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July 10, 2018

Intravenous Alteplase for Mild Nondisabling Acute Ischemic Stroke: A Bridge Too Far?

Author Affiliations
  • 1School of Medicine, University of North Carolina at Chapel Hill
JAMA. 2018;320(2):141-143. doi:10.1001/jama.2018.8511

Treatment of patients with stroke has changed substantially during the past 25 years. In 1995, the NINDS rt-PA trial showed among selected patients with acute ischemic stroke who were treated with intravenous alteplase within 3 hours of known stroke onset or last known well time had reduced disability at 3 months.1 In 2008, the ECASS III trial demonstrated benefit of intravenous alteplase among selected patients treated up to 4.5 hours after known stroke onset or last known well time.2 Benefit from alteplase treatment occurred despite higher rates of symptomatic intracranial hemorrhage compared with placebo (6.4% vs 0.6% in the NINDS rt-PA trial; 2.4% vs 0.3% in ECASS III).1,2 More recently, thrombectomy has been shown to substantially reduce morbidity in selected patients with ischemic stroke.3