Management of ischaemic stroke in the acute setting: review of the current status

Abstract Acute ischaemic stroke can be treated by clot busting and clot removal. Thrombolysis using intravenous recombinant-tissue plasminogen activator (IV r-TPA) is the current gold standard for the treatment of acute ischaemic stroke (AIS). The main failure of this type of treatment is the short time interval from stroke onset within which it has to be used for any benefit. The evidence is that IV r-TPA has to be used within 4.5 hours. Other modalities of treatment are not as effective and need more scrutiny and examination. The available modalities are intra-arterial thrombolysis and clot-retrieval devices. Not unexpectedly, recanalisation treatments have flourished at a rapid rate. Although vessel recanalisation is vital to increasing the possibility of significant tissue reperfusion, clinical trials need to emphasise functional outcomes rather than reperfusion/recanalisation rates to adequately assess success of these devices/techniques. Our view is that until these treatments become proven in large-scale studies, a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5-hour period following onset of stroke. The resources required are small with the main costs being a CT scan of the brain and the cost of r-tPA. This can easily be done in any emergency facility in any part of the world. What is needed is public awareness, and campaigns of ‘stroke attack’ should be revisited, especially in the resource-limited context. This approach at present will halt to some extent the stroke pandemic that we are facing.

• Publication year

  2013

• Venue

  Cardiovascular Journal of Africa

• Publication date

  2013-04-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.5830/CVJA-2013-001PMID 23736133PMCID 3721925
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation in Canada

  2012cited by this paper
• Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: Focus on Apixaban

  2012cited by this paper
• Systematic Review and Adjusted Indirect Comparison Meta-Analysis of Oral Anticoagulants in Atrial Fibrillation

  2012cited by this paper
• Meta-analysis of efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus warfarin in patients with atrial fibrillation.

  2012cited by this paper
• Atorvastatin

  2012cited by this paper
• Apixaban versus Warfarin in Patients with Atrial Fibrillation

  2012cited by this paper
• Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial.

  2012cited by this paper
• An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation

  2012cited by this paper
• A randomized trial of tenecteplase versus alteplase for acute ischemic stroke.

  2012cited by this paper
• Thromobolysis for acute ischemic stroke: is intra-arterial better than intravenous? A treatment effects model.

  2012influential reference
• Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent

  2011cited by this paper
• State-of-the-art reperfusion strategies for acute ischemic stroke.

  2011influential reference
• Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.

  2011cited by this paper
• Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (review of Technology Appraisal No. 90): a systematic review and economic analysis.

  2011cited by this paper
• Reduction in Mortality in Subjects With Homozygous Familial Hypercholesterolemia Associated With Advances in Lipid-Lowering Therapy

  2011cited by this paper
• Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.

  2011cited by this paper
• Acute stroke intervention.

  2011cited by this paper
• Apixaban versus warfarin in patients with atrial fibrillation.

  2011cited by this paper
• Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association.

  2011cited by this paper
• Neurothrombectomy Devices for the Treatment of Acute Ischemic Stroke: State of the Evidence

  2011influential reference
• Primary Intracranial Stenting in Acute Ischemic Stroke

  2010cited by this paper
• South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: a guideline from the South African Stroke Society (SASS) and the SASS Writing Committee.

  2010influential reference
• Antithrombotic drugs for patients with ischaemic stroke and transient ischaemic attack to prevent recurrent major vascular events.

  2010cited by this paper
• [Cost of stroke in Lomé (Togo).]

  2010cited by this paper
• Costs of Stroke Using Patient-Level Data: A Critical Review of the Literature

  2009cited by this paper
• Routine Use of Intravenous Low-Dose Recombinant Tissue Plasminogen Activator in Japanese Patients: General Outcomes and Prognostic Factors From the SAMURAI Register

  2009cited by this paper
• Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.

  2009cited by this paper
• Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.

  2009cited by this paper
• Number Needed to Treat to Benefit and to Harm for Intravenous Tissue Plasminogen Activator Therapy in the 3- to 4.5-Hour Window: Joint Outcome Table Analysis of the ECASS 3 Trial

  2009cited by this paper
• Dabigatran versus warfarin in patients with atrial fibrillation.

  2009cited by this paper
• The Penumbra Pivotal Stroke Trial: Safety and Effectiveness of a New Generation of Mechanical Devices for Clot Removal in Intracranial Large Vessel Occlusive Disease

  2009cited by this paper
• Dipyridamole plus aspirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk

  2008cited by this paper
• Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial

  2008influential reference
• Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.

  2008influential reference
• Risk indicators for development of headache during dipyridamole treatment after cerebral ischaemia of arterial origin

  2008cited by this paper
• Hemorrhage After Thrombolytic Therapy for Stroke: The Clinically Relevant Number Needed to Harm

  2007cited by this paper
• Preventing stroke: saving lives around the world.

  2007cited by this paper
• Guidelines for the Early Management of Adults With Ischemic Stroke

  2007influential reference
• The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke

  2005cited by this paper
• Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke: Results of the MERCI Trial

  2005cited by this paper
• CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke

  2005cited by this paper
• Statins in Stroke Prevention and Carotid Atherosclerosis: Systematic Review and Up-to-Date Meta-Analysis

  2004cited by this paper
• Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.

  2004cited by this paper
• Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial.

  2004cited by this paper
• The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g) : results of a double-blind, placebo-controlled, multicenter study. Thromblytic therapy in acute ischemic stroke study investigators.

  2000cited by this paper
• Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial

  1999cited by this paper
• Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.

  1999cited by this paper
• Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke.

  1999cited by this paper
• Ischemic penumbra

  1998cited by this paper
• Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.

  1998cited by this paper
• Assessment of clinical outcomes in acute stroke trials.

  1998cited by this paper
• CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group.

  1997cited by this paper
• The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group.

  1997cited by this paper
• Tissue plasminogen activator for acute ischemic stroke.

  1996cited by this paper
• A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)

  1996cited by this paper
• A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee.

  1996cited by this paper
• Tissue plasminogen activator for acute ischemic stroke.

  1995cited by this paper
• Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)

  1995cited by this paper

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  2025cites this paper
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  2025cites this paper
• Stem cell-derived extracellular vesicles in the therapeutic intervention of Alzheimer's Disease, Parkinson's Disease, and stroke

  2024cites this paper
• Lipid engineered nanomaterials: A novel paradigm shift for combating stroke

  2024cites this paper
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  2023cites this paper
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  2023cites this paper
• Intravenous Thrombolytics in the Treatment of Acute Ischemic Stroke

  2023cites this paper
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  2022cites this paper
• High Neutrophil–Lymphocyte Ratio and Low Lymphocyte–Monocyte Ratio Combination after Thrombolysis Is a Potential Predictor of Poor Functional Outcome of Acute Ischemic Stroke

  2022influential citation
• Fabrication and Characterization of Double-Walled Microsphere as a Drug Delivery System for Stroke Treatment

  2021cites this paper
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  2021cites this paper
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  2020cites this paper
• Environmental enrichment enhances post-ischemic cerebral blood flow and functional hyperemia in the ipsilesional somatosensory cortex.

  2020cites this paper
• A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse

  2019cites this paper
• Emergency nurses' knowledge about tissue plasminogen activator therapy and their perception about barriers for thrombolysis in acute stroke care

  2019cites this paper
• ecrostatin-1 protects hippocampal neurons against schemia / reperfusion injury via the RIP 3 / DAXX signaling pathway in ats

  2017cites this paper
• Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

  2017cites this paper
• Frostbite.

  2017cites this paper
• Providing full recovery with single‐dose intravenous reteplase in a patient presented to emergency department with acute ischemic stroke

  2017cites this paper
• Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

  2016cites this paper
• Are There Disparities in Thrombolytic Treatment and Mortality in Acute Ischemic Stroke in the Hispanic Population Living in Border States versus Nonborder States?

  2016cites this paper
• Vitexin protects brain against ischemia/reperfusion injury via modulating mitogen-activated protein kinase and apoptosis signaling in mice.

  2015cites this paper
• FACULDADE DE MEDICINA DA UNIVERSIDADE DE COIMBRA TRABALHO FINAL DO 6o ANO MÉDICO COM VISTA À ATRIBUIÇÃO DO GRAU DE MESTRE NO ÂMBITO DO CICLO DE ESTUDOS DE MESTRADO INTEGRADO EM MEDICINA

  2015cites this paper
• Effects of decompressive craniectomy, hypertonic saline solution and mannitol on an experimental model of cerebral ischemia.

  2015cites this paper
• Targeted delivery of extracellular matrix protected against neurologic defects after focal ischemia reperfusion in rats.

  2015cites this paper
• Intravenous Thrombolysis and Risk Factors for Ischemic Stroke.

  2014cites this paper
• Tissue regeneration in stroke: cellular and trophic mechanisms

  2014cites this paper