Perfusion imaging may guide thrombolysis up to 9 hours after onset of stroke

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New Delhi, May 09, 2019 :

The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. This treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging.

The EXTEND trial is 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 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.

A total of 113 patients were randomly assigned to the alteplase group and 112 to the placebo group. The primary outcome (score of 0 or 1 on the modified Rankin scale) 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)… (Source: N Engl J Med 2019; 380:1795-1803; published May 9, 2019)

The Author of this article is Dr K K Aggarwal, Padma Shri Awardee.

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