Acute Ischemic Stroke Treatment Options After the Thrombolytic Window

Understanding the Treatment Timeline for Acute Ischemic Stroke

When it comes to treating acute ischemic stroke, the most effective intervention during the early phase is endovascular therapy, which includes thrombolysis combined with bridging treatment. The first three hours after symptom onset are considered the golden window for thrombolytic therapy. However, eligible patients may still benefit from treatment within six hours. Once this timeframe has passed, thrombolytic drugs are no longer recommended due to increased risks and reduced efficacy.

Effective Therapies Available Beyond the Thrombolytic Window

Even if the thrombolytic window has passed, there are still several treatment options available to manage acute ischemic stroke. Antiplatelet agents remain a cornerstone of therapy, with dual antiplatelet therapy combining aspirin and clopidogrel being a common approach. In some cases, early administration of tirofiban via intravenous infusion can be considered to prevent further clot formation.

Optimizing Cholesterol-Lowering Therapy

During the acute phase, intensifying statin therapy with medications like atorvastatin or rosuvastatin can provide significant benefits. These drugs help stabilize atherosclerotic plaques, reducing the risk of further embolic events while potentially promoting collateral circulation. This aggressive lipid-lowering strategy plays a crucial role in secondary stroke prevention.

Improving Cerebral Perfusion and Microcirculation

Several medications can help improve cerebral blood flow and microcirculation. Drugs like urokinase and butylphthalide can be used to enhance cerebral perfusion. Increasing fluid intake to maintain adequate hydration also supports better microcirculatory function. Traditional Chinese medicine formulations with blood-activating and stasis-resolving properties may offer additional benefits in select cases.

Promising New Treatment: Edaravone Dexborneol

One of the most promising developments in acute stroke treatment is the novel combination drug edaravone dexborneol. This medication offers multiple neuroprotective benefits, including free radical scavenging, improved cerebral metabolism, and direct neuroprotective effects. As a cutting-edge treatment option, it represents significant progress in managing acute cerebral infarction beyond the thrombolytic window.