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Advances in Acute Ischemic Stroke Therapy.

Yunyun Xiong1,2, Ajay K Wakhloo3, Marc Fisher4

  • 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.X.).

Circulation Research
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Summary

Advanced acute ischemic stroke treatments include thrombolysis with alteplase or tenecteplase and mechanical thrombectomy up to 24 hours. Further research into cytoprotective therapies is warranted.

Keywords:
cytoprotectionischemic strokereperfusiontenecteplasethrombectomy

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Cardiovascular Research

Background:

  • Acute ischemic stroke treatment is evolving.
  • Intravenous thrombolysis with alteplase is the standard care.
  • Advanced imaging aids in selecting patients for later thrombolysis.

Purpose of the Study:

  • To review current and emerging treatments for acute ischemic stroke.
  • To evaluate the efficacy of tenecteplase as an alternative thrombolytic.
  • To discuss the expanding role of mechanical thrombectomy and potential of cytoprotection.

Main Methods:

  • Review of recent clinical studies and evidence.
  • Analysis of data on alteplase, tenecteplase, and mechanical thrombectomy.
  • Discussion of ongoing research in stroke treatment.

Main Results:

  • Tenecteplase shows comparable or superior efficacy to alteplase, especially for large vessel clots.
  • Mechanical thrombectomy is effective up to 24 hours in selected patients with large vessel occlusions.
  • Cytoprotective therapies have not yet proven effective but warrant further investigation.

Conclusions:

  • Mechanical thrombectomy's window is expanding, with ongoing trials for broader patient groups.
  • Tenecteplase presents a promising alternative thrombolytic agent.
  • Revisiting cytoprotection as an adjunct to reperfusion therapy is suggested.