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Of people admitted within 2 h of mild/improving stroke, 31% do not receive rtPA, although many of these people have poor outcomes
  1. Joshua Z Willey
  1. Division of Stroke, Department of Neurology, Columbia University, New York, USA
  1. Correspondence to Joshua Z Willey
    Division of Stroke, Department of Neurology, Columbia University, 710 West 168th street, New York, NY 10032, USA; Jzw2{at}columbia.edu

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Few patients with acute ischaemic stroke receive intravenous recombinant tissue plasminogen activator (rtPA), with the main exclusion criterion being hospital arrival after 4½ h.1 The second most common exclusion criterion from rtPA treatment, which is present in approximately 1/3 of all patients, is a mild or rapidly improving syndrome, termed ‘too good to treat’.2 Uncertainty remains as to whether these …

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