Thrombolysis 2004: the good, the bad, and the ugly.

Nearly 8 years have passed since the U.S. Food and Drug Administration (FDA) released recombinant tissue plasminogen activator (rt-PA) for treatment of patients with acute ischemic stroke. Yet thrombolysis remains an intensely controversial treatment strategy. Clearly thrombolysis is a step forward but there remain problems with its application. The author reviews early investigations that preceded the National Institute of Neurological Disorders and Stroke (NINDS) trial report, discusses NINDS and other randomized trials, and comments on results since the approval and release of tissue type plasminogen activator (tPA). Technology development and use have improved since the release of tPA, and the impact of this development is discussed. Finally, the author shares his advice to doctors about present thrombolytic management of patients with acute ischemic stroke.