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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Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association.
Clifford J. Eskey,Philip M. Meyers,Thanh N. Nguyen,Sameer A. Ansari,Mahesh V Jayaraman,Cameron G. McDougall,J. Kevin DeMarco,William A. Gray,David C. Hess,Randall T. Higashida,Dilip K. Pandey,Constantino Peña,Hermann Christian Schumacher +12 more
TL;DR: The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
Journal ArticleDOI
Revascularization in acute ischaemic stroke using the penumbra system: the first single center experience
Iris Q. Grunwald,Silke Walter,P. Papanagiotou,C. Krick,K. Hartmann,A. Dautermann,K. Faßbender,Anton Haass,L. J. Bolar,W. Reith,C. Roth +10 more
TL;DR: This is the first single center experience illustrating the effectiveness of the penumbra system (PS) in the treatment of large vessel occlusive disease in the arena of acute ischaemic stroke.
Journal ArticleDOI
The effects of alteplase 3 to 6 hours after stroke in the EPITHET-DEFUSE combined dataset: post hoc case-control study.
Toshiyasu Ogata,Soren Christensen,Yoshinari Nagakane,Henry Hin Kui Ma,Bruce C.V. Campbell,Leonid Churilov,Maarten G Lansberg,Matus Straka,Deidre A De Silva,Michael Mlynash,Roland Bammer,Jean-Marc Olivot,Patricia Desmond,Gregory W. Albers,Stephen M. Davis,Geoffrey A. Donnan +15 more
TL;DR: The data provide further evidence that alteplase significantly attenuates infarct growth and increases reperfusion compared with placebo in the 3- to 6- hour time window in patients selected based on MR penumbral imaging.
Journal ArticleDOI
A novel magnetic resonance imaging approach to collateral flow imaging in ischemic stroke.
Suk Jae Kim,Jeong Pyo Son,Sookyung Ryoo,Mi Ji Lee,Jihoon Cha,Keon Ha Kim,Gyeong-Moon Kim,Chin-Sang Chung,Kwang Ho Lee,Pyoung Jeon,Oh Young Bang +10 more
TL;DR: A novel collateral flow imaging technique is compared with digital subtraction angiography (DSA) for determining collateral circulation in acute stroke and the ability of MR‐based collateral flow maps to predict outcomes after recanalization therapy is evaluated.
Journal ArticleDOI
Thrombolysis in Cervical Artery Dissection – Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database
Stefan T. Engelter,Jean Dallongeville,Manja Kloss,T. M. Metso,Didier Leys,Tobias Brandt,Yves Samson,V Caso,Alessandro Pezzini,Maria Sessa,Simone Beretta,Stéphanie Debette,Caspar Grond-Ginsbach,A. J. Metso,Vincent Thijs,C. Lamy,Elisabeth De Bustos Medeiros,J.J. Martin,Anna Bersano,Turgut Tatlisumak,Emmanuel Touzé,Philippe Lyrer,Cervical Artery Dissection +22 more
TL;DR: Whether thrombolysis for stroke attributable to cervical artery dissection (CeADStroke) affects outcome and major haemorrhage rates is examined.
References
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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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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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