Thrombolytic strategies for ischemic stroke in the thrombectomy era

J Thromb Haemost. 2021 Apr 9. doi: 10.1111/jth.15336. Online ahead of print.ABSTRACTTwenty-five years ago, intravenous thrombolysis has revolutionized the care of patients with acute ischemic stroke. Since 2015, randomized clinical trials have demonstrated that mechanical thrombectomy improves functional outcome in stroke patients over intravenous thrombolysis alone. More recently, three randomized clinical trials have suggested that mechanical thrombectomy alone is non-inferior to a combined strategy with both intravenous thrombolysis and mechanical thrombectomy. In the present review, we will present the last clinical and preclinical studies on the use of thrombolysis in stroke patients in the modern thrombectomy era. At the cost of a potential increased risk of hemorrhagic transformation, thrombolysis may promote arterial recanalization before thrombectomy, improve the rate of successful recanalisation after thrombectomy and restore microcirculation patency downstream of the main thrombus. Besides, new thrombolytic strategies targeting tissue-type plasminogen activator resistant thrombi are being developed, which could strengthen the beneficial effects of thrombolysis without carrying additional pro-hemorrhagic effects. For instance, tenecteplase has shown improved rate of recanalisation compared to tissue-type plasminogen activator (alteplase). Beyond fibrinolysis, DNA and von Willebrand factor targeted thrombolytic strategies have shown promising results in experimental ...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Source Type: research