title: Reperfusion therapy in acute cerebrovascular syndrome.
abstract: OBJECTIVE
  Modern reperfusion therapy in acute ischemic stroke therapy is based on an 'as fast as possible' recanalization approach to obtain favorable clinical outcomes. However, arterial recanalization may be achieved without favorable clinical outcome, raising the question of the target population to be treated. We outline key issues that underline acute revascularization therapies.
  
  
  RESULTS
  Intravenous (i.v.) thrombolysis remains the gold standard with the benefit of speed but lower recanalization rates of large artery occlusions as compared with intra-arterial routes. Conversely, intra-arterial therapies report higher recanalization rates, but are hampered by procedural delays and risks. Higher rates of recanalization in intra-arterial studies using clot-removal devices have not translated into improved patient functional outcome as compared with i.v. thrombolysis trials. Combined i.v.-intra-arterial therapy hold great promise with both the advantages of i.v. and intra-arterial routes.
  
  
  CONCLUSIONS
  Endovascular therapy is potentially superior to i.v. tissue-type plasminogen activator with the development of new devices, which are now available, but none has been evaluated vs. i.v. thrombolysis. Future developments may include combined strategies or a 'pure' mechanical approach. The critical issue is time-to-reperfusion based on a brain imaging showing salvageable brain tissue with a reduced risk of adverse events associated with reperfusion. Current brain imaging techniques are probably not good enough to discriminate salvageable brain, and parenchymal lesion that may suffer from reperfusion injury.
authors.affiliation: Neurology and Stroke Departments, Paris 7 Denis Diderot University, Unité INSERM 698: Recherche Clinique en Athérothrombose, Groupe Hospitalier Bichat Claude Bernard, Paris, France. mikael.mazighi@bch.aphp.fr
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D002545:Brain Ischemia / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000628:therapy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome