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(Stroke. 2000;31:1457.)
© 2000 American Heart Association, Inc.

Letters to the Editor

tPA: A Rural Network Experience

J. Davenport, MD¹; S.K. Hanson, MD¹; I.M. Altafullah, MD²; D.C. Anderson, MD³; D.J. Brauer, PhD⁴; R.D. Brown, MD⁵ M. Ramirez-Lassepas, MD⁶

¹ Health Systems Minnesota,
² Minneapolis Clinic of Neurology,
³ Hennepin County Medical Center,
⁴ University of Minnesota, Minneapolis, Minnesota,
⁵ Mayo Clinic, Rochester, Minnesota,
⁶ Health Partners, St. Paul, Minnesota

To the Editor:

We read with considerable interest the report of the Order of St Francis (OSF) Stroke Network in Peoria,¹ discussing their early experience promoting the use of intravenous tissue plasminogen activator (IV tPA) in central Illinois. Since 1996 we have been somewhat differently organized in Minnesota for a similar phase IV assessment of this important therapy. Our initial report in 1998² presented 60 patients collected over 14 months, a quantity similar to the current OSF report. It was our judgment then, and our main criticism now of the OSF report, that such a limited number of patients precludes any meaningful statistical analysis of data and conclusions must be viewed with great reservation. Our most recent report³ of 151 patients accumulated over 34 months—now 252 patients over 43 months, as presented at the recent American Stroke Association 25th Annual Stroke Conference—still is limited by marginally adequate numbers. It has, however, provided us with sufficient data to apply multivariate analysis to questions about size, rural/urban location and academic affiliation of treating hospitals, specialty expertise of supervising physicians, pretreatment patient risk factors, accuracy of pretreatment CT interpretation, incidence and predictors of poor outcomes including symptomatic intracerebral hemorrhage (ICH) and ICH-related death. Our steering committee of volunteer stroke neurologists has reviewed CT images on every patient with a poor outcome; we obtained posttreatment CT scans on approximately 70% of patients and so know much about asymptomatic ICH. All CT images, regardless of clinical outcome, have been reviewed by a neuroradiologist blinded to . . . [Full Text of this Article]

David Z. Wang, DO

Director, OSF Stroke Network, Department of Neurology, University of Illinois College of Medicine at Peoria

Jean A. Rose, MS

Associate Director, OSF Stroke Network, Department of Neuroscience, OSF Saint Francis Medical Center

Debra S. Honings, RN

Stroke Case Manager, OSF Saint Francis Medical Center

Joseph C. Milbrandt, PhD

Research Coordinator, OSF Saint Francis Medical Center, Department of Neurology, University of Illinois College of Medicine at Peoria

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