Intravenous rtPA thrombolysis in acute ischemic stroke

Early intravenous thrombolysis within the first three hours has been consid ered in the United States as the first proven treatment in acute ischemic s troke. However, not all patients will respond to this therapy which is also associated with a risk of symptomatic, including fatal, intracranial hemor rhage. This overview addresses the issue of efficacy and safety of intraven ous alteplase (tPA) in acute cerebral ischemia. The rationale for thromboly tic therapy and its limits are described. The controlled studies show that intravenous tPA is effective and safe when given tinder restrictive conditi ons within 3 hours after stroke onset, but the data for a larger therapeuti c window between 3 and 6 hours remain controversial. The expected functiona l improvement and the risk of intracranial hemorrhage greatly depend on sel ective clinical and imaging criteria. For this purpose, MRI, using the diff usion- and perfusion-weighted sequences combined with MR- angiography, shou ld be preferred to CT scan in the next future. Applicability of tPA thrombo lysis in current neurological practice in Belgium is discussed. Before its generalization, this therapy should be restricted to specialized stroke cen ters and all treated patients should be recorded in a central data bank to guarantee continued surveillance.