Controversies of thrombolytic therapy in acute ischemic stroke

Abstract

Intravenous thrombolysis is approved to treat eligible patients with acute ischemic stroke. However, some controversies remain. Whether efficacy is outweighed risks of the treatment in particular groups of the patients such as those with severe or very mild severities of stroke or very old patients or wake-up stroke, is still debated. Most patients with severe stroke had major artery occlusion. Intravenous thrombolysis has limited efficacy in recanalization. Recently, combination of intravenous thromobolysis and endovascular treatment showed higher rates of recanalization and provided better clinical outcomes than those with intravenous thrombolysis alone. This would be another, better option in treatment of patients with acute severe ischemic stroke. More evidences have shown the benefit of intravenous thrombolysis in patients with very old (> 80 years old) in term of clinical outcomes as compared to those without treatment. There are ongoing studies looking for the benefit of intravenous thrombolysis in patients with very mild stroke or wake-up stroke.