Thrombolytic Therapy for Acute Ischemic Stroke: Issues and Answers

Thrombolytic therapies have perhaps been the most important single development in the management of acute ischemic stroke. Results of the National Institute of Neurologic disorders and Stroke (NINDS) trial revealed a 30% greater chance of being disability free at three months if patients with acute ischemic stroke were treated with recombinant tissue plasminogen activator (rt-PA) within 3 hours of onset. These results have been validated in large community studies in the United States. The Prolyse in Acute Cerebral Thromboembolism (PROACT II) trial further demonstrated that patients with middle cerebral artery occlusion can be treated up to 6 hours of onset of stroke with intra-arterial Pro-urokinase. In spite of these results, community use of thrombolytic therapy remains dismally low. Increasing stroke awareness in the community, establishing primary to tertiary stroke centers and physician education are possible methods of increasing utilization of thrombolytic therapy.