title: [Thrombolytic treatment of acute stroke].
abstract: Ischemic stroke is a medical emergency and must be treated as quickly as possible according to the "time-is-brain" concept. At present, intravenous administration of recombinant tissue plasminogen activator (rt-PA) within the first 4.5 h from stroke onset is the only effective treatment but is currently still only approved within the first 3 h from onset of symptoms (0.9 mg/kg body weight, maximum dose 90 mg, 10% of the cumulative dose as bolus, remaining 90% subsequently infused within 60 min). The therapeutic effect of magnetic resonance imaging (MRI) based thrombolytic therapy beyond the 4.5 h time window remains to be proven. Proximal occlusions of the middle cerebral artery can be treated successfully within the first 6 h from stroke onset by catheter-based intra-arterial administration of plasminogen activator leading to a significant improvement of outcome. Acute basilar artery occlusion should be treated in specialized centres using intra-arterial application of urokinase, rt-PA or mechanical recanalization but intravenous thrombolysis beyond the 3 h window is an acceptable alternative.
authors.affiliation: Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg. Hemasse.Amiri@med.uni-heidelberg.de
authors.forename: H
authors.initials: H
authors.lastname: Amiri
authors.forename: W
authors.initials: W
authors.lastname: Hacke
authors.forename: J
authors.initials: J
authors.lastname: Bösel
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods*; D019396:Tissue Polypeptide Antigen / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D019396:Tissue Polypeptide Antigen