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
Techniques for Endovascular Treatment of Acute Ischemic Stroke: From Intra-Arterial Fibrinolytics to Stent-Retrievers
TL;DR: The results of the first randomized controlled trials were published in 2013 demonstrating no major difference between intravenous r-tPA treatment and EVT for AIS, and these trials had several limitations including the fact that all EVT were approved for use.
Journal ArticleDOI
A novel cell-penetrating peptide protects against neuron apoptosis after cerebral ischemia by inhibiting the nuclear translocation of annexin A1
Xing Li,Xing Li,Lu Zheng,Lu Zheng,Qian Xia,Qian Xia,Lu Liu,Lu Liu,Meng Mao,Meng Mao,Huijuan Zhou,Huijuan Zhou,Yin Zhao,Jing Shi,Jing Shi +14 more
TL;DR: It is suggested that the Tat-NTS peptide represents a novel and potentially promising new therapeutic candidate for the treatment of ischemic stroke and has profound neuroprotective and cognitive-preserving effects.
Journal ArticleDOI
Endovascular treatment of tandem vascular occlusions in acute ischemic stroke
Ajit S. Puri,A.L. Kühn,Hyon-Jo Kwon,Muhib Khan,Samuel Y Hou,Eugene Lin,Juyu Chueh,Imramsjah M. J. van der Bom,Guilherme Dabus,Italo Linfante,Matthew J. Gounis,Ajay K. Wakhloo +11 more
TL;DR: There was a preference to revascularize the proximal occlusion using a stent followed by distal recanalization with mechanical thrombectomy, intra-arterial thrombolysis or a combination of these, which has low periprocedural complications and can achieve an excellent angiographic and clinical outcome.
Journal ArticleDOI
Simultaneous PET/Mri in Stroke: A Case Series:
Peter Werner,Dorothee Saur,Vilia Zeisig,Barbara Ettrich,Marianne Patt,Bernhard Sattler,Thies H. Jochimsen,Donald Lobsien,Philipp Meyer,Florian Then Bergh,Florian Then Bergh,Antje Y. Dreyer,Antje Y. Dreyer,Johannes Boltze,Johannes Boltze,Joseph Classen,Dominik Fritzsch,Karl-Titus Hoffmann,Osama Sabri,Henryk Barthel +19 more
TL;DR: The first cases of simultaneous [15O]H2O-positron emission tomography (PET)/MRI in stroke patients and an ovine model are reported, offering highly complementary information that might help to identify critically hypoperfused tissue resulting in an improved patient stratification in thrombolysis trials.
Journal ArticleDOI
Neuroprotective and neurotrophic curcuminoids to treat stroke: a translational perspective
TL;DR: The novel multi-target curcuminoid, CNB-001, has a superior safety and pharmacokinetic profile and should be further developed as an acute monotherapy or to be used in conjunction with thrombolytics for acute ischemic stroke.
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