Breaking the 3 h barrier for treatment of acute ischaemic stroke

摘要

Thrombolysis with intravenous alteplase was the first major medical treatment for ischaemic stroke and transformed stroke management from nihilism and neglect to active intervention almost overnight. The excitement generated among stroke physicians with the publication of the National Institute of Neurological Disorders and Stroke trial in 1996 was tempered in subsequent years by the failure to extend the time window for treatment to 6 h after stroke onset and modest clinical uptake in most countries. The main reasons for this were the restrictive nature of the 3 h time window and the perceived danger of intracerebral haemorrhage.