Stroke Re-perfusion Therapy..Beyond r-tPA

Intravenous administration of recombinant tissue plasminogen activator (rtPA) is currently the only
Food and Drug Administration approved treatment for ischemic stroke.

The therapeutic window for IV rtPA in ischemic stroke is 3 h.

As per the National Hospital Discharge Survey between 1999 and 2001 out of 1.79 million cases of stroke only 0.6% received rtPA.

Intra-arterial (IA) thrombolysis is recommended when a patient misses the window
for IV rtPA or has a contraindication for rtPA.

Intraarterial thrombolysis is more effective in recanalization because of the delivery of the thrombolytic
agent close to the site of occlusion (up to 70% recanalization rate).

The therapeutic window for IA therapy extends up to 6h after a stroke.
Combined IV rtPA and IA therapy also has been proposed.

Mechanical removal of the clot (clot extraction) is another adjunct treatment for reperfusion/
recanalization in stroke.
The therapeutic window can be extended up to 8h for clot extraction procedures.

IA therapy is more effective in strokes involving larger arteries wherein IV rtPA is not very
effective.

The American Heart Association guidelines offer class I evidence for the efficacy of IA
therapy in stroke.

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