Acute stroke therapy: Perspectives on current, future treatments

Stroke is the third leading cause of death in the United States, yet no acute stroke treatment was available until tissue plasminogen activator (t- PA) was approved for this indication in 1996. This intravenously administered thrombolytic agent is the first to show improved recovery in stroke patients. An associated risk of intracranial hemorrhage (ICH), however, requires careful selection of patients for t-PA therapy. Other intravenously and intra-arterially administered thrombolytics are being investigated for use in stroke, while trials of the thrombolytic streptokinase have been aborted due to high rates of ICH. Stroke therapies categorized as neuroprotective agents are also being studied in clinical trials. These drugs work to preserve cells in the penumbra region of the infarct that have not yet been irreversibly damaged. This article reviews the clinical use of t-PA and the status of investigational acute stroke treatments.