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(Circulation. 2006;114:187-190.)
© 2006 American Heart Association, Inc.

Editorial

Stroke Thrombolysis

Slow Progress

Louis R. Caplan, MD

From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.

Correspondence to Dr Louis Caplan, Palmer 127, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. E-mail lcaplan@bidmc.harvard.edu

Key Words: Editorials • stroke • thrombolysis • embolism

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
During the past decade, few topics have prompted as much controversy as stroke thrombolysis. Although there is general agreement that thrombolysis of stroke patients is effective, the major issue is case selection: Who should give what drug at what dose? Where, how, and to which patients? Like many potent treatments, there is great potential for effectiveness but also important risk of harm. In this issue of Circulation, Georgiadis and his Swiss colleagues¹ analyze some aspects of potential harm.

Article p 237

	Background

 
Stroke thrombolysis was jump-started during the summer of 1996, when the US Food and Drug Administration approved the use of tissue plasminogen activator (tPA) for treatment of patients with stroke when the drug was given within the first 3 hours. Approval was based on publication of the results of a National Institute for Neurological Disorders and Stroke (NINDS)–sponsored trial.² Soon after that trial was reported, committees of the American Heart Association² and the American Academy of Neurology³ published treatment protocols recommending intravenous tPA use according to the NINDS trial protocol. These guidelines (which have never been updated) recommend that patients be treated within 3 hours of symptom onset and that a computed tomography (CT) scan done before thrombolysis should not show major infarction, mass effect, edema, or hemorrhage. Treatment is not recommended in patients who wake up with a deficit, in those with minor signs, or those who are improving. The guidelines do not require or suggest magnetic resonance imaging (MRI) or vascular tests before treatment. Stroke neurologists . . . [Full Text of this Article]

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