Paradigm Shift for Thrombolysis for Patients with Acute Ischaemic Stroke, from Extension of the Time Window to the Rapid Recanalisation After Symptom Onset

Hye Seon Jeong, *Jei Kim

Department of Neurology and Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea
*Correspondence to jeikim@cnu.ac.kr

Disclosure: The authors have declared no conflicts of interest.
Received: 01.02.16 Accepted: 14.06.16
Citation: EMJ. 2017;2[2]:98-103.

Abstract

Intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) are useful therapeutic tools to improve functional outcomes after recanalisation of occluded vessels in patients with acute ischaemic stroke. IVT could be performed for more patients by extending the time interval to 4.5 hours from onset to IVT initiation; however, this does not significantly improve functional outcomes. Recent studies indicated that IAT, particularly intra-arterial thrombectomy (IA-thrombectomy), significantly improved functional outcomes after recanalisation of occluded vessels, particularly when the recanalisation was performed within 6 hours of symptom onset. The focus of thrombolysis for acute ischaemic stroke patients is changing from extending the time window for IVT to successfully achieving good functional outcomes with IA-thrombectomy, by performing it within the 6-hour time limit. In this review, we discuss the present status of and limitations of extending IA-thrombectomy for improved functional outcomes after thrombolysis.

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