State-of-the-art reperfusion strategies for acute ischemic stroke.
Timely recanalization of the occluded artery is the only effective treatment for acute ischemic stroke. Intravenous tissue plasminogen activator (i.v. tPA), administered within 3 hours of symptom onset, is the only United States Food and Drug Administration-approved treatment. This short window often precludes effective intervention, and i.v. tPA often fails to recanalize major and mid-sized arteries. Intra-arterial thrombolysis has been used for decades, but its safety and effectiveness in cerebrovascular occlusions is also limited. Recently, new mechanical neuroendovascular devices have shown high recanalization rates with acceptable safety in early studies. Multi-modal reperfusion therapy (MMRT)--including intra-arterial infusion of thrombolytics and/or antiplatelet agents, mechanical clot disruption and retrieval, and balloon angioplasty with stent placement--is the prevailing concept for the management of major acute stroke. Recent results suggest that MMRT results in higher chances for both recanalization of the occluded artery and reperfusion of the ischemic tissue.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Hadassah Medical Organization, Kiryat Hadassah, P.O. Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
José E
JE
Cohen
Eyal
E
Itshayek
Samuel
S
Moskovici
John M
JM
Gomori
Shifra
S
Fraifeld
Roni
R
Eichel
Ronen R
RR
Leker
D000800:Angioplasty, Balloon / Q000379:methods*; D002986:Clinical Trials as Topic; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*
D005343:Fibrinolytic Agents