title: [Intravenous thrombolysis for acute ischemic stroke: past, present and future].
abstract: The efficacy of intravenous thrombolysis using alteplase, a recombinant tissue plasminogen activator (IV t-PA) within a 4.5-hour time window for acute ischemic stroke patients has been well established. However, a tight time window allows a minority of stroke patients to receive IV t-PA, and low recanalization rates of large intracranial artery occlusions limit the efficacy of IV t-PA. To overcome the limitations of IV t-PA, clinical trials regarding IV t-PA based on DWI-PWI mismatch or DWI-FLAIR mismatch, next-generation agents of t-PA, dose modification of alteplase, sonothrombolysis, and so on are going on worldwide. Shortening of the time of door to treatment (needle or femoral puncture) plays a very important role to enhance the efficacy of acute reperfusion therapy including IV t-PA and acute stroke endovascular therapy, and as a consequence, it could contribute to improve the entire stroke outcomes due to an increase of acute reperfusion therapy-eligible patients.
authors: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center.
authors: Mikito
authors: M
authors: Hayakawa
mesh_terms: D057510:Endovascular Procedures; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D007262:Infusions, Intravenous; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000639:trends; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D010959:Tissue Plasminogen Activator