5-30% of patients come to the ER with a wake-up stroke. Because they don't know when it occurred they can't get tPA. I can't tell if this editorial has an answer but my answer is simple. Use a smaller bolus and deliver it directly to the clot with magnetic nanoparticles. With direct and smaller delivery the chance of bleeding should be reduced substantially. But since I have no medical training its obvious that this is a stupid idea.
http://cjns.metapress.com/content/l0140k320x74l427/?id=L0140K320X74L427
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