Recent advances in thrombolysis of acute ischemic stroke

ABSTRACT

Among the many advances in acute ischemic stroke (AIS) management, thrombolysis with intravenous (IV) tissue plasminogen activator (tPA) within 3 hours after symptom onset has been the only approved pharmacological therapy in AIS. However, IV administration of tPA has many limitations in clinical practice, and the proportion of eligible patients remains quite low. Many clinical trials have attempted to overcome this by increasing the therapeutic time window and enhancing the efficacy of reperfusion by the intra-arterial (IA) approach with novel mechanical devices. In addition, the application of new thrombolytic agents and identification of suitable thrombolytic candidates by multimodal brain imaging is another field of active research in thrombolytic therapy. We reviewed AIS management, focusing on thrombolysis with IV therapy, IA therapy, and IV-IA bridging therapy.