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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The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke
Nicola Logallo,Nicola Logallo,Christopher Elnan Kvistad,Christopher Elnan Kvistad,Aliona Nacu,Aliona Nacu,Halvor Naess,Halvor Naess,Ulrike Waje-Andreassen,Ulrike Waje-Andreassen,Jörg Asmuss,Anne Hege Aamodt,Christian Lund,Martin W. Kurz,Ole Morten Rønning,Rolf Salvesen,Titto T. Idicula,Lars Thomassen,Lars Thomassen +18 more
TL;DR: The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenectePLase vs. alteplase and may establish a novel approach to acute ischaemic stroke treatment.
Journal ArticleDOI
Outcomes of intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 90 years or older.
Farrah J. Mateen,Majeed Nasser,Byron R. Spencer,William D. Freeman,Ashfaq Shuaib,Bart M. Demaerschalk,Eelco F. M. Wijdicks +6 more
TL;DR: Most patients aged 90 years or older who received intravenous tPA for acute ischemic stroke had poor 30-day functional outcomes or died, and Intravenously tPA treatment in this age group does not improve the outcome of isChemic stroke.
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Methylene blue-induced neuronal protective mechanism against hypoxia-reoxygenation stress.
Myoung-Gwi Ryou,Gourav Roy Choudhury,Wenjun Li,Ali Winters,Fang Yuan,Ran Liu,Shao-Hua Yang,Shao-Hua Yang +7 more
TL;DR: It is concluded that MB protects the hippocampus-derived neuronal cells against OGD-reoxygenation injury by enhancing energy metabolism and increasing HIF-1α protein content accompanied by an activation of the EPO signaling pathway.
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Re-irradiation with and without bevacizumab as salvage therapy for recurrent or progressive high-grade gliomas
Thomas Hundsberger,Detlef Brügge,Paul Martin Putora,Patrik Weder,Johannes Weber,Ludwig Plasswilm +5 more
TL;DR: This retrospective study provides additional feasibility and safety data of conventional 3D-conformal re-irradiation and IMRT in combination with bevacizumab in relapsing high-grade gliomas and detects radionecrosis due to advanced imaging in one patient.
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Delays in recognition and management of giant cell arteritis: results from a retrospective audit
TL;DR: The aims of this study are to review the clinical findings in patients with GCA, evaluate the baseline practice in diagnosis and treatment and to identify delays in treating patients with NOC.
References
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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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