ABSTRACT
A meta-analysis of large randomized controlled trials of thrombolysis1 has demonstrated the substantial efficacy of this approach, particularly with intravenous (IV) recombinant tissue-type plasminogen activator (rtPA), but has also highlighted some worrisome side-effects and limits that definitely hamper its wider use in clinical practice. Symptomatic and even fatal hemorrhagic transformation and reperfusion damage still appear to be the most feared possible consequences of treatment – although this may be more the case for non-experts than for clinicians familiar with thrombolysis.2 As with the experience of cardiologists, the rate and degree of arterial recanalization and the potential occurrence of arterial re-occlusion are generally seen as critical aspects limiting the efficacy of thrombolysis.
