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April 3, 1996

Thrombolysis for Acute Stroke

Author Affiliations

University of Milan Milan, Italy

JAMA. 1996;275(13):983-984. doi:10.1001/jama.1996.03530370021011

To the Editor.  —We were interested in the results of the ECASS on rt-PA in acute stroke,1 but we would like to express concern with particular regard to the conclusion. In the summary the authors state that "intravenous thrombolysis in acute ischemic stroke is effective in improving some functional measures and neurologic outcome in a defined subgroup of stroke patients," implying that rt-PA could be recommended in selected populations of acute ischemic stroke patients. The selection to which the authors refer depends on recognition of early major computed tomographic (CT) signs of extensive infarction. However, the CT selection criteria failed to be applied by the same study researchers, although "all centers received a booklet with detailed description and examples of CT-scan inclusion and exclusion criteria," so that 66 patients (11%) had to be excluded based on the "CT-Scan Reading Panel" review after randomization and treatment. Therefore, the proposed exclusion