Neurológia pre prax 3/2020

Reperfusion therapy in acute ischemic stroke – intravenous thrombolysis

The early recanalization of an occluded artery is the primary aim of reperfusion treatment in acute ischemic stroke and is an important predictor of clinical outcome. In the past, the standard treatment of ischemic stroke was intravenous thrombolysis with alteplase within the time window of 4,5 hours from symptom onset. Recent clinical trials have provided evidence for perfusion multimodal imaging-based effective reperfusion therapy within an extended time window and stroke with unknown onset. WAKE-UP trial confirmed the efficacy and safety of intravenous thrombolysis with alteplase in patients with unknown onset stroke based on DWI-FLAIR (diffusion weighted imaging – fluid attenuated inversion recovery) mismatch. EXTEND trial demonstrated the benefit of intravenous alteplase in an extended or unknown time-window in patients with positive CTP or PWI-DWI (perfusion weighted imaging – diffusion weighted imaging) mismatch. This review summarizes the evidence from recent clinical trials and algorithm for selection of imaging methods to guide reperfusion therapy in acute ischemic stroke.

Keywords: acute ischemic stroke, intravenous thrombolysis, alteplase, CT perfusion, DWI-FLAIR mismatch