You are currently browsing the tag archive for the ‘actilyse’ tag.

In the era of mechanical reperfusion, HEMS can be a powerful instrument for improving acute stroke delivery and research that is currently underutilized. The speed of HEMS may allow reperfusion for a large number of patients that would not have immediate access due to geography or traffic congestion. Also, HEMS critical early time period after a stroke where specific interventions to preserve penumbra and prevent reperfusion injury may have a significant influence on outcomes. The impact of physical factors generated by the helicopter on the ischemic brain needs to be studied. HEMS are also an opportunity to increase recruitment of patients in standard clinical trials. Addressing the HEMS stroke gap is necessary to homogenize the delivery of acute stroke care and research capabilities through all care settings, therefore minimizing disparities in outcomes based in geographical location.

European Stroke Journal Sept 2016

Press release

 

Mechanical thrombectomy improves outcomes in acute ischemic stroke.

 

Joint statement of the European Stroke Organisation (ESO), the European Society  of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR)

 

Stroke results from rupture or interruption of blood flow in brain vessels can lead to devastating consequences for patients, their families and society. Steady progress has been achieved in the last 20 years in stroke treatment through better prevention, establishment of stroke care units and the use of clot-busting drugs (intravenous thrombolysis).

 

Last week, new scientific evidence from four major stroke studies was presented at the International Stroke Conference in Nashville, USA. It proved that rapid mechanical thrombectomy (clot retrieval) improves patient function after acute ischemic stroke. To achieve this benefit, patients were treated by interventional neuroradiologists in stroke centers with multidisciplinary stroke teams. This treatment should be performed as rapidly as possible in conjunction with standard intravenous thrombolysis.

 

ESO, ESMINT and ESNR acknowledge this significant progress in acute stroke treatment and strongly support its application in appropriately selected patients in well equipped stroke centers by properly trained neurointerventionists. Further randomized trials of thrombectomy and more detailed analysis of the current trials will help to optimize patient selection and treatment algorithms.

 

Detailed guidelines on mechanical thrombectomy are currently being prepared by the key European societies involved in acute stroke care. Before these detailed guidelines become available, ESO, ESMINT and ESNR have jointly updated and support the consensus statement on thrombectomy by the ESO-Karolinska Stroke Update (see http://2014.strokeupdate.org/consensus-statement-mechanical-thrombectomy-acute-ischemic-stroke).

Background

 

The European Stroke Organisation (ESO) is a society of stroke physicians, researchers, societies and patient organizations with the goal of optimizing  and harmonizing  the management of stroke in Europe by supporting medical education and stroke projects.

More on www.eso-stroke.org

Contact: esoinfo@eso-stroke.org


The European Society of  Minimally Invasive Neurological Therapy (ESMINT) is a multidisciplinary society of individuals and groups working or training in the field of minimally invasive neurological therapy in geographical Europe. It has been established in order to promote the benefits of minimally invasive neurological therapies through education, training and support for high quality scientific research. 

More on www.esmint.eu

Contact email: office@esmint.eu

 

The European Society of Neuroradiology / ESNR Diagnostic and Interventional is a professional society organising European neuroradiologists. The Society organises Annual Scientific meetings – ESNR Congress, common European Training courses in neuroradiology – European Course of Neuroradiology (ECNR) and is a forum for professional development of European Neuroradiology.

More on www.esnr.org

Contact email : info@esnr.org

 

icaro3

The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of those treated with I.V. thrombolysis (27.4 %) (adjusted OR 1.75, 95 % CI 1.00-3.03, p = 0.05). Endovascular treatment of patients with acute ICA occlusion did not result in a better functional outcome than treatment with intravenous thrombolysis, but was associated with a higher rate of intracranial bleeding. Overall mortality was significantly reduced in patients treated with endovascular treatment but the rates of patients with severe disability or death were similar. When excluding all patients treated with the combination of I.V. thrombolysis and I.A. procedures, a potential benefit of I.A. treatment alone compared to I.V. thrombolysis was observed.

IST-3 Bibliography: published full papers in peer-reviewed journals

  1.  Innes K. Thrombolysis for acute ischaemic stroke: core nursing requirements. British Journal of Nursing 2003;12(7):416-24
  2. Kane I, Lindley R, Lewis S, Sandercock P. Impact of stroke syndrome and stroke severity on the process of consent in the Third International Stroke Trial. Cerebrovascular Diseases 2006;21:348-52

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=91541&Ausgabe=231712&ProduktNr=224153&filename=91541.pdf

  1. Whiteley W, Lindley R, Wardlaw J, Sandercock P. Third International Stroke Trial. Int J Stroke. 2006;1:172-6.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2006.00043.x/full

  1. Sandercock P, Lindley R, Wardlaw J, Protocol 06PRT/1269: Third International Stroke Trial (IST-3). Lancet

     http://www.thelancet.com/journals/lancet/misc/protocol/06PRT-1269.

  1. Wardlaw JM, Bath P, Sandercock P, Perry D, Palmer J, Watson G, Lloyd S, Geddes J, Farrall A. The NeuroGrid stroke exemplar clinical trial protocol. Int J Stroke. 2007;2:63-9 http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2007.00092.x/full
  2. The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials 2008;9(1):37. http://www.trialsjournal.com/content/9/1/37
  3. SCOPE (Stroke Complications and Outcomes Prediction Engine) Collaborations and IST. Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3). JNNP 2008;79:397-400

http://jnnp.bmj.com/content/79/4/397.full.pdf+html

  1. EPITHET-where next? Sandercock P, Wardlaw J, Dennis M, Lindley R, Hankey G, Matz K, Peeters A, Phillips S, Gubitz G, Prasad K, Ricci S, Celani MG, Righetti E, Cantisani T, Arauz A, Berge E, Slot KB, Kobayashi A, Czlonkowska A, Correia M, Murray V, Lyrer P, Venables G; IST-3 Collaborative Group. Lancet Neurology 2008;7(7):570-1.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(08)70123-6/fulltext

  1. Oxfordshire community stroke project clinical stroke syndrome and appearances of tissue and vascular lesions on pre-treatment CT in hyper-acute ischemic stroke among the first 510 patients in the Third International Stroke Trial (IST-3). Kobayashi A, Wardlaw J, Lindley R, Lewis S, Sandercock P, Czlonkowska A; IST-3 Collaborative Group.Stroke 2009;40(3):743-8.

http://stroke.ahajournals.org/content/40/3/743.full

  1. Should more patients with acute ischaemic stroke receive thrombolytic treatment? Wardlaw J, Murray V, Sandercock P,BMJ 2009; 339.      http://www.bmj.com/content/339/bmj.b4584
  2. The Third International Stroke Trial: Thrombolysis (IST-3) in Poland: are we recruiting the right patients? Czlonkowska A, Kobayashi A, Lewis S, Sandercock P, Lindley R, Baranska-Gieruszczak M on behalf of the IST-3 collaborative group. Polish Journal of Neurology and Neurosurgery. 2009; 43, 3:228-235.

http://www.termedia.pl/Original-paper-The-Third-International-Stroke-Trial-Thrombolysis-IST-3-in-Poland-are-we-recruiting-the-right-patients-,15,12742,0,1.html

  1. Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials2011, 12:252

http://www.trialsjournal.com/content/12/1/252

  1. How many patients might receive thrombolytic therapy in the light of the ECASS-3 and IST-3 data? Jan Bembenek, Adam Kobayashi, Peter Sandercock, Anna Czlonkowska. Int J Stroke 2010; 5:428–431.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00479.x/full

  1. ‘Where are we now with intravenous thrombolysis for acute ischaemic stroke’? Peter Sandercock, Joanna Wardlaw, and Richard Lindley. Int J Stroke 2010; 5: 381–382: http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00465.x/abstract
  2. Statistical analysis plan for the third International Stroke Trial (IST-3); part of a ‘thread’ of reports of the trial. Int J Stroke 2012; 7: 186–18. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00782.x/full
  3. The IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379(9834):2352-2363.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60768-5/fulltext

  1. Wardlaw J M, Murray V, Berge E, del Z G, Sandercock P, Lindley R L et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379(9834):2364-2372. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60738-7/fulltext
  2. IST-3 Collaborative Group. Effect of thrombolysis with alteplase within 6h of acute ischaemic stroke on long-term outcomes (the third international stroke trial [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurology 2013;12:768-76. doi:10.1016/S1474-4422(13)70130-3.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70130-3/fulltext

  1. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, Sandercock P. Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome. An analysis of the Third International Stroke trial. Stroke 2014;45:1000-6: http://dx.doi.org/1161/STROKEAHA.113.004362
  2. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J et al. Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial). Stroke Published online before print November 4, 2014, http://dx.doi.org/1161/STROKEAHA.114.006890
  3. Mair G, von Kummer R, Adami A, White PM, Adams ME, Yan B et al. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial. Neuroradiology 2014 October 7. http://dx.doi.org/10.1007/s00234-014-1441-0
  4. Impact of treatment delay, age and stroke severity of the effects of intravenous thrombolysis with alteplase in acute ischaemic stroke: an individual participant data meta-analysis of randomised trials Emberson J and the Stroke Thrombolysis Trialists Collaboration Lancet. 2014 Aug 5. pii: S0140-6736(14)60584-5. http://dx.doi.org/10.1016/S0140-6736(14)60584-5 .
  5. Mair G, Boyd EV, Chappell FM, von Kummer R, Lindley RI, Sandercock P, Wardlaw JM IST-3 Collaborative Group. Sensitivity and specificity of the Hyperdense Artery Sign for arterial obstruction in acute ischemic stroke Stroke (in press)
  6. Lindley RI, Wardlaw JM, Whiteley W, Cohen G, Blackwell B, Murray G, Sandercock P & the IST-3 Collaborative Group. Alteplase for acute ischemic stroke: outcomes by clinically important subgroups in the Third International Stroke Trial Stroke (submitted for publication)

Link to video of public lecture on stroke and thrombolysis by Peter Sandercock

http://www.ed.ac.uk/schools-departments/clinical-brain-sciences/news/latest-news/public-lectures-epilepsy-stroke

Editorials and commentaries on IST-3 since 2012

 

  1. Lyden PD. In anticipation of International Stroke Trial-3 (IST-3). Stroke 2012;43:1691-4
  2. Leys L, Cordonnier C. rt-PA for ischaemic stroke: what will the next question be?. Lancet 2012;379:2320-1
  3. Donnan GA, Davis SM. IST-3: a major contribution to thrombolysis research. International Journal of Stroke 2012;7:566-7
  4. Furlan AJ. IST-3: no pragmatic answers. International Journal of Stroke 2012;7:568-9
  5. Hoffman JR, Cooper RJ. How is more negative evidence being used to support claims of benefit: the curious case of the international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:473-6
  6. Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:477-9
  7. Kleinig TJ, Churilov L, Parsch CS, Dewey HM, Barber PA. Stroke thrombolysis and the third international stroke trial: examining “the totality of the evidence”. Emergency Medicine Australasia 2012;25:107-9
  8. Hughes S. IST-3: tPA benefits sustained out to 18 months. Medscape. 2013. Article ID 806690. [http://www.medscape.com]
  9. Anderson C. Thrombolysis with alteplase after stroke: extending outcomes. Lancet Neurology 2013;12:731-2
  10. Evidence and doubt in the translation of research into care. Lancet 2014;384:638

Correspondence since 2012

 

  1. Fatovich DM, MacDonald SP, Brown SG, Smith B, Newman DH, Shreves AE, Barer D, Durtis D, Sandercock P, Wardlaw J, Dennis M, Murray G, Lindley R. Thrombolysis in acute ischaemic stroke. Lancet 2012;380:1053-5
  2. Shinton R, Sandercock P, Wardlaw JM, Hudson I. Questions about authorisation of alteplase for ischaemic stroke. Lancet 2014;384:659-63
  3. Dai Q, Sun W, Liu X,Whiteley WN, Thompson D, Sandercock P. Letter by Dai et al regarding article “Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial”. Stroke 2014;45:e132-3

 

Abstracts published since trial results made public in 2012

  1. Sandercock P, Wardlaw JM, Lindley RI, Dennis MS, Cohen G. The third international stroke trial (IST-3) main results part I: primary and secondary outcomes among 3035 patients randomised. Cerebrovascular Diseases 2012;33 Suppl 2:16
  2. Lindley RI, Sandercock P, Wardlaw JW, Dennis MS, Cohen G. The third international stroke trial (IST-3) of thrombolysis main results III. Effect of iv thrombolysis with iv t-PA on death or dependency in the 3035 patients randomized: subgroup analysis. Cerebrovascular Diseases 2012;33(suppl 2):79 (Abst.1) [Ref 19448]
  3. Roots A, Birns J, Bhalla A, Rudd A. Nurse-led telemedicine-directed hyper-acute stroke trial randomisation and management of post-thrombolysis anaphylaxis. Cerebrovascular Diseases 2012;33(suppl 2):477-8 (Abst.2022) [Ref 19403]
  4. Farrall A, Wardlaw J, Sandercock P, Lindley R, Cohen G, von Kummer R, et al. The third international stroke trial (IST-3) of intravenous thrombolysis with rt-PA: baseline imaging features among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:61-2 (Abst.142)
  5. Sandercock P; IST-3 Collaborative Group. The Third International Stroke Trial (IST-3) of thrombolysis. Main results & implications for clinical practice. Cerebrovascular Diseases 2012;34 Suppl 1:6-7 (Abst.S5-1)
  6. Sandercock PAG, Wardlaw JM, Lindley RI, Cohen G; IST3 collaborative group. The third international stroke trial (IST-3) of intravenous rt-PA: effect of age and time on treatment effect among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:6
  7. Lindley RI, Sandercock PA, Wardlaw JM, Dennis MS, Cohen G, IST-3 Collaborative Group. Third international stroke trial (IST-3): subgroup effects of iv rt-PA < 6 hrs in acute ischemic stroke on symptomatic intracranial haemorrhage and outcome at 6 months. Stroke 2013;44 (Abst.TMP23)
  8. Sandercock PA, Wardlaw JM, Lindley RI, Dennis MS, IST-3 Collaborative Group. Third international stroke trial (IST-3): effect of iv rt-pa < 6 hours in acute ischaemic stroke on living circumstances and health related quality of life at six months. Stroke 2013;44 (Abst.WMP22)]
  9. Wardlaw J, Carpenter T, von Kummer R, Cohen G, Lindley R, Sandercock P. Perfusion imaging in patients randomised to rt-PA or control in the third international stroke trial (IST-3): baseline characteristics and association with outcome. Stroke 2013;44 (Abst.A10)
  10. Wardlaw J, von Kummer R, Farrall A, Cala L, von Heijne A, Peeters A, etal. The impact of ischemic and structural brain tissue changes on response to rt-PA: an analysis of imaging from 3035 patients in the third international stroke trial. Stroke 2013;44 (Abst.A104)
  11. Sandercock P, Wardlaw J, Dennis M, Cohen G, Whiteley W, Lindley, et al. Impact of thrombolysis on important aspects of daily life at 18 months in the third International Stroke Trial (IST-3). International Journal of Stroke 2013;8 Suppl 3:4
  12. Whiteley WN, Cohen G, Wardlaw J, Lindley R, Sandercock PAG. IST-3 trial: impact of rt-PA on survival to 18 months post ischaemic stroke. Cerebrovascular Diseases 2013;35(Suppl 3):19 (Abst.6)
  13. Sandercock PAG, Lindley RI, Wardlaw JM, Dennis MS, Cohen G. The third international stroke trial (IST-3): benefits of iv thrombolysis on functional outcome and health-related quality of life (HRQoL) persist to 18 months after treatment. Cerebrovascular Diseases 2013;35(Suppl 3):34 (Abst.4)
  14. Wardlaw JM, Carpenter T, Cohen G, von Kimmer R, Lindley R, Sandercock P. Does perfusion imaging lesion size or mismatch influence six month outcomes after rt-PA given up to six hours after acute ischaemic stroke? The third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):111 (Abst.12)
  15. Whiteley WN, Thompson D, Cohen G, Lindley R, Wardlaw JM, Sandercock PAG. Predictions of intracranial haemorrhage and the risks and benefits of rtPA in acute ischaemic stroke: an analysis of the IST-3 trial. Cerebrovascular Diseases 2013;35(Suppl 3):169 (Abst.4)
  16. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R. Combining CT angiography with non-contrast CT to predict infarct on follow up CT in acute ischaemic stroke. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):237 (Abst.15)
  17. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R, Farrall AJ. Association of non-contrast CT and CT angiography with baseline clinical deficit and functional outcome. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):405 (Abst.226)
  18. Sakka E, Perry D, Buchanan D, Innes K, Sandercock P, Lindley RI, Wardlaw JM. Medical image management for multicentre trials. Experience from the Third International Stroke Trial (IST-3) with 6576 scans. Cerebrovascular Diseases 2013;35(Suppl 3):562 (Abst.24)
  19. Mair G, Wardlaw JM, von Kummer R, Sandercock PA. Response to thrombolysis treatment in ischemic stroke patients with and without arterial occlusion on computed tomographic angiography: the Third International Stroke Trial. Stroke 2014;45(Suppl 1) (Abst.A6)
  20. Khatri P, Tayama D, Cohen G, Lindley RI, Wardlaw JM, Yeatts SD, et al. Effect of IV rtPA in mild strokes in the third international stroke trial (IST3): a post hoc analysis. Stroke 2014;45(Suppl 1) (Abst.ATMP21)

 

 

 

https://www.youtube.com/watch?v=YaQjM-SSohg

Starting on 29 May 2013 with many Oral Sessions fresh updates on Stroke Large clinical trials (RCTs)
at 11:25-12:30 Room: Auditorium INTERACT2, STICH II, CHIMES, IST-3, SPS3, next day PC-Trial, RESPECT, ALIAS, PHANTOM-S, ICSS, EVA-3S, STICH II.
lamp

Image

Boehringer in end 2012 announced the approval in 15 European countries with the mutual recognition procedure, the extent of window treatment with alteplase, rt-PA in cases of acute ischemic stroke within 4 hours of symptom onset and after have ruled out the diagnosis of intracranial hemorrhage. The completion of the regulatory process has been reported by Germany, the Reference Member State, and will allow the implementation of this approval also to the European Union member states that adhere to the mutual recognition procedure. Alteplase is indicated for the fibrinolytic treatment of acute ischemic stroke, or for the dissolution of the clot that has blocked artery, helping to restore the normal blood flow, preventing or limiting damage to ischemic brain tissue. To achieve the greatest possible benefits, treatment should be initiated as early as possible after symptom onset. Alteplase was approved in 1987 for various indications in many countries, and since 1996 for the treatment of ischemic stroke with administration within three hours of the onset of symptoms. The combined analysis of the results of different studies, with placebo control group, showed that treatment with rt-PA within 180 minutes after the onset of ischemic symptoms allows more likely to residuare 30% in less than disability arising from ischemic damage compared to untreated patients or little or no disability after three months of the event compared to patients who did not receive thrombolytic therapy. An official statement by the Italian regulatory agency is likely to be soon released in early 2013. For many Italian hospitals until the official statement of the agency the use of alteplase will not be considered fully appropriate

Ist 3 trial results will be presented in the next European Stroke conference meeting held in Lisbon on 22-25 May. With more than 3000 enrolled patients this is likely to be one of the larget acute stroke trials. Check out the official site and preliminary publications on Trials. 2011 Nov 30;12:252.

The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. A multicentric study gave new data on this topic. According to Italian investigators: in patients with stroke attributable to ICA occlusion, thrombolytic therapy,  results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.

In 2011 SITS enrollment  is approaching 50,000 patients. This number of patients is important to enable an appriate analyses of the benefit and safety of thrombolysis in subgroups such as in the elderly (recent SITS and SITS-VISTA publications in Lancet Neurology and Stroke) and in a later time window (recently in Lancet Neurology). Alse mechanical means of disostruction will be included in the registry.