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Thrombolytic therapy for stroke

Jonathan Birns and Lalit Kalra

This review article describes thrombolysis as an effective treatment for acute ischemic stroke. The aim of acute thrombolytic therapy is to break up the thrombus or embolus occluding a cerebral artery and restore perfusion to reversibly ischemic brain. Current evidence from randomized, controlled trials limits the therapeutic time window for thrombolysis to 4.5 h for intravenous treatment and 6 h for intra-arterial treatment. Guidelines emphasize the need to identify acute stroke as a clinical priority, and to develop ‘fast-track’ protocols for the early assessment and treatment of stroke patients. The use of advanced imaging techniques and adjuncts to thrombolysis that may have the potential to improve the ability to select patients who may benefit from reperfusion therapy, and allow treatment decisions to be based on individual brain pathophysiology rather than arbitrary time windows, are discussed.