title: Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III Trial.
abstract: OBJECTIVE
  The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population-based study.
  
  
  METHODS
  All patients with an ischemic stroke presenting to an emergency department during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati/Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded timeframes with varying door-to-needle times.
  
  
  RESULTS
  During the study period, 1838 ischemic strokes presenting to an emergency department were identified. A small proportion of them arrived in the expanded time window (3.4%) compared with the standard time window (22%). Only 0.5% of those who arrived in this timeframe met eligibility criteria for thrombolysis compared with 5.9% using standard eligibility criteria in the standard timeframe. These results did not vary significantly by repeated analysis varying the door-to-needle time or the expanded time window's exclusion criteria.
  
  
  CONCLUSIONS
  In reality, the expanded time window for thrombolysis in acute ischemic stroke benefits few patients. If we are to improve recombinant tissue-type plasminogen activator administration rates, our focus should be on improving stroke awareness, transport to facilities with ability to administer thrombolysis, and familiarity of physicians with acute stroke treatment guidelines.
authors.affiliation: Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: de Los Ríos la Rosa
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D004632:Emergency Medical Services; D005060:Europe; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator