To the Editor: In their analysis of data from
the National Institute of Neurological Disorders and Stroke (NINDS) study
of recombinant tissue plasminogen activator (rt-PA), Dr Patel and colleagues1 found that early ischemic changes (EICs) on computed
tomography (CT) within 3 hours of stroke onset are correlated with later severity
of stroke, but that EIC is not helpful in determining which patients would
benefit from rt-PA. Patel et al also found a relatively low rate of EICs.
In contrast with the ECASS II cohort,2 where
the frequency of EIC was 58% for the first hour, 66% for the second, and 65%
for the third, Patel et al found EICs in only 31% of their patients. Other
studies also found higher incidence rates for EIC within 3 hours of stroke
onset.3,4 Explanations for
this discrepancy may include technical reasons as well as different definitions
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