Anyone who has faced the awkwardness of setting up a thrombolysis service will empathise with the determination and tenacity of the author of this paper; it was a heroic effort and, through example, he has set a potentially helpful precedent. However, having read three drafts, I am still not convinced that thrombolysis was appropriate in this case, for the following reasons.

Even the most evangelical thrombolyser might question stroke thrombolysis using a cardiac thrombolytic agent—unlicensed for cerebrovascular disease—in a unit without an established thrombolysis service: the poststroke care, …