title: Medical therapy for ischemic stroke: review of intravenous and intra-arterial treatment options.
abstract: BACKGROUND
  Thrombolytic therapy is of proven and substantial benefit for select patients with acute cerebral ischemia. Diagnostic options and medical treatment options for acute stroke ischemia have undergone enormous changes in the past decades. Whereas initially stroke treatment was reduced to prevention, management of symptoms, and rehabilitation, nowadays a multitude of different fibrinolytic drugs are available. The wide availability of computed tomography in the late 1980s made thrombolysis a real therapeutic option because it allowed a fast and accurate differentiation between ischemic and hemorrhagic stroke.
  
  
  METHODS
  This study reviews these developments and how they have shaped our current use and understanding of thrombolytics in the treatment of acute ischemic stroke.
  
  
  RESULTS
  Patient selection remains a central aspect of thrombolytic treatment, and to date, the use of different fibrinolytics has been studied in over 20 large randomized trials for different clinical settings, time windows, and routes of administration. These studies included over 7000 patients, and led to our current understanding of the use of thrombolysis in acute stroke.
  
  
  CONCLUSIONS
  Intravenous fibrinolytic therapy within the first 3 hours of ischemic stroke onset offers substantial benefits for virtually all patients with potentially disabling deficits. In the 3- to 4.5-hour treatment window, intravenous fibrinolytic therapy has been shown to offer moderate net benefits when applied to all patients with potentially disabling deficits. Intra-arterial fibrinolytic therapy in the 3- to 6-hour window offers moderate net benefits when applied to all patients with potentially disabling deficits and large-artery cerebral thrombotic occlusions.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Taussky
authors.forename: Rabih G
authors.initials: RG
authors.lastname: Tawk
authors.forename: Wilson P
authors.initials: WP
authors.lastname: Daugherty
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator