Fibrinolyse intraveineuse à la phase aiguë de l'infarctus cérébral : comment traiter plus de patients ?

Thrombolytic therapy with intravenous recombinant tissue plasminogen activator within 4.5 h of onset of acute ischemic stroke is associated with a significant increase in survival free of disability, despite an early excess of symptomatic intracranial haemorrhage. About 10% of whole population could benefit of this treatment and it is crucial to treat all eligible patients and to treat more patients. To increase the number of treated patients, population has to be informed about symptoms of stroke and it is necessary to improve the quality of stroke care and reduce treatment delays. Treatment might be beneficial in some minor stroke or patients older than 80 years. To increase the time window after 4.5 h, we have to select acute ischemic stroke patients who could benefit of this treatment. The clinical-diffusion or perfusion-diffusion mismatch has been suggested as a useful tool.