ACUTE ISCHEMIC STROKE - REVASCULARIZING THERAPY

The principal goals of thrombolytic therapy for stroke are early resti tution of cerebral blood flow, reduction of ischaemia, and attenuation of neurological disability through lysis of an occluding thrombus and consequent rapid restoration of circulation in the affected territory . Therapy should be initiated as soon as possible, at least within 4-6 h of stroke onset, to prevent major infarction and to salvage the hyp operfused but potentially viable zone adjacent to the central ischaemi c area known as the ischaemic penumbra. This survey focuses on the saf ety and efficacy of thrombolytic therapy in acute ischaemic stroke in clinical trials. The results of two successful major randomized studie s using tissue plasminogen activator (t-PA) were recently published. I ntravenous thrombolysis seemed to be effective in improving functional and neurological outcome in a clearly defined subgroup of patients me eting the inclusion criteria of the studies. However, the identificati on of those patients proved to be difficult and depended on expertise in recognizing the early infarction signs on initial computed tomograp hy. Since treating ineligible patients is associated with an unaccepta ble risk of intracranial bleeding complications and death, intravenous thrombolysis should only be performed at selected centres in selected patients.