Intravenous
tissue plasminogen activator (tPA) is the only thrombolytic agent that has been
established as effective for the treatment of acute ischemic stroke [1,2].
However, about 50% of acute ischemic stroke patients remain permanently
disabled or die despite treatment with intravenous tPA. Thrombolytic therapy
with tPA is strongly time-sensitive and with any delay in treatment initiation
the likelihood for favorable functional outcome decreases rapidly over time
from stroke-onset. Also, in patients with proximal intracranial arterial
occlusion and extensive thrombus burden tPA is not as effective as in more
distal occlusions, decreasing the likelihood for functional recovery and
survival in stroke patients who fail to recanalize [3,4]. Rapid arterial
recanalization and restoration of perfusion remain one of the main independent
predictors of good functional outcome after acute ischemic stroke [5]. Adjuvant
treatment strategies that amplify the only approved acute stroke therapy are
needed to improve recanalization rate, reperfusion and clinical outcome in
patients with acute ischemic stroke.
By Dr K Barlinn and Dr AV Alexandrov