THROMBOLYTIC THERAPY IN ACUTE STROKE - RECENT EXPERIENCE

The use of fibrinolytic agents for the reestablishment of flow in acute cerebral ischemia is investigational. A number of prospective multicenter trials have indicated the feasibility of cerebral arterial recanalization by either intravenous or intra-arterial infusion approaches. The most recently reported angiography-based studies, which have focussed on the efficacy of intravenous-infusion recombinant tissue plasminogen activator (rt-PA), have indicated no apparent dose-rate relationship to recanalization with rt-PA (duteplase), and that recanalization and neurological outcome at 30 days may be improved by early intervention. The incidence of hemorrhagic transformation with associated neurological deterioration has not been greater than that of untreated patients in those studies, or from literature sources. There is evidence that maintenance of leptomeningeal collaterals may be associated with positive outcome following intravenous rt-PA (alteplase). Those recent prospectively derived experiences provide a base against which future studies of fibrinolysis in acute ischemic stroke may be judged.