Acute stroke intervention

Acute ischemic stroke is a common cause of death and disability. To date, the only therapy proven to be effective is to restore blood flow by pharmacological fibrinolysis within the first few hours of stroke onset. The margin of benefit in the clinical trials of fibrinolysis has been small, however. This is due in part to the risk of intracranial hemorrhage after fibrinolytic therapy. Furthermore, many patients with acute ischemic stroke are not candidates for this treatment because of late presentation. Consequently, better and safer methods for the rapid dissolution of occlusive thrombus and better methods of patient selection based on advanced imaging have become two complementary areas of very active investigation. In this article, we will review the pathophysiology of acute ischemic stroke, the current proven therapies - intravenous (IV) tissue plasminogen activator (t-PA) and intra-arterial pro-urokinase (pro-UK) - ongoing research involving physiological imaging for patient triage, and new endovascular methods of revascularization.