Therapy for early reperfusion after stroke.
Ischemic stroke is a leading cause of death and disability in the Western world. At present, intravenous administration of tissue plasminogen activator within 3 h of symptom onset is the only proven effective treatment to re-establish cerebral blood flow in the case of acute vessel occlusion. Unfortunately, few patients presenting with acute ischemic stroke qualify for intravenous tissue plasminogen activator therapy. The focus of current research is, therefore, to find new treatment options by which to obtain early reperfusion, and to extend the therapeutic window for intervention beyond 3 h. The purpose of this Review is to provide an integrated view of the current state of reperfusion therapy in patients with acute stroke, including pharmacologic agents and the methods of delivery. The focus will be on intravenous and intra-arterial use of plasminogen activators in acute supratentorial infarction. Other therapies, such as antiplatelet agents (i.e. glycoprotein IIb/IIIa inhibitors), and anticoagulant drugs will be discussed briefly.
Juttler
Eric
E
Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. eric.juettler@med.uni-heidelberg.de
Kohrmann
Martin
M
Schellinger
Peter D
PD
D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D038524:Diffusion Magnetic Resonance Imaging; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017128:Embolectomy / Q000379:methods; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D015424:Reperfusion / Q000379:methods; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D001241:Aspirin; C067551:saruplase