Thrombolysis for acute ischemic stroke: future directions.
Intravenous tissue plasminogen activator remains the standard for treating acute ischemic stroke. Citicoline, dizocilpine, nimodipine, tirilizad, and other agents have been tested with thrombolytics in preclinical trials with mixed but encouraging results. Lessons from prior failed attempts to develop neuroprotectives as monotherapies should be applied to the development of combination therapies. In the future, there will be efforts to improve reperfusion rates without increasing intracranial hemorrhage rates. In addition to studying intra-arterial thrombolysis, there is a need for further testing of newer fibrinolytics and combination antithrombotics. Advancements in neuroimaging also will allow more tailored use of thrombolytic therapy.
Meschia
James F
JF
Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA. meschia.james@mayo.edu
Brott
Thomas G
TG