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Thrombolytic therapy, while highly effective in improving functional outcome, continues to be offered to a very small number of patients because of a number of limitations, including a short window of efficacy, expense and the requirement that cranial CT (CCT) be done prior to treatment (to rule out brain haemorrhage).1 It also carries the very serious risk of brain haemorrhage (up to 5% of patients).2 With increasing experience using tissue plasminogen activator (tPA), we have learned that the treatment may not be very effective if brain imaging shows signs of early infarction and if blood pressure or blood glucose are high.3 It has also been suggested that intravenous tPA may not be effective in the presence of a proximal occlusion of the middle cerebral …
Competing interests: None.