Abstract
The author contributed to accomplish a phase III clinical trial named Japan Alteplase Clinical Trial (J-ACT), that examined the efficacy and safety of intravenous (i.v.) thrombolytic therapy with a recombinant tissue-type plasminogen activator (rt-PA), alteplase, and to issue a Japanese guideline of i.v. alteplase therapy. In this joint symposium, the author reviewed results of clinical studies performed in Japan after the approval of alteplase in 2005, which included the SUMO study, the NCVC rt-PA Registry, the SAMURAI Register, a clinical trial of J-ACT II, and the nation-wide post-marketing registry of J-MARS. For these years, many clinical studies have been performed in the North America and Europe to prolong the therapeutic time window from the initial 3 hours to the 4.5 hours by using alteplase and to the 9 hours with a new rt-PA, desmoteplase, and to develop intravascular devices such as Merci and Penumbra, sonothrombolysis and hybrid revascularization therapy. These new therapeutic strategies are also going to be tested clinically in Japan.
