Current Neurology and Neuroscience Reports

, Volume 10, Issue 1, pp 29-33

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Evolution of the Thrombolytic Treatment Window for Acute Ischemic Stroke

  • Andrew StemerAffiliated withUniversity of California Email author 
  • , Patrick LydenAffiliated withUniversity of California


Ischemic stroke is a major cause of morbidity and mortality for which the only approved treatment in the acute setting is intravenous thrombolysis. The efficacy and safety of recombinant tissue plasminogen activator (rt-PA) have been firmly established within 3 h of symptom onset; however, few patients are eligible for treatment in this time window. Expanding the time for treatment has been challenging, but new evidence has demonstrated a modest statistical improvement in selected patients when rt-PA is administered within 4.5 h. This important finding hopefully will enable more patients to receive treatment and simultaneously provides an opportunity to reaffirm that the benefits of rt-PA diminish with time.


Ischemic stroke Intravenous rt-PA ECASS III Time window