Intra-Arterial Thrombolysis in Acute Ischemic Stroke
Hyo Suk Nam, MD
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
ABSTRACT
Early and complete recanalization of an occluded artery is the main therapeutic goal of acute ischemic stroke. Since the National Institute of Neurologic Disorders and Stroke (NINDS) study was done, intravenous (IV) recombinant tissue plasminogen activator (tPA) therapy within 3 hours after the onset of symptoms has been widely used. Despite the advantage of the rapid and easy initiation of thrombolytic therapy, IV tPA treatment is limited by low recanalization rates, particularly in cases of larger proximal arterial occlusions. Compared with the IV approach, intra-arterial (IA) thrombolysis is reported to have higher recanalization rates and an extended therapeutic window. However, IA thrombolysis is limited by the delay to the initiation of treatment and the need for specialized angiographic techniques. In this article, the previous IA thrombolytic therapy trial will be reviewed and the limitations and hope of IA thrombolytic therapy will be discussed.
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