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Internal and Emergency Medicine
Published in: Internal and Emergency Medicine 2/2013

01-03-2013 | IM - Editorial

Ischaemic stroke and thrombolysis: ask the onset time, not the age!

Authors: Silvia Cenciarelli, Tatiana Mazzoli, Stefano Ricci

Published in: Internal and Emergency Medicine | Issue 2/2013

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Excerpt

As of May 2012, indications for thrombolysis in acute ischaemic stroke were particularly limited [1]: patients had to be treated within 4.5 h from the onset, should be younger than 80 years old, should present with a moderate neurological deficit, and should not present important early ischaemic changes on admission head CT scan, and should not have any of the traditional contraindications for rt-PA therapy. As a consequence, it is not surprising that, despite the commendable efforts of many stroke clinicians, the number of treated patients was very small, with figures around 2–3 % of all strokes [2]. …
Literature
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Rudd AG, Hoffman A, Grant R, Campbell JT, Lowe D, On behalf of the intercollegiate working party for stroke (2009) Stroke thrombolysis in England, Wales and Northern Ireland: how much do we do and how much do we need? J Neurol Neurosurg Psychiatry 82:13–19. doi:10.​1136/​jnnp
3.
The IST-3 collaborative group (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379(9834):2352–2363CrossRef
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Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidett D, Larrue V, Lees K, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, and Toni D, for the ECASS Investigators (2008) Thrombolysis with Alteplase 3 to 4.5 h after Acute Ischemic Stroke. NEJM 359:1317–1329CrossRef
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Saver J (2007) Novel end point analytic techniques and interpreting shifts across the entire range of outcome scales in acute stroke trials. Stroke 38:3055–3062PubMedCrossRef
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IST 3 Collaborative Group (2012) Statistical analysis plan for the third International Stroke Trial (IST-3); part of a ‘thread’ of reports of the trial. Int J Stroke 7:186–187
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Wardlaw J, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley R, Cohen G (2012) r-tPA for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379:2364–2372PubMedCrossRef
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Leys D, Cordonnier C (2012) rt-PA for ischaemic stroke: what will the next question be? Lancet 379:2320–2321PubMedCrossRef
Metadata
Title
Ischaemic stroke and thrombolysis: ask the onset time, not the age!
Authors
Silvia Cenciarelli
Tatiana Mazzoli
Stefano Ricci
Publication date
01-03-2013
Publisher
Springer Milan
Published in
Internal and Emergency Medicine / Issue 2/2013
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-012-0879-5

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