title: Ischemic stroke--novel therapeutic strategies.
abstract: OBJECTIVE
  Treatment of acute, ischemic stroke has changed markedly during the last two decades. We review existing data for optimizing modern stroke care.
  
  
  RESULTS
  Implementation of stroke units, giving systematic treatment and observation to stroke patients, has lead to a significant reduction in death and dependency. Introduction of intravenous rt-PA (IVT) within 3 h for selected stroke patients and recent extension of the time window to 4.5 h improved the outcome even further. Still, one must consider that IVT has several limitations, such as a narrow time window and several contraindications, and the effect is modest, particularly in strokes with a large vessel occlusion. Recanalization of the occluded vessel is a major predictor for good outcome and should be set as a goal. Intra-arterial rt-PA (IAT) and the concept of bridging therapy (IVT prior to IAT or thrombectomy with a mechanical device) may improve recanalization rates and outcome. Randomized controlled trials (RCT) are available for IAT, but not for thrombectomy with devices, and we mostly have retrospective non-controlled data. The Merci- and Penumbra system are the most studied devices, for which recent studies report acceptable safety and efficacy.
  
  
  CONCLUSIONS
  Sufficiently powered RCTs to evaluate the effect of thrombectomy with mechanical devices are warranted, but as the natural course of a large vessel stroke carries a devastating prognosis, a proactive recanalization approach is justified based on today's knowledge.
authors.affiliation: Department of Neurology, Stavanger University Hospital, Stavanger, Norway. elfa@sus.no
authors.forename: E
authors.initials: E
authors.lastname: Farbu
authors.forename: K D
authors.initials: KD
authors.lastname: Kurz
authors.forename: M W
authors.initials: MW
authors.lastname: Kurz
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator