Prevention and Treatment of Cerebrovascular Disease

Intravenous thrombolysis with alteplase (Genentech; San Francisco, CA) is the only FDA approved treatment for acute ischemic stroke when administered fewer than 3 hours after the onset of symptoms. The European Cooperative Acute Stroke Study-III (ECASS III) investigators tested the efficacy and safety of alteplase administered between 3 and 4.5 hours after the onset of a stroke.1 After excluding patients with intracranial hemorrhage or major ischemic stroke, patients were randomized in a doubleblind fashion to receive treatment with intravenous (IV) alteplase or placebo. The primary end point was disability at 90 days with either a favorable outcome (modified Rankin Scale [mRS] 0-1) or unfavorable outcome (mRS 2-6). The secondary end point was a global outcome assessment combining 4 neurologic and disability scores. Safety outcomes included death, symptomatic intracerebral emorrhage (ICH), and other serious adverse events.