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000140918 0247_ $$2doi$$a10.1111/ene.14051
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000140918 0247_ $$2ISSN$$a1351-5101
000140918 0247_ $$2ISSN$$a1468-1331
000140918 0247_ $$2ISSN$$a1471-0552
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000140918 037__ $$aDZNE-2020-07240
000140918 041__ $$aEnglish
000140918 082__ $$a610
000140918 1001_ $$0P:(DE-HGF)0$$aFeil, K.$$b0
000140918 245__ $$aAddressing a real-life problem: treatment with intravenous thrombolysis and mechanical thrombectomy in acute stroke patients with an extended time window beyond 4.5 h based on computed tomography perfusion imaging.
000140918 260__ $$aOxford$$bBlackwell Science78889$$c2020
000140918 264_1 $$2Crossref$$3online$$bWiley$$c2019-08-21
000140918 264_1 $$2Crossref$$3print$$bWiley$$c2020-01-01
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000140918 520__ $$aAcute ischemic stroke treatment with intravenous thrombolysis (IVT) is restricted to a time window of 4.5 h after known or presumed onset. Recently, magnetic resonance imaging-guided treatment decision-making in wake-up stroke (WUS) was shown to be effective. The aim of this study was to determine the safety and outcome of IVT in patients with a time window beyond 4.5 h selected by computed tomography perfusion (CTP) imaging.We analyzed all consecutive patients last seen well beyond 4.5 h after stroke onset treated with IVT based on CTP between January 2015 and October 2018. CTP was visually assessed to estimate the mismatch between cerebral blood flow and cerebral blood volume maps. Early infarct signs were documented according to Alberta Stroke Program Early CT Score (ASPECTS). Safety data were obtained for mortality and symptomatic intracerebral hemorrhage (sICH). Follow-up was assessed with the modified Rankin Scale (mRS).A total of 70 patients fulfilled the inclusion criteria (mean age ± SD 77.6 ± 11.5 years, 50.0% female). Median National Institutes of Health Stroke Scale score on admission was 8.0 [interquartile range (IQR), 4-14]. The most frequent reasons for an extended time window were WUS (60.0%) and delayed hospital admission (27.1%). Median time from last seen well to IVT was 11.4 h. Median ASPECTS was 10 (IQR, 9-10) and CTP mismatch 90% (IQR, 80%-100%). A total of 24 patients (34.3%) underwent additional mechanical thrombectomy. sICH occurred in four patients (5.7%). At follow-up, 49.3% had an mRS score of 0-2 and 22.4% had an mRS score of 0-1.In patients presenting in an extended time window beyond 4.5 h, IVT treatment with decision-making based on CTP might be a safe procedure. Further evaluation in clinical trials is needed.
000140918 536__ $$0G:(DE-HGF)POF3-344$$a344 - Clinical and Health Care Research (POF3-344)$$cPOF3-344$$fPOF III$$x0
000140918 542__ $$2Crossref$$i2019-08-21$$uhttp://creativecommons.org/licenses/by-nc/4.0/
000140918 542__ $$2Crossref$$i2019-08-21$$uhttp://doi.wiley.com/10.1002/tdm_license_1.1
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000140918 650_2 $$2MeSH$$aAdministration, Intravenous
000140918 650_2 $$2MeSH$$aAged
000140918 650_2 $$2MeSH$$aAged, 80 and over
000140918 650_2 $$2MeSH$$aBrain Infarction: diagnostic imaging
000140918 650_2 $$2MeSH$$aCerebrovascular Circulation
000140918 650_2 $$2MeSH$$aFemale
000140918 650_2 $$2MeSH$$aFibrinolytic Agents: administration & dosage
000140918 650_2 $$2MeSH$$aFibrinolytic Agents: therapeutic use
000140918 650_2 $$2MeSH$$aHumans
000140918 650_2 $$2MeSH$$aIntracranial Hemorrhages: diagnostic imaging
000140918 650_2 $$2MeSH$$aMagnetic Resonance Imaging
000140918 650_2 $$2MeSH$$aMale
000140918 650_2 $$2MeSH$$aMiddle Aged
000140918 650_2 $$2MeSH$$aPerfusion Imaging
000140918 650_2 $$2MeSH$$aStroke: diagnostic imaging
000140918 650_2 $$2MeSH$$aStroke: surgery
000140918 650_2 $$2MeSH$$aStroke: therapy
000140918 650_2 $$2MeSH$$aThrombectomy: methods
000140918 650_2 $$2MeSH$$aTime-to-Treatment
000140918 650_2 $$2MeSH$$aTomography, X-Ray Computed
000140918 650_2 $$2MeSH$$aTreatment Outcome
000140918 7001_ $$aReidler, P.$$b1
000140918 7001_ $$aKunz, W. G.$$b2
000140918 7001_ $$0P:(DE-HGF)0$$aKüpper, C.$$b3
000140918 7001_ $$aHeinrich, J.$$b4
000140918 7001_ $$aLaub, C.$$b5
000140918 7001_ $$0P:(DE-HGF)0$$aMüller, K.$$b6
000140918 7001_ $$0P:(DE-2719)2811820$$aVöglein, J.$$b7$$udzne
000140918 7001_ $$0P:(DE-HGF)0$$aLiebig, T.$$b8
000140918 7001_ $$0P:(DE-HGF)0$$aDieterich, M.$$b9
000140918 7001_ $$0P:(DE-HGF)0$$aKellert, L.$$b10$$eCorresponding author
000140918 77318 $$2Crossref$$3journal-article$$a10.1111/ene.14051$$b : Wiley, 2019-08-21$$n1$$p168-174$$tEuropean Journal of Neurology$$v27$$x1351-5101$$y2019
000140918 773__ $$0PERI:(DE-600)2020241-6$$a10.1111/ene.14051$$gVol. 27, no. 1, p. 168 - 174$$n1$$p168-174$$q27:1<168 - 174$$tEuropean journal of neurology$$v27$$x1351-5101$$y2020
000140918 8564_ $$uhttps://pub.dzne.de/record/140918/files/DZNE-2020-07240.pdf$$yOpenAccess
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