Thrombolysis for acute ischaemic stroke: current status and future perspectives

Lancet Neurol. 2023 May;22(5):418-429. doi: 10.1016/S1474-4422(22)00519-1. Epub 2023 Mar 9.


Alteplase is currently the only approved thrombolytic agent for treatment of acute ischaemic stroke, but interest is burgeoning in the development of new thrombolytic agents for systemic reperfusion with an improved safety profile, increased efficacy, and convenient delivery. Tenecteplase has emerged as a potential alternative thrombolytic agent that might be preferred over alteplase because of its ease of administration and reported efficacy in patients with large vessel occlusion. Ongoing research efforts are also looking at potential improvements in recanalisation with the use of adjunct therapies to intravenous thrombolysis. New treatment strategies are also emerging that aim to reduce the risk of vessel reocclusion after intravenous thrombolysis administration. Other research endeavors are looking at the use of intra-arterial thrombolysis after mechanical thrombectomy to induce tissue reperfusion. The growing implementation of mobile stroke units and advanced neuroimaging could boost the number of patients who can receive intravenous thrombolysis by shortening onset-to-treatment times and identifying patients with salvageable penumbra. Continued improvements in this area will be essential to facilitate the ongoing research endeavors and to improve delivery of new interventions.

Publication types

  • Review

MeSH terms

  • Brain Ischemia* / complications
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Ischemic Stroke* / complications
  • Stroke* / diagnostic imaging
  • Stroke* / drug therapy
  • Stroke* / etiology
  • Thrombolytic Therapy / adverse effects
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator