Miroslav Brozman
Thrombolytic therapy with alteplase is actually the only recommended therapy of acute ischemic strokes. The most important factor is the time interval. Intravenous alteplase is recommended for therapy of ischemic strokes during the first three hours; several methods of combined therapy are tested during the first 6 hours time interval. Recanalization of occluded cerebral arteries can be possibly accelerated by concomitant ultrasonic insonation. First promising results have been achieved with several mechanical devices for direct thrombus extraction. Other thrombolytic agents, like reteplase, urokinase, desmoteplase and tenecteplase, continue to be tested in ongoing clinical studies. Cardioembolic stroke is probably the most frequent subtype of ischemic strokes. Serious clinical course is characteristic for embolization into the large cerebral artery, most frequently middle cerebral artery. New organization of health stroke services with the goal to ensure accessibility of acute diagnosis and therapy for patients with acute ischemic strokes is the fundamental precondition for improving the prognosis of affected persons.