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Recent progress in drug treatment for acute ischemic stroke
1Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Cerebrovascular Diseases (Basel, Switzerland)
|March 13, 2001
Summary
Recent thrombolytic trials for acute stroke show mixed results, with alteplase (rt-PA) efficacy debated despite initial positive findings. New treatments like prourokinase and neuroprotective drugs are under investigation for acute ischemic stroke therapy.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- The 1995 NINDS trial of alteplase (rt-PA) for acute stroke sparked interest in thrombolysis.
- Clinical application of thrombolytic therapy remains controversial due to conflicting trial results.
Purpose of the Study:
- To review recent clinical trials on acute stroke therapies.
- To discuss the evolving landscape of thrombolysis, neuroprotection, and antithrombotic treatments for acute ischemic stroke.
Main Methods:
- Review of selected recent clinical trials focusing on acute stroke therapy.
- Analysis of data from studies including NINDS, ECASS II, ATLANTIS, STARS, Cleveland, and PROACT II.
Main Results:
- Alteplase (rt-PA) efficacy in acute stroke treatment is debated, with recent studies yielding disappointing or controversial results.
- Intra-arterial prourokinase showed benefit in PROACT II for middle cerebral artery occlusion.
- Neuroprotection and antithrombotic agents (e.g., abciximab) are areas of ongoing research.
Conclusions:
- The definitive role of alteplase (rt-PA) in acute stroke remains under discussion.
- Emerging therapies like prourokinase and novel neuroprotective/antithrombotic drugs offer potential advancements in acute ischemic stroke management.