Alteplase for ischaemic stroke—much sooner is much better

Abstract

Discussing shadows in a field, an American sage once famously observed, “It gets late early out there.” 1 DeVito C Yogi: the life and times of an American original. Triumph Books, Chicago2008 Google Scholar Directed toward one kind of penumbra, his observation applies equally well to another: the shadow that falls across human brain in acute focal cerebral ischaemia. With acute vascular occlusion, threatened penumbral tissue is lost at all too brisk a pace. 2 Hossmann KA Pathophysiological basis of translational stroke research. Folia Neuropathol. 2009; 47: 213-227 PubMed Google Scholar In a typical infarct in the middle cerebral large artery, 20 million additional neurons die every 10 min if reperfusion is not achieved. 3 Saver JL Time is brain—quantified. Stroke. 2006; 37: 263-266 Crossref PubMed Scopus (1125) Google Scholar Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trialsPatients with ischaemic stroke selected by clinical symptoms and CT benefit from intravenous alteplase when treated up to 4·5 h. To increase benefit to a maximum, every effort should be taken to shorten delay in initiation of treatment. Beyond 4·5 h, risk might outweigh benefit. Full-Text PDF