The article discusses the features of thrombolytic therapy with alteplase in the treatment of ischemic stroke (IS) and acute coronary syndrome (ACS). Acute IS and ST-segment elevation myocardial infarction (STEMI) have a number of common features, but important differences in pathophysiology, diagnostics, and clinical features require an individual approach to each disease, with rapid treatment playing a decisive role in the prognosis of patients. According to the latest international and Russian guidelines and data from randomized clinical trials, approaches to various types of reperfusion therapy in IS and STEMI are analyzed. The objective of this review was to provide an understanding of the common and distinct pathophysiology underlying modern reperfusion strategies in IS and STEMI and to describe new ways to improve their clinical efficacy.

Keywords: tissue plasminogen activator alteplase, ST-segment elevation myocardial infarction, pharmacoinvasive strategy, thrombolytic therapy, reperfusion, thrombectomy, ischemic stroke