Frey James L
Barrow Neurological Institute, Phoenix, Arizona, USA.
Neurologist. 2005 Mar;11(2):123-33. doi: 10.1097/01.nrl.0000156205.66116.84.
To review the 8-year experience with recombinant tissue plasminogen activator (rtPA) for stroke, with commentary on ramifications for the approach to stroke treatment, directions in stroke research, and sociological aspects of stroke as a disease of concern in our society.
Approved in 1996, rtPA remains the only drug indicated for the treatment of ischemic stroke. Stroke treatment and research have evolved rapidly in response to opportunities and discoveries related to the advent of rtPA. The presence of rtPA has engendered an increased level of awareness about all aspects of stroke.
Literature review was performed, focusing on topics that in the author's view are of greatest relevance to the use of rtPA in clinical practice and to the directions in which the presence of rtPA is moving the field of stroke treatment, research, and politics.
Challenges have been raised, and met, regarding the validity of the data upon which the approval for rtPA was based. Limitations in the use of rtPA include the brief time available for treatment, the need for rapid imaging and blood-pressure control, and the fact that large-artery occlusions respond poorly. The major risk of treatment is brain hemorrhage, and although predictors of hemorrhage are known, their presence does not constitute an absolute contraindication to treatment. A virtual subindustry has evolved to enhance the benefit and applicability of rtPA through refined imaging technology and the use of rtPA intra-aterially, as well as in combination with other agents and devices. Sociopolitically, rtPA has elevated the level of awareness of stroke and provided impetus for the stroke center movement and federal legislation to stop stroke.
The development of rtPA has been the most effective advance in the field of stroke. It has generated healthy debate regarding the design, performance, and interpretation of stroke trials, including cost-benefit considerations. rtPA has stimulated research in a multitude of areas, enhanced our understanding of stroke pathophysiology, and defined important limits and risks for urgent intervention. rtPA is the cornerstone of the stroke center movement, as well as legislation in behalf of stroke at the congressional level.
回顾使用重组组织型纤溶酶原激活剂（rtPA）治疗中风8年的经验，并对中风治疗方法的影响、中风研究方向以及中风作为我们社会关注疾病的社会学方面进行评论。
rtPA于1996年获批，仍然是唯一被批准用于治疗缺血性中风的药物。中风治疗和研究随着与rtPA问世相关的机遇和发现而迅速发展。rtPA的出现提高了人们对中风各个方面的认识水平。
进行文献综述，重点关注作者认为与rtPA在临床实践中的使用以及rtPA的存在推动中风治疗、研究和政策领域发展的方向最相关的主题。
rtPA获批所依据的数据的有效性受到了挑战并得到了应对。rtPA使用的局限性包括治疗时间短暂、需要快速成像和控制血压，以及大动脉闭塞反应不佳。治疗的主要风险是脑出血，尽管已知出血的预测因素，但它们的存在并不构成治疗的绝对禁忌证。一个虚拟的子行业已经发展起来，通过改进成像技术、动脉内使用rtPA以及与其他药物和设备联合使用，来提高rtPA的益处和适用性。在社会政治方面，rtPA提高了对中风的认识水平，并为中风中心运动和联邦立法阻止中风提供了动力。
rtPA的发展是中风领域最有效的进展。它引发了关于中风试验的设计、实施和解释的有益辩论，包括成本效益考虑。rtPA刺激了多个领域的研究，增强了我们对中风病理生理学的理解，并确定了紧急干预的重要局限性和风险。rtPA是中风中心运动以及国会层面代表中风的立法的基石。
