Adjunctive and alternative approaches to current reperfusion therapy.
OBJECTIVE
Current ischemic stroke reperfusion therapy consists of intravenous thrombolysis given in eligible patients after review of a noncontrast CT scan and a time-based window of opportunity. Rapid clot lysis has a strong association with clinical improvement but remains incomplete in many patients. This review appraises novel adjunctive or alternative approaches to current reperfusion strategies being tested in all trial phases.  Summary of Review- Alternative approaches to current reperfusion therapy can be separated into 4 main categories: (1) combinatory approaches with other drugs or devices; (2) novel systemic thrombolytic agents; (3) endovascular medical or mechanical reperfusion treatments; and (4) noninvasive or minimally invasive methods to augment cerebral blood flow and alleviate intracranial blood flow steal.


CONCLUSIONS
Reperfusion treatments must be provided as fast as possible in patients most likely to benefit. Patients who fail to rapidly reperfuse may benefit from other strategies that maintain collateral flow or protect tissue at risk.
Department of Neurology, Program, The University of Texas–Houston Medical School, Houston, TX, USA. andrew.d.barreto@uth.tmc.edu
Andrew D
AD
Barreto
Andrei V
AV
Alexandrov
D001241:Aspirin / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D057510:Endovascular Procedures; D005340:Fibrinogen / Q000037:antagonists & inhibitors; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D013917:Thrombin / Q000037:antagonists & inhibitors; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D014464:Ultrasonic Therapy
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D005340:Fibrinogen; D013917:Thrombin; D001241:Aspirin