Home > Publications Database > Addressing 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. > print

001     140918
005     20250718101059.0
024 7 _ |a 10.1111/ene.14051
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024 7 _ |a pmid:31349393
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024 7 _ |a 1351-5101
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024 7 _ |a 1468-1331
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024 7 _ |a 1471-0552
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037 _ _ |a DZNE-2020-07240
041 _ _ |a English
082 _ _ |a 610
100 1 _ |a Feil, K.
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245 _ _ |a Addressing 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.
260 _ _ |a Oxford
|c 2020
|b Blackwell Science78889
264 _ 1 |3 online
|2 Crossref
|b Wiley
|c 2019-08-21
264 _ 1 |3 print
|2 Crossref
|b Wiley
|c 2020-01-01
336 7 _ |a article
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336 7 _ |a Journal Article
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336 7 _ |a ARTICLE
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336 7 _ |a Journal Article
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520 _ _ |a Acute 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.
536 _ _ |a 344 - Clinical and Health Care Research (POF3-344)
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542 _ _ |i 2019-08-21
|2 Crossref
|u http://creativecommons.org/licenses/by-nc/4.0/
542 _ _ |i 2019-08-21
|2 Crossref
|u http://doi.wiley.com/10.1002/tdm_license_1.1
588 _ _ |a Dataset connected to CrossRef, PubMed,
650 _ 2 |a Administration, Intravenous
|2 MeSH
650 _ 2 |a Aged
|2 MeSH
650 _ 2 |a Aged, 80 and over
|2 MeSH
650 _ 2 |a Brain Infarction: diagnostic imaging
|2 MeSH
650 _ 2 |a Cerebrovascular Circulation
|2 MeSH
650 _ 2 |a Female
|2 MeSH
650 _ 2 |a Fibrinolytic Agents: administration & dosage
|2 MeSH
650 _ 2 |a Fibrinolytic Agents: therapeutic use
|2 MeSH
650 _ 2 |a Humans
|2 MeSH
650 _ 2 |a Intracranial Hemorrhages: diagnostic imaging
|2 MeSH
650 _ 2 |a Magnetic Resonance Imaging
|2 MeSH
650 _ 2 |a Male
|2 MeSH
650 _ 2 |a Middle Aged
|2 MeSH
650 _ 2 |a Perfusion Imaging
|2 MeSH
650 _ 2 |a Stroke: diagnostic imaging
|2 MeSH
650 _ 2 |a Stroke: surgery
|2 MeSH
650 _ 2 |a Stroke: therapy
|2 MeSH
650 _ 2 |a Thrombectomy: methods
|2 MeSH
650 _ 2 |a Time-to-Treatment
|2 MeSH
650 _ 2 |a Tomography, X-Ray Computed
|2 MeSH
650 _ 2 |a Treatment Outcome
|2 MeSH
700 1 _ |a Reidler, P.
|b 1
700 1 _ |a Kunz, W. G.
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700 1 _ |a Küpper, C.
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700 1 _ |a Heinrich, J.
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700 1 _ |a Laub, C.
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700 1 _ |a Müller, K.
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700 1 _ |a Vöglein, J.
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700 1 _ |a Liebig, T.
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700 1 _ |a Dieterich, M.
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700 1 _ |a Kellert, L.
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|e Corresponding author
773 1 8 |a 10.1111/ene.14051
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|t European Journal of Neurology
|v 27
|y 2019
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773 _ _ |a 10.1111/ene.14051
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910 1 _ |a Deutsches Zentrum für Neurodegenerative Erkrankungen
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