2022 Volume 39 Issue 4 Pages 501-505
It has passed 16 years since intravenous thrombolysis (IVT) was approved for acute ischemic stroke in Japan. It is crucial not to delay IVT with the minimum required examination and imaging. According to the Japan Stroke Data Bank, the recent administration rate of IVT in ischemic stroke was 10.8%, and the mean door to needle time (DNT) was 62.7 minutes in 2018, but further improvement is expected. In the recent report from the Czech Republic, the administration rate of IVT was 23.5%, and the median DNT was 25 minutes in 2018 by the national stroke registry and feedback system. In Japan, the Stroke and Cardiovascular Disease Control Act was enacted in 2018, and each prefecture will start the promotion plan in 2022. Recent trials using patients' selection with DWI–FLAIR mismatch or perfusion lesion–ischemic core mismatch revealed the efficacy of IVT in ischemic stroke with unclear onset time, including wake–up stroke. A meta–analysis of individual patient data also showed the efficacy. It is important to adequately add imaging evaluation to detect DWI–FLAIR mismatch or perfusion lesion–ischemic core mismatch in ischemic stroke with unclear onset time.
