To the Editor: In their analysis of data from
the National Institute of Neurological Disorders and Stroke (NINDS) study
of recombinant tissue plasminogen activator (rt-PA), Dr Patel and colleagues1 found that early ischemic changes (EICs) on computed
tomography (CT) within 3 hours of stroke onset are correlated with later severity
of stroke, but that EIC is not helpful in determining which patients would
benefit from rt-PA. Patel et al also found a relatively low rate of EICs.
In contrast with the ECASS II cohort,2 where
the frequency of EIC was 58% for the first hour, 66% for the second, and 65%
for the third, Patel et al found EICs in only 31% of their patients. Other
studies also found higher incidence rates for EIC within 3 hours of stroke
onset.3,4 Explanations for
this discrepancy may include technical reasons as well as different definitions
Fiorelli M, von Kummer R. Early Ischemic Changes on Computed Tomography in Patients With Acute Stroke. JAMA. 2002;287(18):2361–2362. doi:10.1001/jama.287.18.2359
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