Fibrinolysis for acute cerebral infarction in 2008: present status and perspectives

Twelve years after FDA approval of rt-PA in the first three hours of stroke, intravenous thrombolysis is still the only effective treatment in the acute phase of stroke. In France, as in other European countries, the number of rt-PA treated patients is still low (less than 2% of all stroke patients). In order to improve this situation, we have to increase the number of stroke units and develop the emergency network. Treatment perspectives include new indications of intravenous rt-PA in a larger therapeutic window and increased usage of multimodal MRI-based selection of patients. Ongoing or future trials will determine the role of other therapeutic approaches such as intra-arterial thrombolysis with rt-PA or mechanical devices, sonothrombolysis and new thrombolytics.