[The future perspective of acute thrombolytic therapy for acute ischemic stroke]

Intravenous (IV) thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) is the evidence-based treatment for acute ischemic stroke patients, and its position as the standard therapy remains unchanged even though newer clinical evidences of the endovascular therapies emerged. In Japan, IV rt-PA was approved in 2005. One of the problems is the limited therapeutic time range, but it was extended from 3 hours to 4.5 hours after stroke onset in 2012 based on the pooled-data analysis of the major clinical trials. There are also candidates for IV rt-PA therapy among the wake-up and unclear-onset stroke patients. The next challenge is to identify the appropriate thrombolytic targets using the penumbral imaging techniques. The optimal strategies might be established by the ongoing clinical trials in the future.