascular disease and present this in the context of daily practice.

Publication of the NINDS study of treatment with t-PA for acute cerebral ischemia led to approval of this treatment for cerebrovascular disease. However, this therapy is associated with a significant frequency of hemorrhagic complications. We analyzed the most relevant studies on the use of thrombolytic drugs. The results of their intravenous and intra-arterial administration were compared with regard to the frequency of recanalization and hemorrhagic complications. We evaluated the results of physician's surveys on the use of t-PA since publication of the NINDS study. These results are interpreted in the context of the potentially generalized use of this treatment.

Although in the NINDS study, administration of i.v. t-PA within three hours of an arterial occlusion resulted in a lower frequency of disability at three months, these results cannot be extrapolated to all medical settings. Until there is a more precise definition of the type of thrombolytic agent, dosage, route of administration, therapeutic window and concomitant use of other drugs, thrombolytic agents should preferably be used in centres specialized in the treatment of cerebrovascular disorders.