Should Thrombolytic Therapy Be the First-Line Treatment for Acute Ischemic Stroke?

To the Editor: Treatment of acute stroke seems to be controversial, as the Clinical Debate between Caplan et al. and Grotta (Oct. 30 issue)^1,2 shows. Caplan and colleagues, on the con side, and Grotta, on the pro side, all stand firmly on the same side of the main argument — namely, that patients with acute stroke should receive aggressive treatment. In the United States today, the real alternative to therapy with tissue plasminogen activator (t-PA) is no therapy at all. Readers should not lose sight of this point in wading through the pros and cons of a specific treatment . . .