Intravenous Thrombolytic Therapy for Acute Ischemic Stroke

To the Editor: Wechsler (June 2 issue)(1) presents a case vignette of an 81-year-old patient who arrived in the emergency department after the apparent onset of a major left hemispheric ischemic stroke about an hour earlier. After the diagnosis was confirmed on imaging, therapy with intravenous recombinant tissue plasminogen activator (rt-PA) was initiated. Timely recanalization of the occluded artery is the only effective treatment for acute ischemic stroke (i.e., time is brain). Intravenous thrombolytic therapy is approved by the Food and Drug Administration in such patients. However, the effectiveness of such therapy in large and midsize arteries is limited, and . .