الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled.
Generally, Stroke can be classified in to two major categories, namely, ischemic stroke and hemorrhagic stroke.
There are several sub classification schemes for ischemic stroke and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria is the most widely used. Based on the TOAST criteria, ischemic stroke can be grouped into five main pathological or etiological types.
Since the 1990s, intravenous (IV) tissue plasminogen activator (IV tPA) has been the only evidence-based therapeutic option for improving outcomes for patients with AIS. Subsequently, intra-arterial thrombolysis (IAT) was tested in the Prolyse in Acute Cerebral Thromboembolism II (PROACT II) study, which found potential safety and efficacy of IAT for middle cerebral artery (MCA) occlusions treated within 6 hours. Subsequently, the Interventional Management of Stroke (IMS) trial investigated the feasibility and safety of combined IV and intra-arterial therapy in AIS.
Recombinant tissue plasminogen activators (rtPAs) produced using genetic engineering techniques exhibit longer half-lives than native tPA, allowing convenient bolus dosing, enhanced fibrin specificity, and higher resistance to inactivation by PAI‐1
Although, intravenous rt-PA for AIS showed a significant increase in survival free of disability, there is still a discrepancy within the published literature regarding the role of rt-PA in the setting AIS. Thus, we performed the present systematic review and meta-analysis to assess the efficacy and safety of intravenous rt-PA when given up to 6 h after stroke for important early and late outcomes.
In this study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till April 2020. The search retrieved 1806 unique records. We then retained 54 potentially eligible records for full-texts screening. Finally, 13 studies (No. of patients =7322 patients) were included.
In this study we assess in hospital mortality, fatal intracranial hemorrhage, symptomatic intracranial hemorrhage, follow up mortality and functional outcomes at the end of follow-up.
The evidence indicates that intravenous rt-PA increased the proportion of patients who were alive with favorable outcome and alive and independent at final follow-up. This benefit occurred despite an increase in the number of early symptomatic intracranial hemorrhages and early deaths. All mortality at the end of follow up is not significantly increased.
This data strengthen previous evidence to treat patients as early as possible after acute ischemic stroke, although some patients might benefit up to 6 h after stroke such as lacunar stroke.
Further studies with rigorous design, large sample size and multiregional cooperation are required to identify how to avoid symptomatic intracranial hemorrhage because it is the single largest hazard.