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(Stroke. 2004;35:1139.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment—Outcome of Acute Stroke Patients Without Visible Occlusion on Early Arteriography

Neurologische Universitätsklinik, Heidelberg, Germany

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

To treat, or not to treat: that is the question: Whether ’tis nobler in the mind to suffer The uncertainties rendered by open case series, Or to take arms against a sea of troubles, And by performing adequate trials end them?

— —Modified from William Shakespeare’s Hamlet (III, i)

At present, only intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) administered within 3 hours after symptom onset is proven to be effective for the treatment of acute stroke. Based on level I evidence from the NINDS trial and several meta-analyses, rt-PA has been approved in many countries around the world, including the USA, Canada, Australia, and most of Europe. A recent meta-analysis (Marler et al, Lancet 2004, in press) also demonstrates a significant effect of rt-PA in the 3- to 4.5-hour window, albeit that has not changed approval regulations. National and international committees and guidelines name IVT with rt-PA within the 3-hour time window as the first-line treatment of choice. In specific, the European Stroke Initiative (EUSI) states "intravenous rt-PA (0.9 mg/kg, maximum 90 mg), with 10% of the dose given as a bolus followed by an infusion lasting 60 minutes, is the recommended treatment within 3 hours of onset of ischemic stroke (level I)" and "the benefit from the use of intravenous rt-PA for acute ischemic stroke beyond 3 hours after onset of the symptoms is smaller, but present up to 4.5 hours (level I)."¹ The American Stroke Association (ASA) guidelines state: "intravenous rt-PA (0.9 mg/kg, maximum dose . . . [Full Text of this Article]