Skip to main content
Log in

Current and Future Use of Intravenous Thrombolysis for Acute Ischemic Stroke

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Stroke is a common and disabling condition. Intravenous tissue plasminogen activator (tPA) administered within 3 h of symptom onset is the standard therapy for eligible patients with acute ischemic stroke. Unfortunately, because of the time limitation, very few patients with ischemic stroke actually receive this treatment. In order to increase the number of patients who may benefit from acute treatment, recent research has focused on expanding the time window for thrombolysis and improving its efficacy to ultimately improve patient outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995, 333:1581–1587.

    Article  Google Scholar 

  2. •• Adams HP, del Zoppo G, Alberts MJ, et al.; American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: Guidelines for the early management of adults with ischemic stroke. Stroke 2007, 38:1655–1711. This is a comprehensive review of AHA-recommended treatment for patients with acute ischemic stroke.

    Article  PubMed  Google Scholar 

  3. Smith EE, Abdullah AR, Petkovska I, et al.: Poor outcomes in patients who do not receive intravenous tissue plasminogen activator because of mild or improving ischemic stroke. Stroke 2005, 36:2497–2499.

    Article  CAS  PubMed  Google Scholar 

  4. • Wahlgren N, Ahmed N, Davalos A, et al.: Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007, 369:275–282. This study provides safety data from a registry of patients treated in the community with IV tPA.

    Article  CAS  PubMed  Google Scholar 

  5. Arora S, Broderick JP, Frankel M, et al.: Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke 2005, 36:1232–1240.

    Article  PubMed  Google Scholar 

  6. Hacke W, Donnan G, Fieschi C, et al. : Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004, 363:768–774.

    Article  PubMed  Google Scholar 

  7. •• Hacke W, Kast M, Bluhmki E, et al.: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008, 359:1317–1329. This randomized clinical trial of IV tPA in patients 3 to 4.5 hours after acute ischemic stroke onset showed safety and efficacy of treatment.

    Article  CAS  PubMed  Google Scholar 

  8. Saver JL, Gornbein J, Grotta J, et al.: Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3 to 4.5 h window : Joint outcome table analysis of the ECASS 3 trial. Stroke 2009, 40:2433–2437.

    Article  CAS  PubMed  Google Scholar 

  9. •• del Zoppo G, Saver JL, Jauch EC, Adams HP: Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a Science Advisory from the American Heart Association/American Stroke Association. Stroke 2009, 40:2945–2948. The AHA recommends expanding the IV tPA window based on recent studies but includes new exclusion criteria for the expanded window.

    Article  PubMed  Google Scholar 

  10. Albers G for the DEFUSE Investigators: Magnetic resonance imaging profiles predict clinical response to early reperfusion: the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke (DEFUSE) Study. Ann Neurol 2006, 60:508–517.

  11. Davis S for the EPITHET Investigators: Effect of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008, 7:299–309.

    Article  PubMed  Google Scholar 

  12. Flint A, Duckwiler GR, Budzik RF, et al.; MERCI and Multi MERCI Writing Committee: Mechanical thrombectomy of intracranial internal carotid occlusion: pooled results of the MERCI and Multi MERCI Part I trials. Multi MERCI Writing Committee. Stroke 2007, 38:1274.

    Article  PubMed  Google Scholar 

  13. Furlan A, Higashida R, Wechsler L, et al.: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA 1999, 282:2003–2011.

    Article  CAS  PubMed  Google Scholar 

  14. Alexandrov AV for the CLOTBUST Investigators: Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004, 351:2170–2178.

    Article  CAS  PubMed  Google Scholar 

  15. Molina CA, Barreto AD, Tsivgoulis G, et al.: Transcranial ultrasound in clinical sonothrombolysis (TUCSON) trial. Ann Neurol 2009, 66:28–38.

    Article  CAS  PubMed  Google Scholar 

  16. Ogawa A for the MELT Japan Study Group: The local randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: Middle Cerebral Artery Embolism Fibrinolytic Intervention Trial (MELT) Japan. Stroke 2007, 38:2633–2639.

    Article  CAS  PubMed  Google Scholar 

  17. The Penumbra Pivotal Stroke Trial Investigators: Safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease: the Penumbra Pivotal Stroke trial. Stroke 2009, 40:2761–2768.

    Article  Google Scholar 

  18. Smith WS for the Multi MERCI Investigators: Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, Part 1. Am J Neuroradiol 2006, 27:1177–1182.

    CAS  PubMed  Google Scholar 

  19. The IMS II Trial Investigators: The Interventional Management of Stroke (IMS) II study. Stroke 2007, 38:2127–2135.

    Article  Google Scholar 

  20. Pancioli AM, Broderick J, Brott T, et al.: The combined approach to lysis utilizing eptifibatide and rtPA in acute ischemic stroke: the CLEAR stroke trial. Stroke 2008, 39:3268–3276.

    Article  CAS  PubMed  Google Scholar 

  21. Meyer BC, Raman R, Hemmen T, et al.: Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 2008, 7:787–795.

    Article  CAS  PubMed  Google Scholar 

  22. Audebert HJ, Kukla C, von Claranau SC, et al.: Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke 2005, 36:287–291.

    Article  CAS  PubMed  Google Scholar 

  23. Pervez MA, Silva G, Masrur S, et al.: Remote supervision of IV tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 2010, 41:e18–e24.

    Article  PubMed  Google Scholar 

  24. Schwamm LH, Audebert H, Amarenco P, et al.: Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke 2009, 40:2635–2660.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ji Y. Chong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elijovich, L., Chong, J.Y. Current and Future Use of Intravenous Thrombolysis for Acute Ischemic Stroke. Curr Atheroscler Rep 12, 316–321 (2010). https://doi.org/10.1007/s11883-010-0121-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-010-0121-8

Keywords

Navigation