A Randomized Trial of Tenecteplase versus Alteplase for Acute Ischemic Stroke

Ischemic core thresholds change with time to reperfusion: A case control study

“…Baseline National Institutes of Health Stroke Scale (median, 15; interquartile range [IQR], [11][12][13][14][15][16][17][18][19], age (median, 65; IQR, 59-80), and time to intravenous treatment (median, 153 minutes; IQR, 82-315) were well matched (all p > 0.05). Despite similar baseline CTP ischemic core volumes using the previously validated measure (relative cerebral blood flow [rCBF], <30%), thrombectomy patients had a smaller median 24-hour infarct core of 17.3ml (IQR, 11.3-32.8) versus 24.3ml (IQR, 16.7-42.2; p 5 0.011) in alteplase-treated controls.…”

Multimodal Diagnostic Imaging for Hyperacute Stroke

“…There are strong advocates for using CTP to select patients for endovascular therapy, though a growing number think that CTP is inappropriate in an individual patient, arguing that the error bars associated with the noisy postprocessing algorithms are large. 23,24 CTP was used in 3 positive randomized controlled trials of endovascular therapy (ESCAPE, 4 EXTEND-IA, 5 and SWIFT-PRIME 6 ) and a trial using IV tenecteplase 25 (genetically modified tissue plasminogen activator), to identify the penumbra before inclusion in the trials. These outcomes do not establish the necessity of CTP for identifying patients who will benefit from reperfusion therapy because numerous trials that did not use perfusion imaging still demonstrated efficacy.…”

Der lange Weg zu einer wirksamen Behandlung der akuten zerebralen Ischämie

“…Die positive Studie Prolyse In Acute Cerebral Thromboembolism (PROACT, [5]) mit lokaler Behandlung von Verschlüssen der A. cerebri media konnte die inzwischen etwa 20 Jahre lang anhaltende Entwicklung einer systemischen Therapie des "Schlaganfalls" nicht aufhalten, nachdem eine kleine Studie die Wirksamkeit eines Plasminogenaktivators ("tissue-type plasminogen activator", tPA) bei Schlaganfallpatienten nachgewiesen hatte, unabhängig von der arteriellen Pathologie, jedoch nach CT-Ausschluss einer zerebralen Blutung [6]. Eine kürzlich erschienene Metaanalyse von 6756 in 9 randomisierten Studien mit tPA behandelten Schlaganfallpatienten ergab als wichtigste Ergebnisse eine absolute Risikore- [9]. Die Patienten wurden mithilfe der CT, CT-Angiographie und -perfusionsmessung rekrutiert.…”