What new thrombolytic therapies following a stroke are being investigated?

Updated: Jan 24, 2018
  • Author: Jeffrey L Saver, MD, FAHA, FAAN; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Additional promising thrombolytic strategies investigated in pilot trials include the following:

  • Combined intravenous and intra-arterial thrombolysis, bringing together the speed of initiation of IV and the higher recanalization rates of IA [34]

  • Combined IV and/or IA thrombolysis with endovascular mechanical clot retrieval or aspiration, joining the ability of mechanical devices to dispose of large proximal clot burdens with the ability of lytics to initiate therapy early (IV lysis) or clean up smaller occlusions in distal arteries not accessible to mechanical attack (IA lysis) [35]

  • Ultrasonography-enhanced thrombolysis, using high-frequency ultrasonography to accelerate enyzymatic fibrinolysis by increasing penetration of drug molecules into the clot [36]

A prospective, observational study by Alonso de Lecinana et al indicated that in patients with large vessel occlusion stroke in whom, owing to comorbidities, intravenous thrombolysis is contraindicated, primary mechanical thrombectomy is a safe alternative. The study involved 131 patients with large vessel occlusion who were treated within 4.5 hours of symptom onset, including 21 contraindicated patients who received primary mechanical thrombectomy and 110 patients without contraindications who received intravenous thrombolysis. Fifty-three patients in the latter group subsequently received mechanical thrombectomy, because the occlusion persisted. No patients in the primary mechanical thrombectomy group had symptomatic intracranial hemorrhage, compared with 6% (three patients) in the intravenous thrombolysis plus intravenous thrombectomy group. Mortality rates in the two groups were 14% (3 patients) and 4% (2 patients), respectively. [37]


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