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Letters
January 26, 2005

Thrombolysis for Acute Stroke—Reply

JAMA. 2005;293(4):421-422. doi:10.1001/jama.293.4.422-a

In Reply: Dr Svoboda suggests a moratorium on acute stroke thrombolysis. It is not the treatment but the practice that needs modification. For nearly all medical and surgical procedures, patient selection and the abilities and experience of the treating physicians are the keys to success. The fault is not with thrombolysis; this treatment can effectively lyse occlusive thromboemboli. The problems are who renders the treatment, delivery (when and where), and selection of appropriate candidate-patients. The present guidelines do not address the first 2 problems. The technology designated in the guidelines—a plain computed tomographic scan—does not adequately identify appropriate patients. The technology used should show experienced stroke physicians whether brain infarction is present, where it is located, and how extensive it is; it should also indicate whether an occlusive thromboembolus is present and where it is located. Such brain and vascular imaging exists and can safely and quickly yield this information. This technology was not available when the National Institute of Neurological Disorders and Stroke study was planned and performed, and is not currently available at many community hospitals.

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