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dc.contributor.authorMa, H
dc.contributor.authorCampbell, BCV
dc.contributor.authorParsons, MW
dc.contributor.authorChurilov, L
dc.contributor.authorLevi, CR
dc.contributor.authorHsu, C
dc.contributor.authorKleinig, TJ
dc.contributor.authorWijeratne, T
dc.contributor.authorCurtze, S
dc.contributor.authorDewey, HM
dc.contributor.authorMiteff, F
dc.contributor.authorTsai, C-H
dc.contributor.authorLee, J-T
dc.contributor.authorPhan, TG
dc.contributor.authorMahant, N
dc.contributor.authorSun, M-C
dc.contributor.authorKrause, M
dc.contributor.authorSturm, J
dc.contributor.authorGrimley, R
dc.contributor.authorChen, C-H
dc.contributor.authorHu, C-J
dc.contributor.authorWong, AA
dc.contributor.authorField, D
dc.contributor.authorSun, Y
dc.contributor.authorBarber, PA
dc.contributor.authorSabet, A
dc.contributor.authorJannes, J
dc.contributor.authorJeng, J-S
dc.contributor.authorClissold, B
dc.contributor.authorMarkus, R
dc.contributor.authorLin, C-H
dc.contributor.authorLien, L-M
dc.contributor.authorBladin, CF
dc.contributor.authorChristensen, S
dc.contributor.authorYassi, N
dc.contributor.authorSharma, G
dc.contributor.authorBivard, A
dc.contributor.authorDesmond, PM
dc.contributor.authorYan, B
dc.contributor.authorMitchell, PJ
dc.contributor.authorThijs, V
dc.contributor.authorCarey, L
dc.contributor.authorMeretoja, A
dc.contributor.authorDavis, SM
dc.contributor.authorDonnan, GA
dc.date.accessioned2020-01-30T04:28:40Z
dc.date.available2020-01-30T04:28:40Z
dc.date.issued2019
dc.identifier.issn0028-4793
dc.identifier.doi10.1056/NEJMoa1813046
dc.identifier.urihttp://hdl.handle.net/10072/390986
dc.description.abstractBACKGROUND: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging. METHODS: We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging. The patients were randomly assigned to receive intravenous alteplase or placebo between 4.5 and 9.0 hours after the onset of stroke or on awakening with stroke (if within 9 hours from the midpoint of sleep). The primary outcome was a score of 0 or 1 on the modified Rankin scale, on which scores range from 0 (no symptoms) to 6 (death), at 90 days. The risk ratio for the primary outcome was adjusted for age and clinical severity at baseline. RESULTS: After 225 of the planned 310 patients had been enrolled, the trial was terminated because of a loss of equipoise after the publication of positive results from a previous trial. A total of 113 patients were randomly assigned to the alteplase group and 112 to the placebo group. The primary outcome occurred in 40 patients (35.4%) in the alteplase group and in 33 patients (29.5%) in the placebo group (adjusted risk ratio, 1.44; 95% confidence interval [CI], 1.01 to 2.06; P = 0.04). Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group (adjusted risk ratio, 7.22; 95% CI, 0.97 to 53.5; P = 0.05). A secondary ordinal analysis of the distribution of scores on the modified Rankin scale did not show a significant between-group difference in functional improvement at 90 days. CONCLUSIONS: Among the patients in this trial who had ischemic stroke and salvageable brain tissue, the use of alteplase between 4.5 and 9.0 hours after stroke onset or at the time the patient awoke with stroke symptoms resulted in a higher percentage of patients with no or minor neurologic deficits than the use of placebo. There were more cases of symptomatic cerebral hemorrhage in the alteplase group than in the placebo group. (Funded by the Australian National Health and Medical Research Council and others; EXTEND ClinicalTrials.gov numbers, NCT00887328 and NCT01580839.).
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherMassachusetts Medical Society
dc.relation.ispartofpagefrom1795
dc.relation.ispartofpageto1803
dc.relation.ispartofissue19
dc.relation.ispartofjournalNew England Journal of Medicine
dc.relation.ispartofvolume380
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchcode32
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsMedicine, General & Internal
dc.subject.keywordsGeneral & Internal Medicine
dc.subject.keywordsACUTE ISCHEMIC-STROKE
dc.titleThrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationMa, et al., Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke, New England Journal of Medicine, 2019, 380 (19), pp. 1795-1803
dc.date.updated2020-01-30T04:22:18Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2019 Massachusetts Medical Society. The attached file is reproduced here in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version.
gro.hasfulltextFull Text
gro.griffith.authorSabet, Arman
gro.griffith.authorGrimley, Rohan


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