Clinical experience and future prospect of thrombolytic therapy using rt-PA from neurosurgeon's view

• Published in: Japanese Journal of Stroke Vol. 28; no. 4; pp. 668 - 672
• Main Author: Nakagawara, Jyoji
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2006
• Subjects: brain protection; ischemic penumbra; recombinant tissue plasminogen activator; therapeutic time window; thrombolytic therapy
• ISSN: 0912-0726; 1883-1923; 1883-1923
• DOI: 10.3995/jstroke.28.668

Intravenous rt-PA for acute ischemic stroke could be widely accepted as the only treatment which efficacy was proved by well-controlled clinical trials. Based on this clinical evidence, it could be major target for clinical trial how to expand the efficacy of thrombolytic therapy for acute ischemic stroke. Intra-arterial local fibrinolytic intervention which is not necessarily alternative treatment for intravenous rt-PA could be additional treatment for intravenous rt-PA which fails to achieve reopening of occluded vessels within therapeutic time window. Concerning on thrombolytic therapy using intravenous rt-PA, efficacy of newly developed rt-PA which might have wider therapeutic time window should be verified by randomized controlled trials. In addition to that, the combination therapy using intravenous rt-PA and brain protective agents such as free radical scavengers also should be inspected to show improvement of patients outcome or expansion of therapeutic time window. Approval of intravenous rt-PA for acute ischemic stroke in this country make a chance to discuss about local medical care system for acute stroke patients should be, and make a progress to establish primary or comprehensive stroke centers in all over the country.