Intravenous thrombolysis for acute ischemic stroke

LI Xiao-gang

Abstract：Reperfusion therapies (thrombolysis, mechanical thrombectomy, or stenting, etc.) for acute ischemic stroke are the most effective therapy. Reperfusion therapy may limit ischemic tissue enlargement,leading to a reduced infarct size and favorable clinical outcome by restoring the blood flow before the salvageable penumbra became the progress of ischernic brain infarction, intravenous (Ⅳ) recombinant tissue plasminogen activator (rt-PA) therapy is the only proven effective treatment of acute ischemic stroke. Although thrombolytic therapy has matured,but the standard intravenous thrombolytic therapy (nonenhanced computed tomography (CT)-guided, 3 h time window,the intravenous injection of tPA) have many restrictions, including a short therapeutic time window, recanalization rate was only 50 %, and the major dangers of symptomatic hemorrhagic transformation. As a result,currently in clinical practice, only a minority of patients (usually 1% to 3%) received thrombolytic therapy. So there are some issues still need to be further explored, such as the expansion of thrombolytic time window,a new thrombolytic drugs are used for more than 3h incidence of acute ischemic stroke patients, the evaluation of new eperfusion methods (in particular, multi-modal imaging technology), intravenous, and intra-arterial thrombolysis combined pplication of thrombolytic therapy, and new anti-platelet drug combination,and the application of mechanical devices or by transcranial Doppler ultrasound to promote the role of thrombolytic drugs.