Intravenous Thrombolysis in Acute Ischemic Stroke

Acute ischemic stroke imposes significant morbidity and mortality on patients and proves costly for the society. The most common pathophysiology involves the obstruction of a cerebral arterial vessel with a thrombus leading to distal ischemia which unrelieved proceeds to infarction. Intravenous thrombolysis has emerged as an effective and safe strategy for reperfusion and has been shown to increase the odds of a long-term favorable outcome. For more than 2 decades, the mainstay of intravenous thrombolysis has been Alteplase. More recently however, Tenecteplase is increasingly incorporated into routine practice, and it has been shown to be superior to Alteplase for recanalization in patients with large vessel occlusion, and at least non-inferior in patients without large vessel occlusion. Newer studies have expanded the time windows, introduced “the tissue clock”, and included patients that were previously considered ineligible for thrombolysis, altogether increasing the pool of stroke patients with favorable outcomes.