ECASS: lessons for future thrombolytic stroke trials. European Cooperative Acute Stroke Study

Fisher, Miles

doi:10.1001/jama.274.13.1058

Cited by 16 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The confirmation of a vascular occlusion seems to be quite important, knowing that up to 20% of patients with suspected cerebral ischemia will have a negative angiogram (possibly due to early spontaneous clot lysis or microvessel occlusion) and another 10% to 20% have other angiographic exclusion criteria. 14,48 Also, patients with an acute ischemic stroke might have a variety of arterial occlusion sites despite similar clinical presentations. 30 A complete diagnostic cerebral angiogram of the affected territory should be obtained at baseline.…”

Section: Angiographymentioning

confidence: 99%

Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke

Higashida

Furlan

Roberts

et al. 2003

Stroke

1,314

759

View full text Add to dashboard Cite

Background and Purpose-The National Institutes of Health (NIH) estimates that stroke costs now exceed $45 billion per year.Stroke is the third leading cause of death and one of the leading causes of adult disability in North America, Europe, and Asia. A number of well-designed randomized stroke trials and case series have now been reported in the literature to evaluate the safety and efficacy of thrombolytic therapy for the treatment of acute ischemic stroke. These stroke trials have included intravenous studies, intra-arterial studies, and combinations of both, as well as use of mechanical devices for removal of thromboemboli and of neuroprotectant drugs, alone or in combination with thrombolytic therapy. At this time, the only therapy demonstrated to improve outcomes from an acute stroke is thrombolysis of the clot responsible for the ischemic event.There is room for improvement in stroke lysis studies. Divergent criteria, with disparate reporting standards and definitions, have made direct comparisons between stroke trials difficult to compare and contrast in terms of overall patient outcomes and efficacy of treatment. There is a need for more uniform definitions of multiple variables such as collateral flow, degree of recanalization, assessment of perfusion, and infarct size.In addition, there are multiple unanswered questions that require further investigation, in particular, questions as to which patients are best treated with thrombolysis. One of the most important predictors of clinical success is time to treatment, with early treatment of Ͻ3 hours for intravenous tissue plasminogen activator and Ͻ6 hours for intra-arterial thrombolysis demonstrating significant improvement in terms of 90-day clinical outcome and reduced cerebral hemorrhage. It is possible that improved imaging that identifies the ischemic penumbra and distinguishes it from irreversibly infarcted tissue will more accurately select patients for therapy than duration of symptoms. There are additional problems in the assessment of patients eligible for thrombolysis. These include being able to predict whether a particular site of occlusion can be successfully revascularized, predict an individual patient's prognosis and outcome after revascularization, and in particular, to predict the development of intracerebral hemorrhage, with and without clinical deterioration. It is not clear to assume that achieving immediate flow restoration due to thrombolytic therapy implies clinical success and improved outcome. There is no simple correlation between recanalization and observed clinical benefit in all ischemic stroke patients, because other interactive variables, such as collateral circulation, the ischemic penumbra, lesion location and extent, time to treatment, and hemorrhagic conversion, are all interrelated to outcome. Methods-This article was written under the auspices of the Technology Assessment Committees for both the AmericanSociety of Interventional and Therapeutic Neuroradiology and the Society of Interventional Radiology. The purpose ...

show abstract

Section: Angiographymentioning

confidence: 99%

Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke

Higashida

Furlan

Roberts

et al. 2003

Stroke

1,314

759

View full text Add to dashboard Cite

show abstract

“…Unfortunately, with this approach, the diagnosis of cerebral ischemic infarction is assigned incorrectly in as many as 20% of these patients (32). Further, analysis of subjects in studies that used similar selection criteria demonstrated that up to 20% of patients will have a negative angiogram, possibly due to early spontaneous lysis of clot (33).…”

Section: Limitations Of Ct In Stroke Interventionmentioning

confidence: 99%

“…Another 10%-20% had arterial dissections, occlusions sites not readily susceptible to thrombolysis, or minor branch occlusions that without intervention have a favorable natural outcome (33). The lack of sensitivity and specificity in the diagnosis of stroke limits the attainable benefit.…”

Section: Limitations Of Ct In Stroke Interventionmentioning

confidence: 99%

Imaging of Acute Cerebral Ischemia

Beauchamp¹,

Barker²,

Wang³

et al. 1999

Radiology

157

View full text Add to dashboard Cite

Until recently, there was no efficacious treatment for acute cerebral ischemia. As a result, the role of neuroimaging and the radiologist was peripheral in the diagnosis and management of this disease. The demonstration of efficacy using thrombolysis has redefined this role, with the success of intervention becoming increasingly dependent on timely imaging and accurate interpretation. The potential benefits of intervention have only begun to be realized. In this State-of-the-Art review of imaging of acute stroke, the role of imaging in the current and future management of stroke is presented. The role of computed tomography is emphasized in that it is currently the most utilized technique, and its value has been demonstrated in prospective clinical trials. Magnetic resonance techniques are equally emphasized in that they have the potential to provide a single modality evaluation of tissue viability and vessel patency in an increasingly rapid evaluation.

show abstract

“…1 The signal defect of black-hole patterns appears to be due to low-velocity multidirectional turbulent flow during the systolic phase. PMD displays the power instead of the frequency of the Doppler signal.…”

Section: Discussionmentioning

confidence: 99%

“…1 The rapid identification of the location and severity of an arterial obstruction is important for the triage of acute stroke patients. 1 The rapid identification of the location and severity of an arterial obstruction is important for the triage of acute stroke patients.…”

mentioning

confidence: 99%

Power motion‐mode doppler signature: A useful tool for assessing middle cerebral artery stenosis

Kim

Lee

Eun

et al. 2014

J of Clinical Ultrasound

View full text Add to dashboard Cite

show abstract

ECASS: lessons for future thrombolytic stroke trials. European Cooperative Acute Stroke Study

Cited by 16 publications

References 0 publications

Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke

Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke

Imaging of Acute Cerebral Ischemia

Power motion‐mode doppler signature: A useful tool for assessing middle cerebral artery stenosis

Contact Info

Product

Resources

About