Joanna Wardlaw, Reudiger von Krummer, Trevor Carpenter, Mark Parsons, Richard Lindley, Geoff Cohen, Veronica Murray, Adam Kobayashi, Andre Peeters, Francesca Chappell and Peter Sandercock.
Abstract
Rationale: Intravenous thrombolysis with recombinant tissue plasminogen Activator (rt- PA) improves outcomes in patients treated early after stroke but at the risk of causing intracranial haemorrhage. Restricting rt-P A use to patients with evidence of still salvageable tissue, or with definite arterial occlusion, might help reduce risk, increase benefit and identify patients for treatment at late time windows.
Aims: To determine if perfusion or angiographic imaging with CT or MR help identify patients who are more likely to benefit from rt-PA in the context of a large multicentre randomised trial of rt-PA given within six hours of onset of acute ischaemic stroke, the Third International Stroke Trial (IST-3).
Design: IST-3 is a prospective multicentre randomised controlled trial testing rt-PA (0.9mg/kg, maximum dose 90mg) started up to six hours after onset of acute ischaemic stroke, in patients with no clear indication for or contraindication to rt-PA. Brain imaging (CT or MR) was mandatory pre-randomisation to exclude haemorrhage. Scans were read centrally, blinded to treatment and clinical information. In centres where perfusion and/or angiography imaging were used routinely in stroke, these images were also collected centrally, processed and assessed using validated visual scores and computational measures.
Study Outcomes: The primary outcome in IST-3 is alive and independent (Oxford Handicap Score 0-2) at 6 months; secondary outcomes are symptomatic and fatal intracranial haemorrhage, early and late death. The perfusion and angiography study additionally will examine interactions between rt-PA and clinical outcomes, infarct growth and recanalisation in the presence or absence of perfusion lesions and/or arterial occlusion at presentation. The study is registered ISRCTN25765518.
Coming to IJS.
Abstract
Rationale: Intravenous thrombolysis with recombinant tissue plasminogen Activator (rt- PA) improves outcomes in patients treated early after stroke but at the risk of causing intracranial haemorrhage. Restricting rt-P A use to patients with evidence of still salvageable tissue, or with definite arterial occlusion, might help reduce risk, increase benefit and identify patients for treatment at late time windows.
Aims: To determine if perfusion or angiographic imaging with CT or MR help identify patients who are more likely to benefit from rt-PA in the context of a large multicentre randomised trial of rt-PA given within six hours of onset of acute ischaemic stroke, the Third International Stroke Trial (IST-3).
Design: IST-3 is a prospective multicentre randomised controlled trial testing rt-PA (0.9mg/kg, maximum dose 90mg) started up to six hours after onset of acute ischaemic stroke, in patients with no clear indication for or contraindication to rt-PA. Brain imaging (CT or MR) was mandatory pre-randomisation to exclude haemorrhage. Scans were read centrally, blinded to treatment and clinical information. In centres where perfusion and/or angiography imaging were used routinely in stroke, these images were also collected centrally, processed and assessed using validated visual scores and computational measures.
Study Outcomes: The primary outcome in IST-3 is alive and independent (Oxford Handicap Score 0-2) at 6 months; secondary outcomes are symptomatic and fatal intracranial haemorrhage, early and late death. The perfusion and angiography study additionally will examine interactions between rt-PA and clinical outcomes, infarct growth and recanalisation in the presence or absence of perfusion lesions and/or arterial occlusion at presentation. The study is registered ISRCTN25765518.
Coming to IJS.
