European Cooperative Acute Stroke Study III
Support for and Questions About a Truly Emerging Therapy
Marc Fisher MD Kennedy Lees MD Section Editors:
The results of the European Cooperative Acute Stroke Study III (ECASS III) provide an important advance for the field of acute stroke therapy. The study was well-designed and conducted. The trial provides unequivocal and straightforward evidence that treatment with intravenous (IV) tissue plasminogen activator (tPA) initiated 3 to 4.5 hours after the onset of ischemic stroke improves 90-day outcome and that the risk of symptomatic intracerebral hemorrhage is modest and acceptable relative to the derived benefit. ECASS III represents the most important advance in the acute stroke therapy arena since the publication of the National Institute of Neurological Diseases and Stroke tPA trial in 1995 that confirmed the benefits of IV in the <3-hour time window.1 The results of ECASS III will likely lead to swift regulatory approval of an extension of the IV tPA treatment window to 4.5 hours and a substantial increase in the number of patients with acute stroke treated up to this time point from stroke onset.
The critiques by Ingall and Davis/Donnan …