Thrombolysis in Acute Ischemic Stroke: Advances and Prospects

This perspective article synthesizes contemporary evidence on advancing thrombolytic strategies for acute ischemic stroke, focusing on extended-window intravenous thrombolysis (IVT) and adjunctive intra-arterial thrombolysis (IAT) during thrombectomy. Future directions for extended-window thrombolysis should integrate artificial intelligence (AI)-powered neuroimaging interpretation to precisely identify the tissue window and quantify hemorrhage risk, while a simplified paradigm based on non-contrast CT and AI collaboration is critical for expanding IVT access in resource-limited settings. For adjunctive IAT, candidate selection should be refined by integrating residual thrombus burden with perfusion status. Collectively, these precision strategies are poised to enhance reperfusion benefits and alleviate the global stroke burden.