Practical considerations in the early treatment of ischemic stroke.

Successful treatment of patients with ischemic stroke depends on the ability to treat within three hours of onset, because tissue plasminogen activator has not yet been proved effective beyond this time frame. The two major causes of delay in treatment are failure, on the part of the patient or family, to recognize stroke symptoms and failure to access the medical system most efficiently--by calling 911. Hospital stroke teams can shorten the time between patient arrival at the emergency department and treatment. Guidelines for the evaluation and treatment of potential stroke patients are presented, along with goal times for arrival-to-treatment intervals.