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Letters |

Early Ischemic Changes on Computed Tomography in Patients With Acute Stroke—Reply

Suresh C. Patel, MD; Steven R. Levine, MD; Barbara C. Tilley, PhD ;
JAMA. 2002;287(18):2361-2362. doi:10.1001/jama.287.18.2359.
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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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