Symptom-Based Trials of Intravenous rt-PA in Acute Stroke

As thrombolytic therapy developed as a potential intervention for acute ischemic stroke during the 1980s, early clinical investigation depended upon pretreatment cerebral arteriography [5]. The pathologic cerebral anatomy was first defined, and then thrombolytic therapy could be administered selectively to the site of thrombosis via the intra-arterial route [3, 6, 11]. These intra-arterial thrombolytic interventions, carried out with the benefit of computed tomographic (CT) scanning to exclude hemorrhagic stroke, demonstrated the feasibility of cerebral arterial clot lysis. Several thrombolytic agents administered in a variety of doses [3–6, 11–13] were shown to accomplish partial or complete arterial recanalization in the setting of acute cerebral embolism or thrombosis.

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