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September 25, 1996

Thrombolysis in StrokeBetween the Promise and the Peril

Author Affiliations

From the Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario.

JAMA. 1996;276(12):995-996. doi:10.1001/jama.1996.03540120073038

Thrombolysis in stroke represents a break, through clots and nihilism.1 Although thrombolysis can only be recommended for a minority of patients and under the strictest circumstances, it demonstrates dramatically that stroke can be treated. While the Australian Streptokinase (ASK) Trial2 reported in this issue of THE JOURNAL was stopped early, it adds to the growing evidence that prompt intervention makes a difference in stroke. Unlike a cardiac arrest, in which brain viability is counted in minutes, early ischemic stroke harbors a dynamic mixture of salvageable tissue offering therapeutic windows lasting for hours.3 The earlier the intervention, the better the prognosis; time is brain.4 Similarly, the sooner thrombolytics are given, the better the chance for arterial recanalization and the lower the risk of complications.5 This was a prior hypothesis and a finding of the ASK Trial, which suggested a beneficial effect in patients treated with streptokinase within