Stroke: Thrombolysis Guided by Perfusion Imaging Extended Time Window up to 9 Hours after Onset

MedicalResearch.com Interview with:

Geoffrey A Donnan AOMBBS, MD, FRCP, FRACP, FAAHMSProfessor of NeurologyUniversity of Melbourne, Melbourne Brain Centre,Royal Melbourne and Austin Hospitals

Prof. Donnan

Geoffrey A Donnan AO
MBBS, MD, FRCP, FRACP, FAAHMS
Professor of Neurology
University of Melbourne, Melbourne Brain Centre
Royal Melbourne and Austin Hospital

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Currently the thrombolysis time window for acute ischemic stroke is restricted to less than 4.5 hours from stroke onset and patients with wake-up stroke are not eligible.

EXTEND is a multi-centre randomised placebo-controlled trial involving patient with acute ischemic stroke who presented between 4.5 to 9 hours of stroke onset or with wake-up-stroke and had penumbral tissue demonstrated on automated perfusion imaging.

Patients were randomised to receive either alteplase or placebo. In total there were 225 patients recruited and the patients who received alteplase had higher rate of excellent functional outcome at 3 months (35.4% vs 29.5% adjusted odd ration 1.44 with 95% confidence interval 1.01 – 2.06 p=0.04). Patients who received alteplase achieved higher rate of early neurological improvement at day 3, reperfusion and recanalization at 24 hours. There was numerically more haemorrhage in the alteplase group but this not negate the functional benefit and there was no difference in the rate of mortality between the two groups.  Continue reading

Stroke: Speedier Thrombolysis Therapy Prolongs Disability-Free Life

Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital L4C, Grattan St, Parkville VIC 3050, Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, FinlandMedicalResearch.com Interview with:
Atte Meretoja, MD, PhD, MSc (Stroke Medicine)
Associate Professor and Principal Fellow (Neurology),
University of Melbourne
The Royal Melbourne Hospital Australia
Associate Professor of Neurology, University of Helsinki
Helsinki University Central Hospital, Finland

MedicalResearch.com: What are the main findings of the study?

Dr. Meretoja: We used observational prospective data of consecutive stroke patients (n=2258) treated with intravenous thrombolysis in Australian and Finnish centers and a pooled analysis of thrombolysis trials to model the shift in patient outcomes with reducing treatment delays. We found out that each minute the treatment can be delivered faster granted on average 1.8 days of extra healthy life (95% prediction interval 0.9 to 2.7). In practice, this means that each 15 minute decrease in treatment delays provides an average equivalent of one month of additional disability-free life.
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