Journal ArticleDOI
Thrombolysis with Alteplase 3 to 4.5 Hours After Acute Ischemic Stroke
Werner Hacke,Markku Kaste,Erich Bluhmki,Miroslav Brozman,Antoni Dávalos,Donata Guidetti,Vincent Larrue,Kennedy R. Lees,Zakaria Medeghri,Thomas Machnig,Dietmar Schneider,Rüdiger von Kummer,Nils Wahlgren,Danilo Toni +13 more
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TLDR
As compared with placebo, intravenous alteplase administered between 3 and 4.5 hours after the onset of symptoms significantly improved clinical outcomes in patients with acute ischemic stroke; altePlase was more frequently associated with symptomatic intracranial hemorrhage.Abstract:
Background Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke, but its efficacy and safety when administered more than 3 hours after the onset of symptoms have not been established. We tested the efficacy and safety of alteplase administered between 3 and 4.5 hours after the onset of a stroke. Methods After exclusion of patients with a brain hemorrhage or major infarction, as detected on a computed tomographic scan, we randomly assigned patients with acute ischemic stroke in a 1:1 double-blind fashion to receive treatment with intravenous alteplase (0.9 mg per kilogram of body weight) or placebo. The primary end point was disability at 90 days, dichotomized as a favorable outcome (a score of 0 or 1 on the modified Rankin scale, which has a range of 0 to 6, with 0 indicating no symptoms at all and 6 indicating death) or an unfavorable outcome (a score of 2 to 6 on the modified Rankin scale). The secondary end point was a global outcome analysis of four neurologic and disability scores combined. Safety end points included death, symptomatic intracranial hemorrhage, and other serious adverse events. Results We enrolled a total of 821 patients in the study and randomly assigned 418 to the alteplase group and 403 to the placebo group. The median time for the administration of alteplase was 3 hours 59 minutes. More patients had a favorable outcome with alte plase than with placebo (52.4% vs. 45.2%; odds ratio, 1.34; 95% confidence interval [CI], 1.02 to 1.76; P = 0.04). In the global analysis, the outcome was also improved with alteplase as compared with placebo (odds ratio, 1.28; 95% CI, 1.00 to 1.65; P<0.05). The incidence of intracranial hemorrhage was higher with alteplase than with placebo (for any intracranial hemorrhage, 27.0% vs. 17.6%; P = 0.001; for symptomatic intracranial hemorrhage, 2.4% vs. 0.2%; P = 0.008). Mortality did not differ significant ly between the alteplase and placebo groups (7.7% and 8.4%, respectively; P = 0.68). There was no significant difference in the rate of other serious adverse events. Conclusions As compared with placebo, intravenous alteplase administered between 3 and 4.5 hours after the onset of symptoms significantly improved clinical outcomes in patients with acute ischemic stroke; alteplase was more frequently associated with symptomatic intracranial hemorrhage. (ClinicalTrials.gov number, NCT00153036.)read more
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Journal ArticleDOI
A novel quantification of blood-brain barrier damage and histochemical typing after embolic stroke in rats.
Dominik Michalski,Jens Grosche,Johann Otto Pelz,Dietmar Schneider,Christopher M. Weise,Ute Bauer,Johannes Kacza,Ulrich Gärtner,Carsten Hobohm,Wolfgang Härtig +9 more
TL;DR: This is the first report confirming the usefulness of simultaneously applied FITC-albumin and biotinylated rat IgG as BBB permeability markers in experimental stroke, and, specifying antibodies and lectins for multiple fluorescence labeling of NVU components.
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Cost-Effectiveness of Recombinant Tissue-Type Plasminogen Activator Within 3 Hours of Acute Ischemic Stroke Current Evidence
Denise M. Boudreau,Gregory F. Guzauskas,Er Chen,Deepa Lalla,Darren Tayama,Susan C. Fagan,David L. Veenstra +6 more
TL;DR: A disease-based decision model to project lifetime outcomes of patients after acute ischemic stroke by r-tPA treatment status from the US payer perspective supports earlier economic evaluations that r- tPA is a cost-effective method to treat stroke.
Journal ArticleDOI
Endovascular treatment of acute ischemic stroke: the end or just the beginning?
Maxim Mokin,Alexander A. Khalessi,J Mocco,Giuseppe Lanzino,Travis M. Dumont,Ricardo A. Hanel,Demetrius K. Lopes,Richard D. Fessler,Andrew J. Ringer,Bernard R. Bendok,Erol Veznedaroglu,Adnan H. Siddiqui,L. Nelson Hopkins,Elad I. Levy +13 more
TL;DR: The authors discuss the advantage of stent-retriever technology over earlier endov vascular approaches and review the current status and future directions of endovascular acute stroke studies based on lessons learned from previous trials.
Journal ArticleDOI
Population-Based Intervention to Reduce Prehospital Delays in Patients With Cerebrovascular Events
Jacqueline Müller-Nordhorn,Karl Wegscheider,Christian H. Nolte,Gerhard J. Jungehulsing,Karin Rossnagel,Andreas Reich,Stephanie Roll,Arno Villringer,Stefan N. Willich +8 more
TL;DR: A population-based intervention was effective in reducing prehospital delays in women but not in men, and future research should focus on the potential transferability of the intervention, its sustainability, and sex-specific impact.
Journal ArticleDOI
Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study.
Krista Lundelin,Auxiliadora Graciani,Juan García-Puig,Pilar Guallar-Castillón,José M. Taboada,Fernando Rodríguez-Artalejo,José R. Banegas +6 more
TL;DR: Stroke symptom knowledge was suboptimal and only modestly associated with the intent to call for an ambulance, and educational interventions are needed to link stroke recognition more strongly to an immediate need to call an ambulance in order to increase stroke patients’ access to thrombolysis.
References
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James C. Grotta,M Kothari,K.M.A. Welch,Joseph P. Broderick,Barbara C. Tilley,Thomas G. Brott,Marler,Patrick D. Lyden,Paul M. O'Byrne +8 more
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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
Bryan Jennett,Michael R. Bond +1 more
TL;DR: In this article, a five-point scale is described, which includes death, persistent vegetative state, severe disability, moderate disability, and good recovery, and duration as well as intensity of disability should be included in an index of ill-health.
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Interobserver agreement for the assessment of handicap in stroke patients.
TL;DR: The results confirm the value of the modified Rankin scale in the assessment of handicap in stroke patients; nevertheless, further improvements are possible.
Journal ArticleDOI
Measurements of acute cerebral infarction: a clinical examination scale.
Thomas Brott,Harold P. Adams,Charles P. Olinger,John R. Marler,William G. Barsan,José Biller,Judith Spilker,R Holleran,Robert Eberle,Vicki S. Hertzberg +9 more
TL;DR: A 15-item neurologic examination stroke scale for use in acute stroke therapy trials was designed and interrater reliability for the scale was found to be high, and test-retest reliability was also high, suggesting acceptable examination and scale validity.
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