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(Stroke. 2007;38:3119.)
© 2007 American Heart Association, Inc.

Editorials

Do Not Wait, Act Now

Markku Kaste, MD, PhD

From the Department of Neurology, Helsinki University Central Hospital, Finland.

Correspondence to Markku Kaste, Helsinki University Central Hospital, Department of Neurology, Haartmaninkatu 4, PO Box 340, Helsinki FI-00029 HUS, Finland. E-mail markku.kaste@hus.fi

Key Words: acute stroke • brain infarction • organized stroke care • stroke care • thrombolysis

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

See related article, pages 3213–3217.

Utilizing a population-based study¹ Dr Majersik and her coworkers provide excellent data on stroke patient arrival times in a community without academic centers. Because most patients present after 3 hours from stroke onset—the ratio in their study is 62% to 69% of patients—the idea of Majersik and her coworkers is to extend the time window beyond 3 hours to make more stroke patients eligible for recanalization therapy. Of those 31% to 38% of their patients presenting within the 3-hour time window, 4% received intravenous recombinant tissue plasminogen activator (rt-PA), which compares well with the 5% of acute stroke patients receiving rt-PA in the United States.² Because effective recanalization therapy is time dependent, we should concentrate our efforts on shortening the onset to treatment times³ instead of trying to extend the time window for such therapies. The experience in Helsinki shows that it is possible to increase the number of patients treated within 90 minutes from the onset of symptoms and even earlier, and thereby increase the number of patients with good outcome.⁴

In the efforts to extend the time window for reperfusion beyond 3 hours, desmoteplase has been closest to a breakthrough. Both DIAS and DEDAS trials revealed that when using diffusion-perfusion MRI in the patient selection desmoteplase recanalized occluded brain arteries up to 9 hours and the majority of patients with recanalization had a good functional outcome.^5,6 DIAS-2 could not verify the results of DIAS and DEDAS.⁷ Why not, is not presently understood. . . . [Full Text of this Article]

Related Article:

Population-Based Analysis of the Impact of Expanding the Time Window for Acute Stroke Treatment

Jennifer Juhl Majersik, Melinda A. Smith, Darin B. Zahuranec, Brisa N. Sánchez, and Lewis B. Morgenstern
Stroke 2007 38: 3213-3217. [Abstract] [Full Text] [PDF]