In Reply: In response to Drs Fiorelli and von
Kummer, our definition of EIC is consistent with current and prior work, and
the prevalence of EICs in the NINDS rt-PA Stroke Trial1
is comparable to that in ECASS I done during a similar time period (1991-1994).2
The NINDS rt-PA Stroke Trial, ECASS I, ECASS II (1996-1998),3 and a current thrombolytic study for acute ischemic
stroke (2000)4 have shown a progressive
trend toward higher detection rate of EICs on baseline CT scans of patients
with acute ischemic stroke within the first 3 hours of stroke onset. Barber
et al4 have shown an even higher rate of
detection (75%) of EICs on baseline CT scans than has ECASS II. This trend
toward higher detection and prevalence of EICs on baseline CT scans within
3 hours of acute ischemic stroke will likely continue with fast-evolving newer
imaging CT technology and with physicians' increasing familiarity with EICs
on CT scans. Patients with EICs that are both subtle and clear on baseline
CT scans remain more likely to have a favorable clinical outcome with rt-PA
and our data do not support excluding eligible patients with EICs on CT scans
from thrombolytic therapy with rt-PA.1
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