Reperfusion of ischemia in the heart or brain

The current treatment of choice for an acute myocardial infarction (AMI) is an interventional procedure like percutaneous coronary intervention (PCI), which takes 2 to 3 hours and is not appropriate for clots in arteries smaller than the catheter. Because PCI requires inpatient catheterization, there is an inevitable delay in reperfusion of the ischemia. This delay was shown to have a linear relationship with AMI mortality. The longer the delay, from <5 minutes to >3 hours, the greater the cardiovascular disease mortality. Instead of PCI, a sequential combination of tissue-type plasminogen activator and prourokinase is the most effective treatment for conditions like AMI and ischemic stroke that mirrors the endogenous fibrinolytic process. (c) 2025 The Author(s). Published by Elsevier Inc. on behalf of American Society for Pharmacology and Experimental Therapeutics. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).