<International Circulation>：My first question is about thrombolytic therapy and there’s a lot of issue about the time-window debate， or what the time-window is for when patients should be given thrombolytic therapy. So what is your opinion on this time-window debate?

　　《国际循环网》：我的第一个问题是关于溶栓治疗，请问您对溶栓治疗时间窗有何看法？
　　Kaste Markku：The time-window is still 4.5 hours. There was the IST-3 (Third International Stroke) trial run by Peter Sandercock from Edinburgh that recently published their results. They studied up to six hours. Just as we did earlier in ECASS-1 and ECASS-2 and it was not effective up to the sixth hour. It was reasonably effective up to the four-and-a-half. So far， there is no evidence that the effective window should be longer than four-point-five hours. Although for selected patients it is obvious longer. Every other year we have in Stockholm， at Karlinska Institute， we have a consensus meeting. I have been chairing the task force responsible for thrombolysis which I became responsible for last November. In that statement we came to the conclusion that thrombolytic therapy is good up to the four-and-a-half hours but it cannot be recommended after four-point-five hours although for academic centers which have excellent imaging possibilities like the use the of diffusion- MRI and MRI Angiography， there are patients that can be treated after four-point-five hours but not on a routine basis so it’s highly selective. And just like in our own institution， if you have partial artery occlusion， which means mortality is 90 percent without recanalization. And so for those patients we treat up to 24 hours and if they are slowly progressive up to 48 hours and there is similar data from other academic hospitals but as I said it’s not recommended after four-point-five hours and we have a so-called “PUT” analysis which as the last one which included all randomized trials and was published in 2010 in the Lancet. The last author was Kennedy Lees. This study showed clearly that if you gave thrombolysis after four-point-five hours the death rate increased. So at the moment it is four-point-five although there are on-going studies， for example there’s a molecule called desmoteplase and we are studying it at the moment up to nine hours. Patients are highly selective based on their MRI Angiography and their perfusion imaging. So it’s not for every stroke patient， only a tiny minority. And these studies have gone quite slowly because it’s not easy to find patients who you would like to treat after four-point-five hours.

　　Kaste Markku：溶栓治疗的时间窗仍为4.5小时，Peter Sandercock最近公布了IST-3（Third International Stroke）试验结果，他们将溶栓治疗时间窗延长至6小时，如同ECASS-1和ECASS-2试验中得到的结果，把治疗时间窗延至6小时并无效果，控制在4.5小时内是合理有效的。目前还没有证据表明有效时间窗应大于4.5小时。虽然，我们选择患者时常会延长有效时间窗。每隔1年，我们都会在斯德哥尔摩Karlinska研究院举行共识会议。去年11月起，我成为主持溶栓治疗的主要负责人。会议中我们达成共识，即溶栓治疗时间窗控制在4.5小时内是合理的，不推荐大于4.5小时。尽管在一些成像设施很好的中心利用弥散MRI和MRI血管造影等技术使得有些患者溶栓治疗时间窗可以大于4.5小时，但这只是高度选择性的特例，并不能作为临床诊疗常规。就我们研究中心而言，如果患者有部分动脉阻塞，如果不进行血管再通，将有90%死亡率。对于此类患者，在24小时内我们都会给予治疗，如果病情继续缓慢进展，即使在48小时内也会给予治疗，别的教学医院也有类似试验数据，但我们仍不推荐溶栓时间窗大于4.5小时。2010年我们发表在Lancet杂志的“PUT”分析包含所有随机临床研究，研究明确表明，如果大于4.5小时给予患者溶栓治疗，会增加患者死亡率。因此，目前治疗时间窗推荐控制在4.5小时内，但仍有探索性的临床试验正在进行，例如，我们正在研究的desmoteplase分子在9小时内的溶栓效果。根据MRI血管造影和弥散成像严格筛选患者。因此，这仅适用于极少数而非全部卒中患者。由于筛选4.5小时后治疗的患者并不容易，这项研究进展很慢。

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