Recent progress in drug treatment for acute ischemic stroke

The publication of the positive results of the National Institute of Neurol ogical Disorders and Stroke (NINDS) trial of alteplase (a recombinant tissu e plasminogen activator; rt-PA) for acute stroke patients in 1995 and its a pproval by the US Food and Drug Administration as well as the American Acad emy of Neurology and American Heart Association increased the interest and attention of the medical community in acute stroke treatment. However, the implication of this NINDS Stroke Study and other thrombolytic trials in cli nical practice remains controversial and debated. Furthermore, the recent p ublication of the results from the European Cooperative Acute Stroke Study II (ECASS ii) and Alteplase Thrombolysis of Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) studies will feed the controversy, since the results of these two studies are disappointing and do not confirm the posi tive results of the NINDS Stroke Study as expected by clinicians managing p atients with acute stroke. The Standard Treatment with Alteplase to Reverse Stroke (STARS) and Cleveland studies, which involved a large number of com munity hospitals to assess the safety profile and the benefit of rt-PA thro mbolysis for acute stroke patients in clinical practice, have shown controv ersial results. Consequently, the issue arises of which is the more reasona ble position concerning thrombolysis by alteplase, which seems to work but has not been proven yet beyond reasonable doubt? The recent publication of the results from the Prolyse in Acute Cerebral Thromboembolism (PROACT II) study has shown that intra-arterial thrombolysis with prourokinase is a ben efit treatment in stroke patients with a proven middle cerebral artery occl usion within 6 h of stroke onset. Numerous trials devoted to neuroprotectio n against acute ischemic stroke have been prematurely stopped because of sa fety concerns or poor risk-benefit ratios, but some new neuroprotective dru gs seem prom ising and are being tested in ongoing studies. The third issue under study concerns the use of antithrombotic drugs in the acute phase of stroke, particularly the new potent platelet glycoprotein IIb/IIIa antagon ists such as abciximab. In this paper, we have reviewed selected recent cli nical trials focusing on recent advances in acute stroke therapy. Copyright (C) 2001 S. Karger AG, Basel.