ABSTRACT
Acute ischemic stroke is a common cause of death and disability. To date, the only
therapy proven to be effective is to restore blood flow by pharmacological fibrinolysis
within the first few hours of stroke onset. The margin of benefit in the clinical
trials of fibrinolysis has been small, however. This is due in part to the risk of
intracranial hemorrhage after fibrinolytic therapy. Furthermore, many patients with
acute ischemic stroke are not candidates for this treatment because of late presentation.
Consequently, better and safer methods for the rapid dissolution of occlusive thrombus
and better methods of patient selection based on advanced imaging have become two
complementary areas of very active investigation. In this article, we will review
the pathophysiology of acute ischemic stroke, the current proven therapies-intravenous
(IV) tissue plasminogen activator (t-PA) and intra-arterial pro-urokinase (pro-UK)-ongoing
research involving physiological imaging for patient triage, and new endovascular
methods of revascularization.
KEYWORD
Ischemic stroke - fibrinolysis - cerebral blood flow
