This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Despite earnest attempts to increase the use of IV thrombolysis, overall usage remains very low even with the expansion of the time window for treatment to 4.5 hours. Although 20%–30% of patients arrive within 3 hours of symptom onset1 only 1%–3% of all ischemic stroke patients receive thrombolysis.2 A substantial number of patients who would otherwise qualify for treatment do not receive it due to strict application of thrombolytic exclusion criteria. This reason for low rates of IV thrombolysis has received little attention. Importantly, few, if any, of the commonly cited IV recombinant tissue plasminogen activator (rtPA) exclusion criteria are evidence-based. Most, if not all, were derived from expert medical opinion at the time of the original National Institute of Neurological Disorders and Stroke trial. Unfortunately, such expert medical opinion is commonly found to be wanting, including in cerebrovascular disease.3 Moreover, in recent years numerous studies suggest that IV rtPA can be used safely and effectively in many of these excluded groups, such as those with fluctuating symptom severity, seizure at stroke onset, …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
