Current Opinion


, Volume 72, Issue 14, pp 1833-1845

First online:

Thrombolytic Therapy for Acute Ischaemic Stroke

What Can We Do to Improve Outcomes?
  • Andrew M. DemchukAffiliated withCalgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary Email author 
  • , Simerpreet BalAffiliated withSection of Neurology, Department of Internal Medicine, Health Sciences Centre

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Constant efforts are being made in the stroke community to aim for maximum benefit from thrombolytic therapy since the approval of intravenous recombinant tissue plasminogen activator (rt-PA; alteplase) for the management of acute ischaemic stroke. However, fear of symptomatic haemorrhage secondary to thrombolytic therapy has been a major concern for treating physicians. Certain imaging and clinical variables may help guide the clinician towards better treatment decision making. Aggressive management of some predictive variables that have been shown to be surrogate outcome measures has been related to better clinical outcomes. Achieving faster, safer and complete recanalization with evolving endovascular techniques is routinely practiced to achieve better clinical outcomes. Selection of an ‘ideal candidate’ for thrombolysis can maximize functional outcomes in these patients. Although speed and safety are the key factors in acute management of stroke patients, there must also be a systematic and organized pattern to assist the stroke physician in making decisions to select the ‘ideal candidate’ for treatment to maximize results.