History of Intra-arterial Thrombolysis

Abstract

Timely recanalization of the occluded vessels may restore cerebral perfusion of still-salvageable, infarcted brain tissue, thereby possibly improving clinical outcome in patients with acute ischemic stroke (AIS). The administration of intravenous recombinant tissue plasminogen activator (IV rt-PA) within 4.5 h of symptom onset is the only US Food and Drug Administration-approved medical treatment in AIS. However, most patients with AIS present more than the time window for IV rt-PA. In addition, IV rt-PA often fails to recanalize large proximal arteries. Therefore, the numerous recanalization therapies for AIS patients have been developed substantially over the past decades, which include the use of intra-arterial fibrinolysis, the bridging of intravenous with intra-arterial thrombolysis, and the use of multimodal approaches to recanalization therapy including thrombectomy and thromboaspiration with different available devices. In this chapter, we outlined the brief history of endovascular stroke management.