Response to Letter by Ng and Sharma
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We thank Drs Ng and Sharma for their comments regarding our recent article1 in which we demonstrated the efficacy of 0.6 mg/kg intravenous alteplase for vascular and clinical outcomes in Japanese patients with middle cerebral artery occlusion. Our prospective, multicenter, cohort study (the Japan Alteplase Clinical Trial II [J-ACT II]), together with the previous trials2 and registries3 performed in Japan, strongly suggest that the efficacy/safety profile of the regimen of 0.6 mg/kg alteplase for Japanese patients is comparable to that of 0.9 mg/kg for European/North American patients. Drs Ng and Sharma express concern about a lower recanalization efficacy with low-dose alteplase, which would increase delayed recanalization, leading to symptomatic intracerebral hemorrhage (SICH). However, in the J-ACT II,1 recanalization of the middle cerebral artery was observed in 51.7% of patients receiving intravenous recombinant tissue plasminogen activator at 0.6 mg/kg on MRA at 6 hours after stroke onset, which …