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
Usefulness of ADAMTS13 to predict response to recanalization therapies in acute ischemic stroke.
Alejandro Bustamante,MingMing Ning,Teresa García-Berrocoso,Anna Penalba,Cristina Boada,Alba Simats,Jorge Pagola,Marc Ribó,Carlos A. Molina,Eng H. Lo,Joan Montaner +10 more
TL;DR: A reduced ADAMTS13 was associated with poor response to recanalization therapies and might be a useful tool to guide reperfusion therapies.
Journal ArticleDOI
Stroke Mimics in a Stroke Care Pathway Based on MRI Screening
Véronique Quenardelle,Valérie Lauer-Ober,Ielyzaveta Zinchenko,Marc Bataillard,Olivier Rouyer,Rémy Beaujeux,Raoul Pop,Nicolas Meyer,Hervé Delplancq,Stéphane Kremer,Christian Marescaux,Bernard Geny,Valérie Wolff +12 more
TL;DR: Using cerebral MRI in first intention was of special interest in patients with acute neurological symptoms to differentiate an NVD from an SM, confirming the difficulty to distinguish clinically a stroke from another diagnosis.
Journal ArticleDOI
Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time
Jens Minnerup,Heike Wersching,E. Bernd Ringelstein,Matthias Schilling,Wolf-Rüdiger Schäbitz,Jürgen Wellmann,Klaus Berger +6 more
TL;DR: The effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treated stroke patients and on the time of treatment initiation after hospital arrival was investigated.
Journal ArticleDOI
Transplantation of human dental pulp stem cells ameliorates brain damage following acute cerebral ischemia.
Chikako Nito,Kota Sowa,Masataka Nakajima,Yuki Sakamoto,Satoshi Suda,Yasuhiro Nishiyama,Aki Nakamura-Takahashi,Yuko Nitahara-Kasahara,Masayuki Ueda,Takashi Okada,Kazumi Kimura +10 more
TL;DR: Systemic delivery of human DPSCs after reperfusion reduced ischemic damage and improved functional recovery in a rodent ischemia model, with a clinically relevant therapeutic window.
Journal ArticleDOI
Coagulation factor Xa activates thrombin in ischemic neural tissue.
TL;DR: Results indicate that FXa activates thrombin in cerebral ischemia, which leads via PAR‐1 to the activation of the JNK pathway resulting in neuronal death.
References
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Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
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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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
Bryan Jennett,Michael R. Bond +1 more
TL;DR: In this article, a five-point scale is described, which includes death, persistent vegetative state, severe disability, moderate disability, and good recovery, and duration as well as intensity of disability should be included in an index of ill-health.
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Interobserver agreement for the assessment of handicap in stroke patients.
TL;DR: The results confirm the value of the modified Rankin scale in the assessment of handicap in stroke patients; nevertheless, further improvements are possible.
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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