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(Stroke. 1997;28:1518-1521.)
© 1997 American Heart Association, Inc.

Articles

Acute Interventions

Panel
Michael S. Pessin, MD, Chair; Harold P. Adams, Jr, MD; Robert J. Adams, MD; Marc Fisher, MD; Anthony J. Furlan, MD; Werner Hacke, MD; E. Clarke Haley; Mary Fran Hazinski, Jr, MD, MSN, RN; Cathy M. Helgason, MD; Randall T. Higashida, MD; Walter Koroshetz, MD; John R. Marler, MD; Joseph P. Ornato, MD

Key Words: AHA Medical/Scientific Statements • stroke • prevention • thrombolysis • angioplasty

	New and Emerging Treatments for Acute Ischemic Stroke

 
The acute care of patients with stroke aims to control and prevent medical and neurological complications as well as reverse the neurological effects of the stroke itself. The most important advance is the hyperacute administration of r-TPA. A review of thrombolytic drugs and updated guidelines for their use in patients with stroke has recently been prepared.^{1 2}

Recent Trials of Intravenous Thrombolysis
The results of five recent clinical trials of intravenous thrombolytic therapy for acute ischemic stroke are conflicting. A European trial using r-TPA showed benefit in a target subpopulation of patients but not for all patients treated, whereas an American trial of r-TPA yielded positive results. Three trials using streptokinase were prematurely terminated by safety committees concerned about high rates of acute mortality and intracranial bleeding. Differences in study results likely reflect different agents and dosages administered; severity of the stroke; different sites of occlusion; concomitant treatments, including aspirin; and more particularly, the time interval from stroke onset to treatment.

The results of the National Institute of Neurological Disorders and Stroke (NINDS) study showed that intravenous r-TPA significantly improved stroke outcomes at 3 months in carefully selected patients when administered within 3 hours of onset, following protocol requirements.^{1 2}

Recent Studies of Intra-arterial Thrombolysis
Intra-arterial delivery of thrombolytic agents is an alternative to intravenous administration. Available evidence suggests that recanalization after intra-arterial delivery is in the range of 60% to 70%, which is superior to the 30% to 40% rate for intravenous delivery.³ Although these data encourage further testing of intra-arterial thrombolysis, the procedure should still be considered investigational, performed only . . . [Full Text of this Article]

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