Despite recent advances in recanalization therapy, mechanical thrombectomy will never be a treatment for every ischemic stroke because access to mechanical thrombectomy is still limited in many countries. Moreover, many ischemic strokes are caused by occlusion of cerebral arteries that cannot be reached by intra-arterial catheters. Reperfusion using thrombolytic agents will therefore remain an important therapy for hyperacute ischemic stroke. However, thrombolytic drugs have shown limited efficacy and notable hemorrhagic complication rates, leaving room for improvement. A comprehensive understanding of basic and clinical research pipelines as well as the current status of thrombolytic therapy will help facilitate the development of new thrombolytics. Compared with alteplase, an ideal thrombolytic agent is expected to provide faster reperfusion in more patients; prevent re-occlusions; have higher fibrin specificity for selective activation of clot-bound plasminogen to decrease bleeding complications; be retained in the blood for a longer time to minimize dosage and allow administration as a single bolus; be more resistant to inhibitors; and be less antigenic for repetitive usage. Here, we review the currently available thrombolytics, strategies for the development of new clot-dissolving substances, and the assessment of thrombolytic efficacies in vitro and in vivo.

中文翻译：

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中风溶栓剂的开发和测试。

尽管近期在再通疗法方面取得了进步，但是机械血栓切除术绝不会成为每个缺血性卒中的治疗方法，因为在许多国家，机械血栓切除术的使用仍然受到限制。此外，许多缺血性中风是由动脉内导管无法达到的脑动脉闭塞引起的。因此，使用溶栓剂的再灌注将仍然是针对急性急性缺血性中风的重要疗法。但是，溶栓药显示出有限的疗效和明显的出血并发症发生率，尚有待改善。对基础和临床研究流程以及溶栓治疗的当前状态的全面理解将有助于促进新溶栓剂的开发。与阿替普酶相比，理想的溶栓剂有望为更多患者提供更快的再灌注；防止再次阻塞；具有更高的纤维蛋白特异性，可选择性激活凝块结合的纤溶酶原，减少出血并发症；保留在血液中的时间更长，以最大程度减少剂量并允许单次推注；对抑制剂更具抵抗力；并减少重复使用的抗原性。在这里，我们回顾了当前可用的溶栓剂，开发新的溶解血块物质的策略以及对体内和体外溶栓效果的评估。保留在血液中的时间更长，以最大程度减少剂量并允许单次推注；对抑制剂更具抵抗力；并减少重复使用的抗原性。在这里，我们回顾了当前可用的溶栓剂，开发新的溶解血块物质的策略以及对体内和体外溶栓效果的评估。保留在血液中的时间更长，以最大程度减少剂量并允许单次推注；对抑制剂更具抵抗力；并减少重复使用的抗原性。在这里，我们回顾了当前可用的溶栓剂，开发新的溶解血块物质的策略以及对体内和体外溶栓效果的评估。