From the Department of Neurology, Memorial Health Care, University of Massachusetts Medical School, Worcester (Dr Fisher); and Department of Neurology, University of Lausanne, Lausanne, Switzerland (Dr Bogousslavsky).
The effective treatment of acute ischemic stroke remains an important
goal of modern medicine and substantive advances are occurring. Recently,
thrombolytic therapy with tissue-type plasminogen activator was approved for
selected patients with acute ischemic stroke when therapy is started within
3 hours of onset. Streptokinase therapy for acute ischemic stroke has not
been shown to be effective and is associated with an increased risk of hemorrhage,
although it was not evaluated as early after stroke onset as tissue-type plasminogen
activator. Various types of neuroprotective interventions are effective in
animal models, but none has yet been proven effective in patients. In the
future, combinations of thrombolytic and neuroprotective drugs may be used
to attempt maximum rates of recovery after acute ischemic stroke. For combination
therapy to achieve its maximum potential, patients with acute ischemic stroke
will have to be carefully selected and treated.
Fisher M, Bogousslavsky J. Further Evolution Toward Effective Therapy for Acute Ischemic Stroke. JAMA. 1998;279(16):1298-1303. doi:10.1001/jama.279.16.1298