الفهرس 
Pathogenesis of Acute Ischemic StrokeOnly 14 pages are availabe for public view
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Abstract
Stroke is one of the most common causes of death and disability worldwide. The most effective stroke treatments can only be given within the first few hours after a stroke has occurred.
Current treatments for acute ischemic stroke include IV thrombolytic therapy with rtPA and endovascular therapies, including IA thrombolytic therapy and the use of clot retrieval devices.
Currently, there is only one drug approved by the FDA, which is rtPA, for the treatment of acute ischemic stroke within 4.5 hours of symptom onset. Many stroke patients do not receive IV rtPA, however, most commonly because they present beyond the therapeutic window. More recently developed therapeutic strategies offer the hope of safe and effective treatment beyond the time window in selected patients.
For patients who are not eligible for rtPA, aspirin is the only antiplatelet drug that has been evaluated in the acute treatment of stroke. There is no evidence to support urgent anticoagulation to prevent stroke recurrence or extension in patients with acute stroke.
Many neuroprotective agents that were promising in laboratory models of focal ischemia have not shown benefit in clinical studies.
Enhancement of thrombolysis by US appears to be a promising area of research in treatment of subjects with acute ischemic stroke. Additional application of MBs during sonothrombolysis seems to increase the effect on recanalization without increasing the bleeding rate.
Direct administration of IA thrombolytic agents into the clot, while passing the catheter through the clot and mechanically disrupting it, allows for a lower rtPA dose and a decreased risk of systemic hemorrhagic complications.
The combination of IV and IA thrombolysis has been investigated in several pilot studies and may be more effective than either therapy alone in patients with acute, very large vessel occlusions.
Several endovascular devices have been developed in recent years to remove clots from the cerebral circulation. These devices have been tested in patients with acute stroke who are ineligible for or who failed IV rtPA treatment. MERCI retrieval device has been studied most extensively and was approved by the FDA for use in acute stroke patients who are ineligible or fail IV rtPA therapy.
In conclusion, Stroke should be considered a treatable disease, thus more orientation and research are needed to provide the optimal treatment as soon as possible. Different modalities of treatment of acute stroke are now available. IV thrombolysis remains the main option for recanalization, yet mechanical approaches and sonothrombolysis are considered promising alternatives for management of acute ischemic stroke.