Combinatory approaches |
tPA + direct thrombin inhibition
tPA + low molecular weight heparin
tPA + acetylsalicylic acid
fibrinolytic (tPA or reteplase) + GPIIb/IIIa inhibitors
Sonothrombolysis (tPA + therapeutic ultrasound)
|
Agents combined to enhance the efficacy of fibrinolytics, prevent arterial re-occlusion and/or improve microcirculatory flow. |
II
None current
III
II
II & III
|
Novel Systemic Thrombolytic or Defibrinogenating agents |
Tenecteplase (TNK)
Desmoteplase
Plasmin
Ancrod
|
Agents tested in either:
an extended time window from symptom onset (i.e., >4.5 hours)
head-to-head comparison with intravenous tPA
|
None, recently completed Phase II
Phase III
I/IIa
None current
|
Endovascular medical or mechanical reperfusion treatments |
Interventional Management of Stroke-3 (IMS-3)
MR and Recanalization of Stroke Clots Using Embolectomy(MR RESCUE)
|
Direct intra-arterial approach allows for local lytic application and greater rates of arterial recanalization. |
III
II
|
Non-invasive or minimally-invasive methods to augment cerebral blood flow and alleviate intracranial blood flow steal |
External counterpulsation
Non-invasive ventilatory support in stroke patients with steal
Sphenopalatine ganglion (SPG) stimulation
Partial aortic occlusion
|
Device applies one hour of full-pressure (or sham) external cuff inflation around the lower extremities timed with the patient’s electrocardiogram.
Application of bi-level ventilation improves intracranial steal in documented arterial occlusion.
Stimulation of SPG increases cerebral blood flow.
Abdominal intra-aortic catheter partially obstructs blood flow increases cerebral blood flow.
|
I
None current
III
None, recently completed Phase III
|