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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Measuring functional limitations after venous thromboembolism: Optimization of the Post-VTE Functional Status (PVFS) Scale.
Gudula J. A. M. Boon,Stefano Barco,Laurent Bertoletti,Waleed Ghanima,Menno V. Huisman,Susan R. Kahn,Simon Noble,Paolo Prandoni,Rachel P. Rosovsky,Akhilesh K. Sista,Bob Siegerink,Frederikus A. Klok +11 more
TL;DR: The PVFS scale was improved and demonstrated broad consensus on its relevance, optimal grades, and methods of assessing among international VTE experts and patients and may become an important outcome measure of functional impairment for quality of patient care and in future VTE trials.
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Anti-inflammatory Strategies in Stroke: a Potential Therapeutic Target.
Antonio Siniscalchi,Rosario Iannacchero,Sabrina Anticoli,Francesca Romana Pezzella,Giovambattista De Sarro,Luca Gallelli +5 more
TL;DR: Increasing evidence suggests that one of the processes worsening clinical outcome is inflammation with the synthesis and the release of pro-inflammatory cytokines that activate several cells contributing to the progression of brain injury.
Journal ArticleDOI
Neuroprotective profile of novel SRC kinase inhibitors in rodent models of cerebral ischemia
Shi Liang,Kevin Pong,Cathleen Gonzales,Yi Chen,Huai-Ping Ling,Robert Mark,Frank Boschelli,Diane H. Boschelli,Fei Ye,Ana Carolina Barrios Sosa,Tarek S. Mansour,Philip Frost,Andrew R. Wood,Menelas N. Pangalos,Margaret M. Zaleska +14 more
TL;DR: The results demonstrate that both agents potently block VEGF-mediated signaling in human endothelial cells, penetrate rat brain upon systemic administration, and inhibit postischemic Src activation and vascular leakage.
Journal ArticleDOI
Experience of mechanical thrombectomy for paediatric arterial ischaemic stroke
Caroline Bodey,Tony Goddard,Tufail Patankar,Anne Marie Childs,Colin D. Ferrie,Helen G. McCullagh,Karen Pysden +6 more
TL;DR: There may be a role for endovascular clot retrieval in selected patients managed by an experienced multidisciplinary team in paediatric AIS patients.
Journal ArticleDOI
Dielectric properties of brain tissue at 1 GHz in acute ischemic stroke: Experimental study on swine
TL;DR: The goal of this research was to study the dependence of brain dielectric properties at 1GHz using experimental swine model of acute ischemic stroke and it was suggested that frequency near 1GHz might be the best applicable frequency for EMT of human brain as a compromise between stronger attenuation at higher frequency and coarse spatial resolution at lower frequency.
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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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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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