Reperfusion Therapies for Acute Ischemic Stroke: An Update
Acute ischemic stroke is a major cause of morbidity and mortality in developed countries. Intravenous thrombolysis
with tissue plasminogen activator (tPA) within 4.5 hours of symptoms onset significantly improves clinical outcomes
in patients with acute ischemic stroke. This narrow window for treatment leads to a small proportion of eligible patients
to be treated. Intravenous or intra-arterial trials, combined intravenous/intra-arterial trials, and newer devices to mechanically
remove the clot from intracranial arteries have been investigated or are currently being explored to increase patient
eligibility and to improve arterial recanalization and clinical outcome. New retrievable stent-based devices offer
higher revascularization rates with shorter time to recanalization and are now generally preferred to first generation
thrombectomy devices such as Merci Retriever or Penumbra System. These devices have been shown to be effective for
opening up occluded vessels in the brain but its efficacy for improving outcomes in patients with acute stroke has not yet
been demonstrated in a randomized clinical trial. We summarize the results of the major systemic thrombolytic trials and
the latest trials employing different endovascular approaches to ischemic stroke.
Keywords: Endovascular treatment, ischemic stroke, mechanical thrombectomy, stent-retriever, thrombolysis, tPA.
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