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
Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia
Fjorda Myslimi,François Caparros,Nelly Dequatre-Ponchelle,Solène Moulin,Sophie Gautier,Patrick Girardie,Charlotte Cordonnier,Régis Bordet,Didier Leys +8 more
TL;DR: OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors, and their long-term outcome does not differ from that of other patients.
Journal ArticleDOI
Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke
Marian Muchada,Marta Rubiera,David Rodriguez-Luna,Jorge Pagola,Alan Flores,Julia A Kallas,Estela Sanjuan,Pilar Meler,José Alvarez-Sabín,Marc Ribó,Carlos A. Molina +10 more
TL;DR: The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity, and time- to-treatment seemed unrelated to functional outcome in mild and severe stroke.
Journal ArticleDOI
Association of CT Perfusion Parameters with Hemorrhagic Transformation in Acute Ischemic Stroke
Anunaya Jain,Minal Jain,Abhijit R. Kanthala,Dushyant Damania,Latha G. Stead,Henry Z. Wang,Babak S. Jahromi +6 more
TL;DR: Of the examined CTP parameters, only lower rCBV was found to be significantly associated with a relatively higher chance of hemorrhagic transformation, and this finding could help determine treatment and prognostication.
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Cervical Artery Dissections: A Review
Jennifer Robertson,Alex Koyfman +1 more
TL;DR: The prognosis of patients with CeAD is good, with relatively low death rates, and the diagnosis should not be missed, because treatment may help prevent worsening or persistent ischemia, recurrent dissection, and death.
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Atherosclerotic Peripheral Vascular Disease Symposium II Controversies in Abdominal Aortic Aneurysm Repair
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References
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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
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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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