Safer thrombolysis for acute ischemic stroke

The most effective treatment for acute ischemic stroke is early reperfusion therapy to salvage the ischemic penumbrae, the functionally impaired yet still viable brain tissue, thereby improving clinical outcome. IV recombinant tissue plasminogen activator (rt-PA) administered within 3 hours of symptom onset remains the only Food and Drug Administration–approved therapy proven to improve clinical outcome in acute ischemic stroke.¹ The most serious risk of rt-PA treatment is the occurrence of a large intracerebral hemorrhage (ICH) causing severe neurologic deterioration.² In The National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial, symptomatic ICH occurred in 6.4% of rt-PA-treated patients.¹ However, many patients do not have their final outcome altered as a result of ICH: for every 100 patients treated with rt-PA, across all levels of final disability, approximately 32 benefit and 3 are harmed.³ Novel strategies of reperfusion are being pursued to improve efficacy by increasing the likelihood of benefit vs harm.

The outcome of an acute stroke is affected by time-linked complex interactions between the site of arterial occlusion, recanalization, …