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
Functional recovery after hematic administration of allogenic mesenchymal stem cells in acute ischemic stroke in rats.
María Gutiérrez-Fernández,Berta Rodríguez-Frutos,J. Álvarez-Grech,María Teresa Vallejo-Cremades,M. Expósito-Alcaide,J. Merino,J.M. Roda,Exuperio Díez-Tejedor +7 more
TL;DR: It is concluded that allogenic MSCs administration shows therapeutic efficacy in the acute ischemic stroke model and both routes demonstrably improved neurological recovery and provided brain protection.
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The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial.
Erik J.R.J. van der Hoeven,Wouter J. Schonewille,Jan Albert Vos,Ale Algra,Heinrich J. Audebert,Eivind Berge,Alfonso Ciccone,Mikael Mazighi,Patrik Michel,Keith W. Muir,Victor Obach,Volker Puetz,C.A.C. Wijman,Andrea Zini,Jaap Kappelle +14 more
TL;DR: BASICS is a randomised controlled, multicentre, open label, phase III intervention trial with blinded outcome assessment, investigating the efficacy and safety of additional IAT after IVT in patients with BAO.
Journal ArticleDOI
Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion A Patient-Level Meta-analysis
TL;DR: It is suggested that a clinical trial of early systemic fibrinolytic therapy for CRAO is warranted and that conservative treatments are futile and may be harmful.
Journal ArticleDOI
microRNAs: Innovative Targets for Cerebral Ischemia and Stroke
TL;DR: Current knowledge about miRNAs and cerebral ischemia is summarized, focusing on the role of mi RNAs in ischemIA, both changes in expression and identification of potential targets, as well as the potential of miRNAAs as biomarkers and therapeutic targets in cerebral ischemic disease.
Journal ArticleDOI
FLAIR can estimate the onset time in acute ischemic stroke patients
TL;DR: FLAIR can estimate the onset time of stroke in AIS within 24h of onset, as estimated by a total of 389 MRI studies.
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ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
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