Abstract
For nearly two decades, intravenous tissue plasminogen activator (tPA or alteplase) administered within 4.5 h was the only treatment for acute ischemic stroke. This talk will review current standards of treatment for anterior and posterior circulation acute ischemic stroke. Recent clinical trials have shown that alteplase given in extended time window or to wake-up stroke patients with favourable CT or MRI-perfusion profile, leads to improved functional outcomes. Although patients with posterior circulation stroke were excluded from these trials, several observational studies demonstrated comparable efficacy and safety profiles of alteplase within 4.5 h and in extended time window, with few studies suggesting a lower risk of hemorrhagic complications in these patients.
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