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Thrombolytic therapy for acute ischemic stroke.

Jaishri O Blakeley1, Rafael H Llinas

  • 1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Journal of the Neurological Sciences
|July 10, 2007
PubMed
Summary
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Acute stroke treatment advanced significantly following the first positive trial of intravenous thrombolysis. New therapies and devices aim to improve outcomes and extend treatment windows for ischemic stroke patients.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Emergency Medicine

Background:

  • The landscape of acute stroke treatment has been revolutionized by landmark trials, notably the National Institute of Neurological Disorders and Stroke (NINDS) trial for intravenous recombinant tissue plasminogen activator (IV rt-PA).
  • This pivotal trial demonstrated the feasibility of acute stroke intervention, triggering rapid advancements in treatment modalities.
  • The NINDS trial marked a turning point, establishing a positive outcome for early intervention in acute ischemic stroke.

Purpose of the Study:

  • To provide a comprehensive review of thrombolysis trials in acute ischemic stroke.
  • To detail the inclusion and exclusion criteria for both intravenous and intra-arterial pharmacologic and mechanical thrombolysis.
  • To discuss emerging pharmacotherapies and mechanical devices for stroke treatment.

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Main Methods:

  • Review of pivotal thrombolysis trials in acute ischemic stroke.
  • Analysis of patient selection criteria for various thrombolytic interventions.
  • Examination of novel therapeutic agents and mechanical devices.

Main Results:

  • The NINDS trial established IV rt-PA as a feasible and effective treatment for acute ischemic stroke.
  • Significant expansion in acute treatment options has occurred post-NINDS trial.
  • Ongoing research focuses on expanding treatment windows and enhancing thrombolysis safety and efficacy.

Conclusions:

  • Acute ischemic stroke treatment has evolved dramatically, driven by positive thrombolysis trials.
  • Current research aims to broaden therapeutic options and improve patient outcomes.
  • Future advancements in pharmacotherapy and mechanical devices hold promise for safer and more effective stroke interventions.