title: Update on the effects of treatment with recombinant tissue-type plasminogen activator (rt-PA) in acute ischemic stroke.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) represents a major cause of death and disability all over the world. The recommended therapy aims at dissolving the clot to re-establish quickly the blood flow to the brain and reduce neuronal injury. Intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) is clinically used with this goal.
  
  
  METHODS
  A description of beneficial and detrimental effects of rt-PA treatment is addressed. An overview of new therapies against AIS, such as new thrombolytics, sonolysis and sonothrombolysis, endovascular procedures, and association therapies is provided. Updates on the pathophysiological process leading to intracranial hemorrhage (ICH) is also discussed.
  
  
  CONCLUSIONS
  rt-PA treatment in AIS patients is beneficial to recovery outcomes. To weaken risks and improve benefits, it might be relevant to consider: i) a definitive identification of risk factors for symptomatic ICH; ii). a better organization of the health care system to reduce time-to-treatment and enhance discharge management. The pharmacological improvement of new thrombolytic drugs (such as tenecteplase and desmoteplase) targeting harmful and maximally exploiting beneficial effects might further reduce mortality and disability in AIS.
authors.affiliation: a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.|b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonaventura
authors.affiliation: a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.|b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy.|c Centre of Excellence for Biomedical Research (CEBR) , University of Genoa , Genoa , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.|b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Dallegri
keywords: Alteplase; endovascular therapy; hemorrhage; inflammation; metalloproteinases; neutrophils; penumbral imaging; tissue plasminogen activator