saving neurons is the endpoint. You damned idiots aren't even solving the right problem. Solve the neuronal cascade of death.
http://stroke.ahajournals.org/content/45/9/2555.extract?etoc
Time Dependency of Tissue-Type Plasminogen Activator–Induced Recanalization in Acute Ischemic Stroke
- Georgios Tsivgoulis, MD, PhD, MSc, FESO;
- Andrei V. Alexandrov, MD
+ Author Affiliations
- Correspondence to Andrei V. Alexandrov, MD, FAHA, Department of Neurology, The University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163. E-mail avalexandrov@att.net
See related article, p 2734.
Pooled analyses of major randomized controlled trials of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS)1–3 have established the clinical dictum of “Time is Brain”4
because longer times from stroke symptom onset to the initiation of IVT
are associated with a lower likelihood of good clinical
outcomes at 3 months. Recanalization could be
the main mechanism why this time dependency is seen, and the so-called
recanalization
hypothesis is supported by evidence from a
meta-analysis of clinical studies that documented recanalization.5
However, no prospective study to date has demonstrated that indeed
shorter onset-to-treatment times (OTTs) result in shorter
time to recanalization of an intracranial
occlusion, in turn proving it to be the key link to better long-term
functional
outcomes. Conversely, could this also mean that
longer times to treatment produce less recanalization attributable to
clot
maturation and progression of ischemic injury to
brain tissues? Could “Time is Brain” also mean “Time is Clot”? As time
is
lost, clot wins.
In several pilot single-center studies
of real-time monitoring of tissue-type plasminogen activator (tPA)
infusion by transcranial
Doppler (TCD), both the elapsed time from
symptom onset to recanalization6 and the speed of clot lysis7
with IVT thrombolysis were associated with early clinical recovery from
AIS as determined by serial National Institutes of
Health Stroke Scale assessments. Nevertheless,
the effect of the temporal profile of recanalization on 3-month
functional
outcome after adjusting for potential prognostic
factors remains unknown.
In this issue …
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