MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset
Götz Thomalla,Claus Z. Simonsen,Florent Boutitie,Grethe Andersen,Yves Berthezène,Bastian Cheng,Bharath Kumar Cheripelli,Tae-Hee Cho,Franz Fazekas,Jens Fiehler,Ian Ford,Ivana Galinovic,Susanne Gellissen,Amir Golsari,Johannes Gregori,Matthias Günther,Jorge Guibernau,Karl Georg Häusler,M. Hennerici,André Kemmling,Jacob Marstrand,Boris Modrau,Lars Neeb,Natalia Pérez de la Ossa,Josep Puig,Peter Ringleb,Pascal Roy,Enno Scheel,Wouter J. Schonewille,Joaquín Serena,Stefan Sunaert,Kersten Villringer,Anke Wouters,Vincent Thijs,Martin Ebinger,Matthias Endres,Jochen B. Fiebach,Robin Lemmens,Keith W. Muir,N. Nighoghossian,Salvador Pedraza,Christian Gerloff +41 more
TLDR
In patients with acute stroke with an unknown time of onset, intravenous alteplase guided by a mismatch between diffusion‐weighted imaging and FLAIR in the region of ischemia resulted in a significantly better functional outcome and numerically more intracranial hemorrhages than placebo at 90 days.Abstract:
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo. All the patients had an ischemic lesion that was visible on MRI diffusion-weighted imaging but no parenchymal hyperintensity on fluid-attenuated inversion recovery (FLAIR), which indicated that the stroke had occurred approximately within the previous 4.5 hours. We excluded patients for whom thrombectomy was planned. The primary end point was favorable outcome, as defined by a score of 0 or 1 on the modified Rankin scale ...read more
Citations
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Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Journal ArticleDOI
Stroke in China: advances and challenges in epidemiology, prevention, and management
Simiao Wu,Bo Wu,Ming Liu,Zhengming Chen,Wenzhi Wang,Craig S. Anderson,Peter Sandercock,Yongjun Wang,Yining Huang,L Cui,C Pu,Jianping Jia,T Zhang,Xinfeng Liu,S Zhang,Peng Xie,Dongsheng Fan,Xunming Ji,Wong K-Sl.,L Wang +19 more
TL;DR: Future efforts should focus on providing more balanced availability of specialised stroke services across the country, enhancing evidence-based practice, and encouraging greater translational research to improve outcome of patients with stroke.
Journal ArticleDOI
Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke
TL;DR: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms, and some trials have suggested that the...
Journal ArticleDOI
European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.
Eivind Berge,William Whiteley,Heinrich J. Audebert,Gian Marco De Marchis,Ana Catarina Fonseca,Chiara Padiglioni,Natalia Pérez de la Ossa,Daniel Strbian,Georgios Tsivgoulis,Georgios Tsivgoulis,Guillaume Turc,Guillaume Turc +11 more
TL;DR: The European Stroke Organisation (ESO) guidelines provide evidence-based recurrence guidelines for patients with acute ischaemic stroke as mentioned in this paper, where intrvenous thrombolysis is the only approved systemic reperfusion treatment.
Journal ArticleDOI
European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE):
Guillaume Turc,Pervinder Bhogal,Urs Fischer,Pooja Khatri,Kyriakos Lobotesis,Mikael Mazighi,Peter D. Schellinger,Danilo Toni,Joost de Vries,Philip White,Jens Fiehler +10 more
TL;DR: High quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischaemic stroke within 6 hours after symptom onset is found.
References
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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
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Werner Hacke,Markku Kaste,Cesare Fieschi,Rüdiger von Kummer,Antoni Dávalos,Dieter Meier,Vincent Larrue,Erich Bluhmki,Stephen M. Davis,Geoffrey A. Donnan,Dietmar Schneider,Exuperio Díez-Tejedor,Paul Trouillas +12 more
TL;DR: Despite the increased risk of intracranial haemorrhage, thrombolysis with alteplase at a dose of 0·9 mg/kg in selected patients may lead to a clinically relevant improvement in outcome.
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Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging
Gregory W. Albers,Michael P. Marks,Stephanie Kemp,Soren Christensen,Jenny P Tsai,Santiago Ortega-Gutierrez,Ryan A McTaggart,Michel T. Torbey,May Kim-Tenser,Thabele M Leslie-Mazwi,Amrou Sarraj,Scott E. Kasner,Sameer A. Ansari,Sharon D. Yeatts,Scott Hamilton,Michael Mlynash,Jeremy J Heit,Greg Zaharchuk,Sun Kim,Janice Carrozzella,Yuko Y. Palesch,Andrew M. Demchuk,Roland Bammer,Philip W. Lavori,Joseph P. Broderick,Maarten G Lansberg +25 more
TL;DR: Endovascular thrombectomy for ischemic stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical Therapy alone among patients with proximal middle‐cerebral‐artery or internal‐carotid‐arterY occlusion and a region of tissue that was ischeMIC but not yet infarcted.
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Peter A. Ringleb,Marie-Germaine Bousser,Gary A. Ford,Philip M.W. Bath,Michael Brainin,Valeria Caso,Álvaro Cervera,Ángel Chamorro,Charlotte Cordonnier,László Csiba,Antoni Dávalos,Hans-Christoph Diener,José M. Ferro,Werner Hacke,Michael G. Hennerici,Markku Kaste,Peter Langhorne,Kennedy R. Lees,Didier Leys,J. Lodder,Hugh S. Markus,Jean-Louis Mas,Heinrich Mattle,Keith W. Muir,Bo Norrving,Victor Obach,Stefano Paolucci,E. Bernd Ringelstein,Peter D. Schellinger,Juhani Sivenius,Skvortsova Vi,Katharina S. Sunnerhagen,Lars Thomassen,Danilo Toni,Rüdiger von Kummer,Nils Wahlgren,Marion F Walker,Joanna M. Wardlaw +37 more
TL;DR: The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.
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