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Semin Thromb Hemost 2017; 43(2): 185-190
DOI: 10.1055/s-0036-1585078
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thrombolysis and Thrombectomy for Acute Ischemic Stroke: Strengths and Synergies

Bruce C. V. Campbell
1   Department of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
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Publication History

Publication Date:
29 July 2016 (online)

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Abstract

Acute ischemic stroke is responsible for around 80% of all strokes and is a leading cause of disability and death globally. There are two potential treatment strategies: restoring blood flow (reperfusion) and preventing cellular injury (neuroprotection). As yet, all the successful trials have involved reperfusion with numerous failures of neuroprotectants. There are two proven reperfusion strategies. Intravenous thrombolysis with alteplase was first demonstrated to reduce disability with publication of the National Institute of Neurological Disorders and Stroke tissue plasminogen activator trial in 1995. Since that time further trials have solidified the evidence base and demonstrated benefit when alteplase is administered within 4.5 hours of stroke onset. Exploration of potentially more effective thrombolytics is still underway with tenecteplase but others, such as desmoteplase, have been unsuccessful in clinical trials. The second proven reperfusion strategy is endovascular clot retrieval. This has been practiced for several years but came of age with the publication of five strongly positive trials in 2015. This review discusses the evidence for intravenous and intra-arterial reperfusion strategies and the advantages, disadvantages, and synergies of the two approaches.

Keywords

ischemic stroke - thrombolysis - endovascular thrombectomy - tissue plasminogen activator - mechanical clot retrieval
 

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