Thrombolysis in the Treatment of Acute Ischemic Stroke

Unfortunately, intravenous alteplase, when administered within 3 hours of symptom onset, remains the only US Food and Drug Administration-approved treatment for acute ischemic stroke; it is now 7 years since its approval. Intra-arterial thrombolysis of middle cerebral and basilar artery occlusions within 6 hours of stroke onset probably is efficacious also, but the clinical trial evidence supporting this claim is less robust. The whole field of acute stroke intervention is in urgent need of more randomized, controlled clinical trials to advance management. There are several promising avenues of investigation, but clinicians must remain cautious and skeptical until convincing proof of the added benefit of new interventions is obtained.