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November 9, 2011

Acute Stroke Therapy at the Crossroads

Author Affiliations

Author Affiliations: University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Broderick); and Columbia University, New York, New York (Dr Meyers).

JAMA. 2011;306(18):2026-2028. doi:10.1001/jama.2011.1622

Clinical decision making is based on a mix of scientific data, experience, training, and other influences, such as reimbursement, allure of new technology, current opinion, and bias. Acute ischemic stroke care has reached a critical juncture: clinical practice, particularly the use of endovascular therapy, is starting down a road containing little scientific evidence of clinical efficacy, while the conduct of clinical trials to provide such critical data is impeded.

Intravenous tissue plasminogen activator (IV t-PA) is the only treatment approved by the Food and Drug Administration (FDA) that was proven clinically effective in multiple randomized clinical trials for acute ischemic stroke.1 The effectiveness of t-PA is time-dependent; treatment beyond 4.5 hours from stroke onset does not result in improved clinical outcome.1 By reducing long-term disability, IV t-PA is also highly cost-effective.2 No other treatment for acute ischemic stroke has shown greater clinical efficacy than IV t-PA.