Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion

doi:10.1161/STROKEAHA.124.045755

Review

. 2024 Oct;55(10):2536-2546.

doi: 10.1161/STROKEAHA.124.045755. Epub 2024 Aug 6.

Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion

Affiliations

¹ Division of Neurology, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Canada (V.Y.).
² Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (V.Y., B.C.V.C.).
³ Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium (S.V., S.F.D.M.).
⁴ Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (E.A.M., J.P.B.).
⁵ Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., S.B.C.).
⁶ Department of Neurology, University of Pittsburgh, PA (R.G.N.).
⁷ Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.).
⁸ Central Clinical School, Australian Centre for Blood Diseases, Monash University, Australia (R.L.M.).
⁹ Gardner Neuroscience Institute, Cincinnati, OH (J.P.B.).

PMID: 39105286
DOI: 10.1161/STROKEAHA.124.045755

Review

Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion

Vignan Yogendrakumar et al. Stroke. 2024 Oct.

. 2024 Oct;55(10):2536-2546.

doi: 10.1161/STROKEAHA.124.045755. Epub 2024 Aug 6.

Authors

Affiliations

¹ Division of Neurology, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Canada (V.Y.).
² Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia (V.Y., B.C.V.C.).
³ Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium (S.V., S.F.D.M.).
⁴ Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (E.A.M., J.P.B.).
⁵ Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., S.B.C.).
⁶ Department of Neurology, University of Pittsburgh, PA (R.G.N.).
⁷ Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N.).
⁸ Central Clinical School, Australian Centre for Blood Diseases, Monash University, Australia (R.L.M.).
⁹ Gardner Neuroscience Institute, Cincinnati, OH (J.P.B.).

PMID: 39105286
DOI: 10.1161/STROKEAHA.124.045755

Abstract

Thrombolytic therapies for acute ischemic stroke are widely available but only result in recanalization early enough, to be therapeutically useful, in 10% to 30% of cases. This large gap in treatment effectiveness could be filled by novel therapies that can increase the effectiveness of thrombus clearance without significantly increasing the risk of harm. This focused update will describe the current state of emerging adjuvant treatments for acute ischemic stroke reperfusion. We focus on new treatments that are designed to (1) target different components that make up a stroke thrombus, (2) enhance endogenous fibrinolytic systems, (3) reduce stagnant blood flow, and (4) improve recanalization of distal thrombi and postendovascular thrombectomy.

Keywords: reperfusion; stroke; thrombectomy; thrombolytic therapy; treatment outcome.

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Conflict of interest statement

Dr Mistry reports compensation from American Heart Association, AbbVie, RAPID AI, and American Heart Association for consultant services; compensation from Silver Creek Pharmaceuticals Inc and Translational Sciences for other services; employment by University of Cincinnati; and grants from National Institutes of Health, Society of Vascular and Interventional Neurology, National Institute of Neurological Disorders and Stroke, Patient-Centered Outcomes Research Institute, and National Institutes of Health. Dr Hill reports grants from Boehringer Ingelheim, Canadian Institutes of Health Research, Medtronic, and NoNO Inc; employment by University of Calgary; stock options in Basking Bioscience LLC; and compensation from Brainsgate Ltd for consultant services. Dr Coutts reports employment by Hotchkiss Brain Institute, University of Calgary. Dr Nogueira reports compensation from Anaconda Biomed, Medtronic USA Inc, Cerenovus, Genentech, Viz-AI, Prolong Pharmaceuticals, Perfuze, Biogen Inc, Shanghai Wallaby, Brainomix, Hybernia, RapidPulse, Imperative Care, Corindus Inc, NeuroVasc Technologies Inc, Corindus Vascular Robotics, Vesalio, Cerebrotech, Astrocyte, Ceretrieve, Phenox Inc, Philips, Anaconda, and Stryker Corporation for consultant services; compensation from Synchron for data and safety monitoring services; stock options in Ceretrieve, Brainomix, Corindus Inc, Perfuze, Truvic, Viz-AI, Reist/Q?Apel Medical, Vesalio, Cerebrotech, and Viseon Inc; stock holdings in Piraeus Medical, Brain4Care, and Quantanosis AI; and grants from Stryker and Cerenovus. Dr Nguyen reports compensation from Brainomix and Aruna for consultant services; and compensation from American Stroke Association for other services. Dr Medcalf reports grants from National Health and Medical Research Council. Dr Broderick reports grants from Genentech to other; compensation from Brainsgate, F. Hoffmann-La Roche, Basking Bioscience, and Kroger Prescription Plans Inc for consultant services; and grants from Novo Nordisk to other. Dr De Meyer reports grants from KU Leuven and Research Foundation Flanders. The other authors report no conflicts.

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Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion

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Emerging Adjuvant Thrombolytic Therapies for Acute Ischemic Stroke Reperfusion

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