Pharmacological recanalization therapy in acute ischemic stroke – Evolution, current state and perspectives of intravenous and intra-arterial thrombolysis - 31/01/15

Doi : 10.1016/j.neurad.2014.11.004

Martin Hlavica ^a, Michael Diepers ^a, Carlos Garcia-Esperon ^b, Benjamin Victor Ineichen ^c, Krassen Nedeltchev ^b, Timo Kahles ^b,^{^{1
Doctors Remonda and Kahles are joint senior authors.}}, Luca Remonda ^a,^{^{1
Doctors Remonda and Kahles are joint senior authors.},}^⁎
^a Department of Neuroradiology, Kantonsspital of Aarau, Aarau, Switzerland
^b Department of Neurology, Kantonsspital of Aarau, Aarau, Switzerland
^c Brain Research Institute, University of Zurich and Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland

^⁎Corresponding author. Department of Neuroradiology, Kantonsspital of Aarau, Tellstrasse, 5001 Aarau, Switzerland. Tel.: +41 62 838 5252; fax: +41 62 838 5247.

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Summary

Stroke ranges third in mortality in industrialized nations and is the leading cause of disability in older people. Ischemic stroke following thrombotic or embolic vessel occlusion accounts for more than 80% of cerebrovascular events. Immediate restoration of cerebral blood flow is crucial in order to salvage brain tissue. Experimental thrombolytic treatment was introduced into the clinical setting in the late 1950s and required more than 30 years of intense research till its breakthrough and subsequent routine clinical use by the presentation of the NINDS trial results in 1995. To date, intravenous thrombolysis with tissue plasminogen activator up to 4.5h after symptom onset is the only proven reperfusion therapy for acute ischemic stroke. In this review, we summarize the evolution of intravenous and intra-arterial pharmacological recanalization therapies in acute ischemic stroke and present current clinical practice as well as its promising perspectives.

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Keywords : Acute ischemic stroke, rtPA, Alteplase, Thrombolysis, Intravenous, Intra-arterial

Abbreviations : ACA, AHA, BA, BI, CT, ECASS, EMA, FDA, GOS, i.a., ICA, ICH, i.v., MRI, NNT, MCA, mRS, NIHSS, NINDS, OR, r-pro-UK, RCT, rtPA, sICH, SITS-ISTR, UK, SK, vs.