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Stroke Treatment Using Intravenous and Intra-Arterial Tissue Plasminogen Activator

  • Cerebrovascular Disease and Stroke (M Alberts and C Helgason, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Acute ischemic stroke is the most common cause of adult disability in the world and the third most common cause of death. Early restoration of perfusion to ischemic brain has been a highly successful strategy to decrease the disability associated with acute ischemic stroke. For acute stroke, intravenous (IV) tissue plasminogen activator (t-PA) is the only proven acute treatment that results in improved clinical outcomes. IV t-PA is indicated for ischemic stroke when administered within 4.5 h or less of symptom onset. This 4.5-hour treatment window represents a significant expansion from the previous 3-hour treatment window for therapy. Despite a longer time window, patients have the greatest chance for an improved outcome when treatment occurs as soon as possible from the time of symptom onset. The Emergency Department goal for treatment is a door to t-PA administration time of 60 min. In order to facilitate rapid evaluation and treatment, systems of care that streamline treatment should be developed at every institution that cares for acute ischemic stroke patients. For those with contraindications to t-PA and those outside the treatment window, catheter-directed intra-arterial (IA) t-PA administration or mechanical clot extraction is a potential means of restoring brain perfusion. These therapies should not preclude the use of IV t-PA when feasible and are frequently only available at tertiary care centers. Technological advances in IA devices for mechanical clot extraction make this a promising and growing area for advancing stroke therapy but remain under ongoing investigation to establish improved clinical outcomes.

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Disclosure

J. Miller: none. C. Harwell: none. C. Lewandowski has funding support through the NIH/NINDS for neurological emergencies research, grant 5U10NS058974.

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Authors and Affiliations

  1. Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, 48202, USA

    Joseph Miller MD, Christopher Hartwell MD & Christopher Lewandowski MD

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  1. Joseph Miller MD
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  2. Christopher Hartwell MD
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  3. Christopher Lewandowski MD
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Correspondence to Joseph Miller MD.

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Miller, J., Hartwell, C. & Lewandowski, C. Stroke Treatment Using Intravenous and Intra-Arterial Tissue Plasminogen Activator. Curr Treat Options Cardio Med 14, 273–283 (2012). https://doi.org/10.1007/s11936-012-0176-7

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  • DOI: https://doi.org/10.1007/s11936-012-0176-7

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