Abstract
To the Editor: In the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) trial reported by Ma et al. (May 9 issue),1 the use of alteplase between 4.5 and 9.0 hours after the onset of stroke or on awakening with stroke symptoms resulted in a higher percentage of patients with no or minor neurologic deficits than the use of placebo. We have two queries and comments. First, could the high rate of “wake-up strokes” (strokes that are first apparent on awakening) among patients in the alteplase group (64.6%) have contributed to better outcomes, since some of these patients .
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