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New insights on thrombolytic treatment of acute ischemic stroke

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Abstract

In 1995, a two-part randomized trial showed the efficacy of intravenous tissue plasminogen activator (tPA) when given within 3 hours of onset of symptoms of acute ischemic stroke. Two subsequent trials were unable to extend the therapeutic window of intravenous tPA beyond 3 hours. A phase IV study performed by experienced stroke centers showed an acceptably low symptomatic intracerebral hemorrhage rate for intravenous tPA of only 3%, whereas a review of the Cleveland area experience showed a disturbingly high rate of symptomatic intracerebral hemorrhage of 15.7%. The Prolyse in Acute Cerebral Thromboembolism (PROACT) II study showed efficacy of intra-arterial pro-urokinase and intravenous heparin over intravenous heparin alone when given within 6 hours of onset of symptoms to patients with thrombotic occlusion of the proximal middle cerebral artery. Additional controlled investigations of intra-arterial thrombolytic therapy are needed. Neuroprotectants in combination with intravenous tPA have yet to show improved efficacy over the use of tPA alone.

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  1. Department of Neurology, Mayo Clinic, 4500 San Pablo Road, 32224, Jacksonville, FL, USA

    James F. Meschia MD & Thomas G. Brott MD

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  1. James F. Meschia MD
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  2. Thomas G. Brott MD
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Meschia, J.F., Brott, T.G. New insights on thrombolytic treatment of acute ischemic stroke. Curr Neurol Neurosci Rep 1, 19–25 (2001). https://doi.org/10.1007/s11910-001-0073-z

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