Thrombolysis For Ischemic Stroke, Where We Are.

Abstract

For years, the management of acute ischemic stroke has been a source of frustration and dismay for physicians, families, and even patients alike, as effective treatment to reverse a neurologic deficit was lacking. The application of fibrinolysis has revolutionized the care for patients with acute ischemic stroke in the clinical practice. Intravenous recombinant tissue plasminogen activator (rt-PA) has been proven to improve functional outcomes following acute ischemic stroke and can be administered to a select group of patients up to 4.5 h after symptom onset. ``Time is brain`` ; Time from symptom onset to thrombolysis is the most important determinant of the success of treatment, with greatest efficacy if given within 90 min. Hospitals should implement standardized processes and protocols for acute stroke to guide immediate patient assessment, brain imaging, drug administration, and post-thrombolysis care. In the other hand ``Physiology is brain``, is new replacing concept as imaging technology can potentially free us from the time constrains by objectively demarcating the penumbra regardless of the time frame and therefore unleashing this hidden dimension that can help expand the benefit of thrombolysis to a wider acute stroke patients population (Mansour et al., 2010).