Interventional use of plasminogen activators in central nervous system diseases

Still an experimental approach, the direct intra-arterial infusion of plasminogen activators in the setting of acute thrombotic stroke has received impetus from successful clinical trials of intravenous infusion therapy. Direct therapy, employing catheter delivery, has successfully produced evidence of recanalization in carotid artery territory and vertebrobasilar artery territory thrombotic occlusions. One very recent prospective randomized study has demonstrated the success and limitations of this approach. Attention to safety concerns will be important to the future success of direct intra-arterial delivery of plasminogen activators in acute thrombotic stroke.