Thrombolysis in the acute phase of stroke

Intravenous (IV) thrombolysis using recombinant tissular plasminogen activator (rt-PA) is the unique approved therapy in the setting of acute ischemic strokes. The beginning of acute ischemic stroke therapy is revisited through the first positive randomized control trial, the National Institute of Neurological Disorders and Stroke rt-PA Stroke (NINDS) Study published in 1995. In the present time, critical issues concern the small number of patients treated with rt-PA, partly explained by a limited therapeutic window, a restricted number of stroke units and the lack of people's awareness and behaviour to stroke symptoms. On the other hand, IV thrombolysis is limited by small recanalization rates, facts that argue for new therapeutic approaches such as endovascular therapy or combined IV and IA thrombolysis. The next step is the extension of the therapeutic window using new imaging modalities, which will identify individual opportunities of revascularisation.