Thrombolytic and Endovascular Therapies for Acute Ischemic Stroke

Abstract

Although clinical trials have investigated thrombolytic therapies such as streptokinase, urokinase, and desmoteplase in acute ischemic stroke treatment, only trials assessing intravenous (IV) tissue plasminogen activator (tPA) and intraarterial prourokinase were successful in showing efficacy. Since a confirmatory trial with prourokinase was not performed, it has not been approved for treatment and IV tPA remains the standard of care. Advances in fluoroscopic imaging led to additional research in endovascular therapies as performing interventional cerebrovascular procedures became more feasible. After years of device development, enhanced acute stroke imaging, and improvements in systems of care, endovascular therapy has now shown efficacy in acute stroke treatment in randomized trials as well. Trials have shown the efficacy of stent retrievers compared to medical therapy alone in patients with anterior circulation large vessel occlusions. This has resulted in a paradigm shift in the management of acute ischemic stroke.