Prehospital Thrombolysis for Stroke

Abstract

Soon after thrombolytic therapy was established as a therapy for ischemic stroke, our colleague Anthony Furlan, MD, f amously c irculated a c artoon o f a c omputed tomographic (CT) scanner visible through the back doors of an ambulance, where a happy stroke physician had hung a bottle dripping tissue plasminogen activator (tPA) into the scanned patient’s arm. Because the time interval from stroke onset to initiation of thrombolysis after ischemic stroke is inversely related to the probability of disability-free recovery, prehospital initiation of thrombolytic therapy seemed a compelling and logical ambition, if one could rule out intracranial hemorrhage prior to treatment. Nearly 20 years later, that fantasy has become reality. The current 1 and prior 2 reports of Ebinger and colleagues demonstrated increased and quicker access to tPA treatment through the use of the Stroke Emergency Mobile