| Autor: |
Bruce C V Campbell, Henry Ma, Peter A Ringleb, Mark W Parsons, Leonid Churilov, Martin Bendszus, Christopher R Levi, Chung Hsu, Timothy J Kleinig, Marc Fatar, Didier Leys, Carlos Molina, Tissa Wijeratne, Sami Curtze, Helen M Dewey, P Alan Barber, Kenneth S Butcher, Deidre A De Silva, Christopher F Bladin, Nawaf Yassi, Johannes A R Pfaff, Gagan Sharma, Andrew Bivard, Patricia M Desmond, Stefan Schwab, Peter D Schellinger, Bernard Yan, Peter J Mitchell, Joaquín Serena, Danilo Toni, Vincent Thijs, Werner Hacke, Stephen M Davis, Geoffrey A Donnan, Geoffrey A. Donnan, Stephen M. Davis, Bruce C.V. Campbell, Mark W. Parsons, Peter J. Mitchell, Patricia M. Desmond, Thomas Oxley, Teddy Y. Wu, Darshan Shah, Henry Zhao, Edrich Rodrigues, Patrick Salvaris, Fana Alemseged, Felix Ng, Cameron Williams, Jo-Lyn Ng, Hans T-H. Tu, Amy McDonald, David Jackson, Jessica Tsoleridis, Rachael McCoy, Lauren Pesavento, Louise Weir, Timothy J. Kleinig, S. Patel, J. Harvey, J. Mahadevan, E. Cheong, Anna Balabanski, Michael Waters, Roy Drew, Jennifer Cranefield, Elizabeth Mackey, Sherisse Celestino, Essie Low, Helen M. Dewey, Christopher F. Bladin, Poh Sien Loh, Philip M. Choi, Skye Coote, Tanya Frost, K. Hogan, C. Ding, S. McModie, W.W. Zhang, Christopher Kyndt, A. Moore, Z. Ross, J. Liu, Ferdinand Miteff, Christopher R. Levi, Timothy Ang, Neil Spratt, Carlos Garcia-Esperon, Lara Kaauwai, Thanh G. Phan, John Ly, Shaloo Singhal, Benjamin Clissold, Kitty Wong, Martin Krause, Susan Day, Jonathan Sturm, Bill O'Brian, Rohan Grimley, Marion Simpson, Matthew Lee-Archer, Amy Brodtmann, Bronwyn Coulton, Dennis Young, Andrew A. Wong, Claire Muller, Deborah K. Field, W. Vallat, Vanessa Maxwell, Peter Bailey, Arman Sabet, Sachin Mishra, Meng Tan, K. George, P. Alan Barber, L. Zhao, Atte Meretoja, Turgut Tatlisumak, G. Sibolt, M. Tiainen, M. Koivu, K. Aarnio, J. Virta, O. Kasari, S. Eirola, M.C. Sun, T.C. Chen, C.S. Chuang, Y.Y. Chen, C.M. Lin, S.C. Ho, P.M. Hsiao, C.H. Tsai, W.S. Huang, Y.W. Yang, H.Y. Huang, W.C. Wang, C.H. Liu, M.K. Lu, C.H. Lu, W.L. Kung, S.K. Jiang, Y.H. Wu, S.C. Huang, C.H. Tseng, L.T. Tseng, Y.C. Guo, D. Lin, C.T. Hsu, C.W. Kuan, J.P. Hsu, H.T. Tsai, M. Suzuki, Y. Sun, H.F. Chen, C.J. Lu, C.H. Lin, C.C. Huang, H.J. Chu, C.Y. Lee, W.H. Chang, Y.C. Lo, Y.T. Hsu, C.H. Chen, P.S. Sung, C.L. Ysai, J.S. Jeng, S.C. Tang, L.K. Tsai, S.J. Yeh, Y.C. Lee, Y.T. Wang, T.C. Chung, C.J. Hu, L. Chan, Y.W. Chiou, L.M. Lien, H.L. Yeh, J.H. Yeh, W.H. Chen, C.L. Lau, A. Chang, I.Y. Lee, M.Y. Huang, J.T. Lee, G.S. Peng, J.C. Lim, Y.D. Hsu, C.C. Lin, C.A. Cheng, C.H. Yen, F.C. Yang, C.H. Hsu, Y.F. Sung, C.K. Tsai, C.L. Tsai, A. Lee, Graeme Hankey, David Blacker, Richard Gerraty, C-I. Chen, C-S. Hsu, Elise Cowley, Michele Sallaberger, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Catherine D'Este, Julie Bernhardt, Leeanne Carey, Dominique Cadilhac, Craig Anderson, David Howells, A. Barber, Alan Connelly, Malcolm Macleod, Victoria O'Collins, W. Wilson, L. Macaulay, Erich Bluhmki, Christoph Eschenfelder, Peter Ringleb, Peter Schellinger, Nils Wahlgren, Joanna Wardlaw, Catherine Oppenheim, Kennedy R. Lees, Markku Kaste, Rüdiger von Kummer, Gilles Chatellier, Rico Laage, Xavier Nuñez, Christina Ehrenkrona, Ann-Sofie Svenson, Lynda Cove, Kurt Niederkorn, Franz Gruber, Peter Kapeller, Robert Mikulik, Jean-Louis Mas, Jörg Berrouschot, Jan Sobesky, Martin Köhrmann, Thorsten Steiner, Christof Kessler, Rainer Dziewas, Sven Poli, Katharina Althaus-Knaurer, Paolo Bovi, Alain L. Rodriguez, Juan F. Arenillas, Keith Muir, Roland Veltkamp, Anand Dixit, Girish Muddegowda, Lalit Kala, Deidre A. De Silva, Kenneth S. Butcher, G. Byrnes, Andre Peeters, J.B. Chalk, John N. Fink, Thomas E. Kimber, David Schultz, Peter J. Hand, Judith Frayne, Brian M. Tress, John McNeil, R. Burns, C. Johnston, M. Williams |
| Jazyk: |
angličtina |
| Rok vydání: |
2019 |
| Předmět: |
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| Popis: |
Stroke thrombolysis with alteplase is currently recommended 0-4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis.In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036.We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15-2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23-76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81-2·96, p=0·66).Patients with ischaemic stroke 4·5-9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis.None. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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