Advances in revascularization for acute ischemic stroke treatment.
Intravenous thrombolysis with recombinant tissue plasminogen activator is the established treatment for acute ischemic stroke patients presenting within 3 h after stroke onset. In a significant number of patients, however, intravenous thrombolysis with recombinant tissue plasminogen activator remains ineffective. New thrombolytic agents, such as reteplase, tenecteplase or desmoteplase, offer pharmacokinetic and dynamic advantages over recombinant tissue plasminogen activator and have been or are currently being tested for safety and efficacy in clinical trials. Endovascular revascularization is an evolving treatment option enabling mechanical clot disruption or extraction in combination with thrombolysis. Several new endovascular devices have been successfully tested for safety in acute ischemic stroke patients and are now being tested for efficacy in larger clinical trials. Continued innovation and refinement of endovascular technology and techniques is expected to increase technical success with a minimal procedure-related morbidity in the treatment of acute ischemic stroke.
Schumacher
H Christian
HC
Doris and Stanley Tananbaum Stroke Center, Neurological Institute, New York-Presbyterian Hospital, College of Physicians & Surgeons, Columbia University, 710 West 168th Street, Box 163, NY 10032, USA. hs775@columbia.edu
Gupta
Rishi
R
Higashida
Randall T
RT
Meyers
Philip M
PM
D002548:Cerebral Revascularization / Q000379:methods*; D005104:Expert Testimony; D005343:Fibrinolytic Agents / Q000145:classification / Q000627:therapeutic use; D006801:Humans; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000037:antagonists & inhibitors; D010980:Platelet Membrane Glycoproteins / Q000037:antagonists & inhibitors; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D019038:Platelet Glycoprotein GPIb-IX Complex; D010980:Platelet Membrane Glycoproteins; C032193:glycoprotein receptor GPIb-IX