J Stroke.  2013 May;15(2):90-98. 10.5853/jos.2013.15.2.90.

Review of Stroke Thrombolytics

• Bivard A
• Lin L
• Parsonsb M

• KMID: 1824944
• DOI: http://doi.org/10.5853/jos.2013.15.2.90

Abstract

The cornerstone of acute ischemic stroke treatment relies on rapid clearance of an offending thrombus in the cerebrovascular system. There are various drugs and different methods of assessment to select patients more likely to respond to treatment. Current clinical guidelines recommend the administration of intravenous alteplase (following a brain noncontract CT to exclude hemorrhage) within 4.5 hours of stroke onset. Because of the short therapeutic time window, the risk of hemorrhage, and relatively limited efficacy of alteplase for large clot burden, research is ongoing to find more effective and safer reperfusion therapy, as well as focussing on refinement of patient selection for acute reperfusion treatment. Studies using advanced imaging (incorporating perfusion CT or diffusion/perfusion MRI) may allow us to use thrombolytics, or possibly endovascular therapy, in an extended time window. Recent clinical trials have suggested that Tenecteplase, used in conjunction with advanced imaging selection, resulted in more effective reperfusion than alteplase, which translated into increased clinical benefit. Studies using Desmoteplase have suggested its potential benefit in a sub-group of patients with large artery occlusion and salveageable tissue, in an extended time window. Other ways to improve acute reperfusion approaches are being actively explored, including endovascular therapy, and the enhancement of thrombolysis by ultrasound insonation of the clot (sono-thrombolysis).

Keyword

Ischemic stroke; Thrombolysis; Stroke trials

MeSH Terms

Arteries
Brain
Hemorrhage
Humans
Patient Selection
Perfusion
Plasminogen Activators
Reperfusion
Stroke
Thrombosis
Tissue Plasminogen Activator
Plasminogen Activators
Tissue Plasminogen Activator