Thrombolytic Treatment of Acute Stroke

For the patients suffering from acute ischemic infarct from abrupt occlusion of vessels, prompt reperfusion is necessary to save the ischemic penumbra, eventually leading to a good prognosis. Regarding this, intravenous (IV) recombinant tissue plasminogen activator (rt-PA) thrombolysis as a reperfusion therapy is the only approved method. The IV rt-PA therapy gives us a clinical benefit of 30% or more likelihood of favorable outcome compared to the placebo. However, there is about 6% symptomatic intracranial hemorrhagic risk. Therefore, prudent decision-making by selecting of indicated patients is the role of neurologists. Besides intravenous rt-PA thrombolysis, application of intra-arterial therapy or bridging concept of intra-arterial combined with IV rt-PA is promising. They showed better recanalization rate than that of IV therapy according to the controlled studies. Although the clinical evidence is lacking, they have been performed occasionally in well-facilitated institutions. The results of ongoing trials to support the clinical benefit of these active therapies are expected. In this article, we reviewed the major clinical trials for thrombolytic treatment of acute ischemic stroke and various trials which are under investigation for the extension of the time window for thrombolysis.