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April 26, 2000

Intra-arterial Prourokinase for Acute Ischemic Stroke

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(16):2102-2104. doi:10.1001/jama.283.16.2101

To the Editor: The PROACT II trial1 is the first randomized trial that demonstrates the efficacy of intra-arterial thrombolysis. Unlike trials of systemic thrombolysis, in which patients were included irrespective of their vascular pathology, the patient population in PROACT II was limited to those with angiographically proven middle cerebral artery occlusion. As a consequence of these results, should we treat all patients with middle cerebral artery occlusion with intra-arterial thrombolysis from now on? As stated by the authors, only 1 patient could be treated within 3 hours of symptom onset. Therefore PROACT II can only address outcomes beyond 3 hours of stroke onset. Because delayed treatment is associated with a higher risk of permanent neurological impairment, it may be inappropriate to withhold an effective treatment that can be initiated within an average in-hospital delay of 45 minutes2 to patients who present within 3 hours of onset in favor of a procedure that is technically demanding with an average time delay of 3 hours.