New thrombolytic agents for the treatment of ischaemic stroke

Although during the last years we have witnessed a remarkable progress in the understanding of the pathophysiology of ischaemic stroke, reperfusion induced by tissue-type plasminogen activator (tPA) remains the only approved acute treatment by the health authorities (The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, 1995). Unfortunately, due to severe inclusion criteria, the estimated benefit of 30% that might be expected only applies to 3 to 8.5% of eligible stroke patients, thus leaving most patients with no treatment. Obviously, the primordial concept of acute stroke treatment, namely, the prompt restoration of cerebral blood flow, is a prerequisite to any subsequent successful therapies. However as discussed hereafter, safer thrombolytic agents/regimens or new combination therapies (thrombolytics and neuroprotective agents) are mandatory to improve stroke treatment.