Systemic thrombolytic therapy of acute ischemic stroke with rtPA

Systemic thrombolysis with recombinant tissue plasminogen activator is the first therapy proven to be effective in acute ischemic stroke. Nevertheless, its efficacy and feasibility are still a matter of debate. Much of this debate derives from uncertainties regarding patient eligibility and problems implementing this effective, but potentially harmful therapeutic approach into daily stroke care. Whether a patient with acute ischemic stroke will receive thrombolytic treatment depends on several factors and prerequisites, of which time and expertise are most important. This review is focused on what is known and what remains to be understood in order to integrate thrombolysis into the routine treatment of a disease, which ranks third in mortality and first in acquired disability among adults in Western countries.