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Fibrinolytic therapy in acute stroke.

Authors
  • Millán, Mònica1
  • Dorado, Laura
  • Dávalos, Antoni
  • 1 Stroke Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Spain. , (Spain)
Type
Published Article
Journal
Current cardiology reviews
Publication Date
August 2010
Volume
6
Issue
3
Pages
218–226
Identifiers
DOI: 10.2174/157340310791658758
PMID: 21804781
Source
Medline
Keywords
License
Unknown

Abstract

Acute ischemic stroke is a major cause of morbidity and mortality in Europe, North America, and Asia. Its treatment has completely changed over the past decade with different interventional approaches, such as intravenous trials, intra-arterial trials, combined intravenous/intra-arterial trials, and newer devices to mechanically remove the clot from intracranial arteries. Intravenous thrombolysis with tissue plaminogen activator (tPA) within 4.5 hours of symptoms onset significantly improved clinical outcomes in patients with acute ischemic stroke. Pharmacological intra-arterial thrombolysis has been shown effective until 6 hours after middle cerebral artery occlusion and offers a higher rate of recanalization compared with intravenous thrombolysis, whereas combined intravenous/ intra-arterial thrombolysis seems to be as safe as isolated intravenous thrombolysis. The more recent advances in reperfusion therapies have been done in mechanical embolus disruption or removal. Merci Retriever and Penumbra System have been approved for clot removal in brain arteries, but not as a therapeutic modality for acute ischemic stroke since it is no clear whether mechanical thrombectomy improves clinical outcome in acute stroke. However, mechanical devices are being used in clinical practice for patients who are ineligible for tPA or who have failed to respond to intravenous tPA. We summarize the results of the major thrombolytic trials and the latest neurointerventional approaches to ischemic stroke.

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