[Time and training: keys to success in the treatment of acute ischemic stroke].

The introduction of intravenous cerebral thrombolysis (ICT) with recombinant tissue plasminogen activator (rt-PA) has constituted a milestone in the management of acute ischemic stroke, since both a randomized, controlled clinical trial and posterior studies conducted in the routine clinical practice setting have shown it to improve patient functional prognosis. ICT is moreover cost-effective and is maintained over time; as a result, all the clinical guides currently recommend its administration in indicated patients. However, despite its benefits and recommendations, the use of ICT remains limited. According to most series, ICT is used in less than 5% of all candidate patients, when theoretically it could be used in about 25% of the cases. The greatest barriers against a more widespread use of the technique include patient arrival outside the therapeutic window, and the recommendation of some guides and clinical practices to transfer the patients from hospitals where ICT could be performed to more or less distant reference centers equipped with stroke units--this in some cases leading to a loss of treatment opportunities, and in all cases to a loss of recoverable brain tissue. A useful collateral effect of ICT has been increased physician interest in a hitherto rather neglected disorder. This in some cases has given rise to futile discussions as to where ICT should be performed and by whom. The evidence sustaining the recommendation to treat ischemic stroke patients