Abstract
Appropriate acute treatment with plasminogen activators (PAs) can significantly increase
the probability of minimal or no disability in selected ischemic stroke patients.
There is a great deal of evidence showing that intravenous recombinant tissue PAs
(rt-PA) infusion accomplishes this goal, recanalization with other PAs has also been
demonstrated in the development of this treatment. Recanalization of symptomatic,
documented carotid or vertebrobasilar arterial territory occlusions have also been
achieved by local intra-arterial PA delivery, although only a single prospective double-blinded
randomized placebo-controlled study has been reported. The increase in intracerebral
hemorrhage with these agents by either delivery approach underscores the need for
careful patient selection, dose-appropriate safety and efficacy, proper clinical trial
design, and an understanding of the evolution of cerebral tissue injury due to focal
ischemia. Principles underlying the evolution of focal ischemia have been expanded
by experience with acute PA intervention. Several questions remain open that concern
the manner in which PAs can be applied acutely in ischemic stroke and how injury development
can be limited.
Keywords
stroke - plasminogen activators - acute intervention - thrombolysis - hemorrhage -
intra-arterial - intravenous - thrombosis