Hyperacute Therapy of Acute Ischemic Stroke: Intraarterial Thrombolysis and Mechanical Revascularization Strategies

Ischemic stroke is a major cause of morbidity and mortality. Despite the fact that it is the third most common cause of death in the United States, there is only one FDA approved treatment for patients. This is Intravenous recombinant tissue plasminogen activator given within 3 hours of symptom onset. Furthermore, despite the approval of this drug, it has been underutilized in the community. The limited time window of 3 hours disqualifies many patients from receiving the drug. In addition, fears of intracranial hemorrhage have resulted in underutilization of the drug in the community setting. Efforts to increase the time window to treatment include utilization of the intraarterial route for delivery of thrombolytic drug and interventional mechanical strategies to revascularize intracranial vessels. In this report we review the major intraarterial thrombolysis trials and review the mechanical strategies being developed to treat patients with acute ischemic stroke.