Pharmacological Revascularization of Acute Ischaemic Stroke: Focus on Challenges and Novel Strategies
CNS Drugs,  Clinical Article

Smadja D – Add–on IV drugs could be an antiplatelet glycoprotein (GP) IIb/IIIa receptor antagonist, a direct thrombin inhibitor or a second thrombolytic agent, e.g. tenecteplase. However, neuroimaging to measure the clot burden and infarction size will probably be necessary to predict IV alteplase failure and the subsequent use of these eventual additional therapies.

  • The only currently approved treatment for acute ischaemic stroke (AIS) is alteplase, a thrombolytic agent given intravenously (IV) within 4.5 hours of symptom onset, in an attempt to reopen occluded intracerebral arteries.
  • However, no more than 5% of all AIS patients receive IV alteplase, mainly because of too long symptom–onset–to–hospital intervals.
  • Moreover, this strategy is effective for less than half of the patients treated within the therapeutic window.
  • Early recanalization is the most powerful prognostic factor, and novel drugs or therapeutic strategies are primarily aimed at improving alteplase efficacy to rapidly and safely reopen the occluded arteries.
  • Because IV alteplase–resistant thrombi are those with the largest clot burden, responsible for the most devastating brain–tissue infarctions, development of novel approved AIS therapies is an urgent priority.
  • At present, in the absence of controlled trials, no valid recommendations can be made.
  • However, the most promising emerging strategy is a combination of standard or low–dose IV alteplase with an intra–arterial (IA) procedure, including additional endovascular thrombolytic and/or mechanical clot retrieval.
  • Notably, results of open trials using the IA route had relatively disappointing clinical outcomes, despite remarkable arterial recanalization rates.
  • Controlled trials are urgently needed to evaluate strategies including an IA route.
  • In addition, logistic and cost constraints will likely limit their routine use, even in industrialized countries.
  • Combining of another IV drug and IV alteplase is a far less studied option, although much easier to implement.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Neurology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Neurology Articles

1 Clopidogrel plus aspirin aspirin alone for preventing early neurological deterioration in patients with acute ischemic stroke Journal of Clinical Neuroscience, November 13, 2014    Clinical Article

2 Marijuana use associated with lower death rates in patients with traumatic brain injuries Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center News, November 11, 2014

3 Zolpidem and the risk of Parkinson's disease: A nationwide population-based study Journal of Psychiatric Research, August 1, 2014    Clinical Article

4 Effects of antiplatelet agents on functional outcome and cognitive status in patients with acute ischemic stroke Full Text International Journal of Gerontology, November 21, 2014    Free full text    Clinical Article

5 Efficacy and safety of novel oral anticoagulants in patients with cervical artery dissections Cerebrovascular Diseases, November 14, 2014    Clinical Article

6 Recurrent stroke in the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial Cerebrovascular Diseases, October 16, 2014    Clinical Article

7 Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial The Lancet, October 17, 2014    Evidence Based Medicine    Clinical Article
Exclusive Author Commentary

8 Antithrombotic therapy after acute ischemic stroke in patients with atrial fibrillation Stroke, November 25, 2014    Clinical Article

9 Efficacy of HMG-CoA reductase inhibitors in the prevention of cerebrovascular attack in 1016 patients older than 75 years among 4014 type 2 diabetic individuals International Journal of Cardiology, November 7, 2014    Clinical Article

10 Menopausal hormone therapy and central nervous system tumor risk: Large UK prospective study and meta-analysis International Journal of Cancer, November 7, 2014    Evidence Based Medicine

11 Effects of golden hour thrombolysis a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy JAMA Neurology, November 20, 2014    Clinical Article

12 Safety and efficacy of ceftriaxone for amyotrophic lateral sclerosis: A multi-stage, randomised, double-blind, placebo-controlled trial The Lancet Neurology, October 9, 2014    Clinical Article

13 The efficacy and safety of cilostazol in ischemic Stroke Patients with Peripheral Arterial Disease (SPAD): protocol of a randomized, double-blind, placebo-controlled multicenter trial International Journal of Stroke, November 18, 2014    Clinical Article

14 Neonatal vitamin D and childhood brain tumor risk International Journal of Cancer, November 17, 2014    Clinical Article

15 Emergency and critical care management of acute ischaemic stroke CNS Drugs, November 26, 2014    Clinical Article

16 Results of 2-year vitamin B treatment on cognitive performance: Secondary data from an RCT Neurology®, November 21, 2014    Clinical Article

17 Functional outcome after primary endovascular therapy or IV thrombolysis alone for stroke. an observational, comparative effectiveness study Cerebrovascular Diseases, November 24, 2014    Clinical Article

18 Dairy products and the risk of stroke and coronary heart disease: the Rotterdam Study European Journal of Nutrition, October 14, 2014    Clinical Article

19 Folate, vitamin B-6, and vitamin B-12 intake and mild cognitive impairment and probable dementia in the Women’s Health Initiative Memory Study Journal of the Academy of Nutrition and Dietetics, November 12, 2014    Clinical Article

20 The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT) The Lancet, October 30, 2014    Evidence Based Medicine    Clinical Article

Indexed Journals in Neurology: Current Opinion in Neurology, Stroke, Seizure, Cephalgia, Brain Injurymore