Stroke Rounds: Seeking 'Thenexteplase' Field of IV thrombolysis has focused too much on expanding treatment window

This is so true, the stroke world is focused on the wrong thing. Stopping the neuronal cascade of death would probably save more neurons than any new miracle drug. We'll see if anyone disagrees or even prints my comment.
http://www.medpagetoday.com/Cardiology/Strokes/51900?
Too much emphasis on trying to extend the thrombolytic treatment window for ischemic stroke has bogged down the field, but combinations such as with endovascular treatment may be the key to reinvigorating progress, a review argued.
Stroke treatment research has essentially stagnated for the last 2 decades, Randolph S. Marshall, MD, of New York-Presbyterian/Columbia University Medical Center in New York City wrote in a review article online in JAMA Neurology.

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Thrombolysis relies on alteplase (Activase) in the same 3-hour window it was initially approved with in the U.S. in 1996. While Europe marginally expanded the alteplase window to 4.5 hours, no new drugs have panned out yet.
"The slow progress in thrombolysis for acute stroke has been multifactorial," Marshall wrote. "A focus on extending the time window for alteplase beyond 4.5 hours has encumbered substantial resources in the field for many years, yet these efforts have been largely unsuccessful."
The second-generation clot buster desmoteplase failed phase III trials with a treatment window of 3 to 9 hours.
Only the third-generation agent tenecteplase remains to be tested as a potential alternative to alteplase, Marshall pointed out.
Ongoing phase III trials for tenecteplase are the largely Australian TASTE trial with a 4.5 hour window and the Norwegian NOR-TEST trial with the same window, but also including patients presenting within 4.5 hours of awakening with a stroke and those planned for endovascular embolectomy within a 6-hour window.

"Continued attempts to improve fibrin specificity and reduce other detrimental effects inherent with alteplase are warranted," Marshall wrote.
"Basic pharmacology should be charged with generating what could be termed thenexteplase with rationally implemented modifications similar to what was done with tenecteplase," he added.
Combining IV thrombolysis with other treatments -- as was so successful with mechanical clot retrieval in the recent spate of positive trials -- is a promising focus as well that has "reset" the course toward advancement, Marshall wrote.
"The field of IV thrombolysis has been stagnant for so long and may finally be gaining momentum as the field of acute stroke treatment continues to push forward," he concluded.