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  • Title: Systemic reperfusion therapy in acute ischemic stroke.
    Author: Martínez-Sánchez P, Díez-Tejedor E, Fuentes B, Ortega-Casarrubios MA, Hacke W.
    Journal: Cerebrovasc Dis; 2007; 24 Suppl 1():143-52. PubMed ID: 17971650.
    Abstract:
    INTRODUCTION: Experimental and clinical studies indicate that early reperfusion of occluded brain-supplying arteries reduces the size of injury and improves outcome. Recombinant tissue plasminogen activator (t-PA) is the only drug approved for systemic reperfusion in acute ischemic stroke. However, the use of intravenous t-PA is currently limited by its narrow therapeutic window. METHODS: We reviewed the approaches to extending systemic reperfusion in cerebral ischemia currently under investigation in human clinical studies. RESULTS: Strategies to expand the systemic reperfusion include: a better use of conventional t-PA; to extend the intravenous rt-PA window to 270 min; new fibrinolytic agents (tenecteplase, microplasmin, desmoteplase, V10153); combination of lytics and antithrombotics (t-PA + tirofibran, t-PA + abciximab, reteplase + abciximab, t-PA + eptifibatide and t-PA + eptifibatide + aspirin + tinzaparin); combination of lytics and neuroprotectans; externally applied ultrasound to enhance enzymatic fibrinolysis, and improving patient selection with multimodal imaging. CONCLUSION: There is considerable opportunity to explore safe strategies to expand systemic reperfusion therapy which could further benefit stroke outcome.
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