Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist

Intravenous thrombolysis (IT) with recombinant tissue plasminogen activator has remained the main method of reperfusion therapy in ischaemic stroke for a quarter century. The trends use IT recent years are expansion therapeutic window using additional methods neuroimaging, reducing number contraindications and introduction into clinical practice bolus forms drugs. Providing to largest patients should be considered major challenge primary vascular department. This article presents 10 rules extending while ensuring its efficacy safety: 1) conduct suspected stroke; 2) over 80 (and even 90) age; 3) minor but disabling 4) vertebrobasilar central acute vestibular syndrome; 5) perform cases large artery occlusion; 6) lacunar chronic neuroimaging changes (lacunas, white matter hyperintensity, atrophy); 7) reduce door-to-needle time, thrombolytics administration; 8) options (CT perfusion, MR DWI/FLAIR) expand window; 9) ensure safety IT; 10) prepared complications. Increasing frequency not seen as goal, intensifying this treatment is associated improvement all areas diagnostic process clinic outcomes.