title: Reperfusion therapies for acute ischemic stroke: an update.
abstract: Acute ischemic stroke is a major cause of morbidity and mortality in developed countries. Intravenous thrombolysis with tissue plasminogen activator (tPA) within 4.5 hours of symptoms onset significantly improves clinical outcomes in patients with acute ischemic stroke. This narrow window for treatment leads to a small proportion of eligible patients to be treated. Intravenous or intra-arterial trials, combined intravenous/intra-arterial trials, and newer devices to mechanically remove the clot from intracranial arteries have been investigated or are currently being explored to increase patient eligibility and to improve arterial recanalization and clinical outcome. New retrievable stent-based devices offer higher revascularization rates with shorter time to recanalization and are now generally preferred to first generation thrombectomy devices such as Merci Retriever or Penumbra System. These devices have been shown to be effective for opening up occluded vessels in the brain but its efficacy for improving outcomes in patients with acute stroke has not yet been demonstrated in a randomized clinical trial. We summarize the results of the major systemic thrombolytic trials and the latest trials employing different endovascular approaches to ischemic stroke.
authors.forename: Laura
authors.initials: L
authors.lastname: Dorado
authors.forename: Mònica
authors.initials: M
authors.lastname: Millán
authors.affiliation: Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain. mmillan.germanstrias@gencat.cat.
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
mesh_terms: D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D004867:Equipment Design; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D015424:Reperfusion / Q000379:methods; D015607:Stents; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator