[Treatment of acute ischaemic stroke via the venous and arterial routes].
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the standard therapy for acute ischaemic stroke in the first 4.5 hours after onset of neurological symptoms. The efficacy of IVT increases strongly the sooner it is initiated after onset of neurological symptoms. Intra-arterial thrombolysis (IAT) and mechanical thrombectomy are potentially valuable treatment options in patients with severe ischemic stroke caused by an occlusion in a proximal cerebral artery. Further research is needed to evaluate the safety and efficacy of IAT and mechanical thrombectomy a) compared with IVT within 4.5 hours of symptom onset, b) outside the time window for IVT, c) when there are contraindications for IVT, d) when IVT fails to achieve recanalisation and e) in patients with basilar artery thrombosis. The results of ongoing trials are required to make a decision on the exact indication for IAT and mechanical thrombectomy. These treatments should therefore only be given in specialised centres, preferably in a research setting.
Schonewille
Wouter J
WJ
St. Antonius Ziekenhuis, Nieuwegein, Afd. Neurologie, the Netherlands. w.schonewille@antonius.net
van Dijk
Ewoud J
EJ
Vos
Jan Albert
JA
Boiten
Jelis
J
Dippel
Diederik W
DW
Reekers
Jim A
JA
Kappelle
L Jaap
LJ
D000208:Acute Disease; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator