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  • Review Article
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Therapy for early reperfusion after stroke

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 656–663 (2006)Cite this article

Abstract

Ischemic stroke is a leading cause of death and disability in the Western world. At present, intravenous administration of tissue plasminogen activator within 3 h of symptom onset is the only proven effective treatment to re-establish cerebral blood flow in the case of acute vessel occlusion. Unfortunately, few patients presenting with acute ischemic stroke qualify for intravenous tissue plasminogen activator therapy. The focus of current research is, therefore, to find new treatment options by which to obtain early reperfusion, and to extend the therapeutic window for intervention beyond 3 h. The purpose of this Review is to provide an integrated view of the current state of reperfusion therapy in patients with acute stroke, including pharmacologic agents and the methods of delivery. The focus will be on intravenous and intra-arterial use of plasminogen activators in acute supratentorial infarction. Other therapies, such as antiplatelet agents (i.e. glycoprotein IIb/IIIa inhibitors), and anticoagulant drugs will be discussed briefly.

Key Points

  • Re-establishment of blood flow as soon as possible is crucial in acute ischemic stroke

  • Intravenous administration of tissue plasminogen activator within 3 h of symptom onset is still the only proven effective treatment

  • Several pharmacological and mechanical approaches are currently under investigation to achieve and maintain early reperfusion, and to extend the therapeutic window for intervention beyond 3 h

  • This review provides an integrated view of the current state of reperfusion therapy in patients with acute stroke, including pharmacologic agents such as plasminogen activators, antiplatelet agents, and anticoagulant drugs

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Author information

Authors and Affiliations

  1. Resident in the Department of Neurology, at the University Hospital Heidelberg, Heidelberg

    Eric Juttler

  2. Resident in the Stroke Unit,

    Martin Kohrmann & Peter D Schellinger

  3. both in the Department of Neurology at the University of Erlangen, Professor of Neurology, Erlangen, Germany

    Martin Kohrmann & Peter D Schellinger

Authors
  1. Eric Juttler
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  2. Martin Kohrmann
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  3. Peter D Schellinger
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Corresponding author

Correspondence to Eric Juttler.

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Competing interests

E Juttler and M Kohrmann declared they have no competing interests.

PD Schellinger declined to provide information about competing interests.

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Juttler, E., Kohrmann, M. & Schellinger, P. Therapy for early reperfusion after stroke. Nat Rev Cardiol 3, 656–663 (2006). https://doi.org/10.1038/ncpcardio0721

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