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Editorial
Opening already occluded middle cerebral artery, internal carotid artery or other cerebral arteries: when, where, how and why?
  1. David Wang1,2,
  2. Yongjun Wang3,4
  1. 1 OSF/INI Stroke Network and Comprehensive Stroke Center, OSF Saint Francis Medical Center, Peoria, Illinois, USA
  2. 2 Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
  3. 3 China National Clinical Research Center for Neurological Diseases, Beijing, China
  4. 4 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Professor David Wang; david.wang{at}chinastroke.net

https://doi.org/10.1136/svn-2017-000107

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    Time is of essence in saving brain cells in patients with acute ischaemic stroke, the faster the treatment, the better the outcome. The time window for intravenous tissue plasminogen activator (tPA) treatment is <3 hours. With the recent success of multiple bridging trials, the treatment time window has been opened up to 6–8 hours. In fact, both Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset and Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times trials have treated patients between 8 and 12 hours from the onset.1 2 We know that the number needed to treat (NNT) to have the benefit for intravenous tPA is 1 in 3. In bridging therapy, intravenous tPA plus intra-arterial thrombectomy within 6 hours of onset, the NNT is 1 in 2–4. Most recently, two trials reported successful expansion of treatment window beyond 12 hours. CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project study reported that intra-arterial thrombectomy was effective in treating patients with acute ischaemic stroke within 18 hours of onset.3 The Diffusion Weighted Imaging (DWI) or Computerized …

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