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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Astroglial proteins as diagnostic markers of acute intracerebral hemorrhage-pathophysiological background and clinical findings.
TL;DR: S100B and GFAP may qualify as candidate serum biomarkers which are able to differentiate between ischemic stroke and ICH in the emergency phase of stroke, and an overview on currently available clinical data is provided.
Journal ArticleDOI
Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial
Bertrand Lapergue,Raphaël Blanc,Vincent Costalat,Hubert Desal,Susanna Saleme,Laurent Spelle,Gaultier Marnat,Eimad Shotar,François Eugène,Mikael Mazighi,Emmanuel Houdart,Arturo Consoli,Georges Rodesch,Romain Bourcier,Serge Bracard,Alain Duhamel,Maalek Ben Maacha,Delphine Lopez,Nicholas Renaud,Julien Labreuche,Benjamin Gory,Michel Piotin,Aster Trial Investigators +22 more
TL;DR: In this paper, the authors used a randomized, open-label, blinded end point evaluation that enrolled 408 patients from October 16, 2017, to May 29, 2018, in 11 French comprehensive stroke centers, with a 12-month outcome follow-up.
Journal ArticleDOI
Mechanical Thrombectomy in Acute Stroke: Prospective Pilot Trial of the Solitaire FR Device while Under Conscious Sedation
TL;DR: In this article, the authors evaluated the feasibility, safety, and efficacy of mechanical thrombectomy under conscious sedation in patients with acute ischemic stroke, using the Solitaire FR device, in a prospective single-center, single-arm study.
Journal ArticleDOI
Endovascular therapy for acute ischemic stroke is indicated and evidence based: a position statement
J Mocco,David Fiorella,Kyle M Fargen,Felipe C. Albuquerque,Michael Chen,Rishi Gupta,Joshua A Hirsch,Italo Linfante,William J. Mack,Ansaar T Rai,Robert W Tarr +10 more
TL;DR: A critical and evidence based evaluation of the available data supports the superiority of IAT over standard medical therapies in patients presenting with AIS from LVO within 6 h of stroke onset and having a small infarct core and believes randomization of these patients in trials may no longer be ethical as general community equipoise appropriately disappears.
Journal ArticleDOI
Occult Anterograde Flow Is an Under-Recognized But Crucial Predictor of Early Recanalization With Intravenous Tissue-Type Plasminogen Activator
Seong Hwan Ahn,Christopher D d'Esterre,Emmad Qazi,Mohammed Najm,Marta Rubiera,Enrico Fainardi,Michael D. Hill,Mayank Goyal,Andrew M. Demchuk,Ting Y. Lee,Bijoy K. Menon +10 more
TL;DR: Occult anterograde flow through thrombus can be assessed by perfusion computed tomography T0 maps and predicts early recanalization with intravenous tissue-type plasminogen activator robustly.
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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