Thrombolytic therapy for stroke.

Thrombolytic therapy has recently been shown to be beneficial in the setting of acute myocardial infarction, and thrombolysis resulting in vascular recanalization has been achieved in several other human disease states, including stroke. Advances in the understanding of the fibrinolytic system have led to the development of several new and distinctive thrombolytic strategies. Animal studies of stroke have been encouraging with regard to arterial recanalization and safety. Clinically, the availability of brain computed tomography has allowed pilot studies to proceed by providing rapid identification of patients with nonhemorrhagic stroke. Arterial recanalization has been demonstrated in patients with ischemic stroke following the administration of any one of several thrombolytic drugs. Placebo-controlled trials have not been completed, and so clinical benefit has not been established. Even though the development of brain hemorrhage has been an infrequent complication, the very high morbidity and mortality have been worrisome. Ironically, thrombolytic therapy holds promise for treatment of subarachnoid hemorrhage and perhaps also for spontaneous intracerebral hemorrhage. Human studies have been limited, but complications have been modest, and clinical outcomes have been encouraging.