Track topics on Twitter Track topics that are important to you
The clinical and radiological data of patients with an acute ischemic stroke treated with intravenous thrombolysis (IVT) or intraarterial thrombolysis (IAT) in a Swiss stroke unit are assessed in a Swiss Multicenter Thrombolysis Registry. Like in clinical routine, a clinical evaluation takes place in a 3-months follow-up. Furthermore quality of life is assessed with a standardized questionnaire. The aim of the registry is to compare the safety and efficacy of IVT and IAT in patients with acute ischemic stroke. The registry also helps to improve in-hospital-management of stroke patients.
Background: Intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) have been shown to be effective treatments for acute stroke in controlled randomized trials and meta-analyses. However, prospective studies comparing IVT and IAT have not been performed, and it is not known which patients benefit more from IVT or IAT. Non-invasive neurovascular imaging techniques such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA) have the potential to improve patient selection for the optimal mode of thrombolytic therapy and provide data of pre-treatment neurovascular findings of patients treated with IVT. IAT series have identified several prognostic factors for favourable or poor outcome predictors such as vessel recanalization, location of the vascular occlusion or NIHSS at admission. Additional studies have shown that recanalization rates in patients with central ves-sel occlusions such as middle cerebral artery (MCA) main stem or MCA main branch or basilar artery (BA) is higher when treated with IAT compared to IVT. Therefore we hypothesize that IAT might be more efficacious in these patients.
Objective: Prospective observational multicenter registry with the following aims: To compare the safety and efficacy of IAT and IVT in patients with acute ischemic stroke. To improve safety of IAT and IVT by monitoring the in-hospital management.
Methods: Consecutive patients with acute ischemic stroke who are treated with IVT or IAT within 6 hours of symptom onset in a Swiss stroke unit will be eligible for this registry. Patients are given either intravenous rt-PA or receive IAT such as intra-arterial urokinase, intra-arterial rt-PA or mechanical endovascular recanalization techniques. Patient involvement in the registry shall not influence any treatment decision. Patients will undergo a complete diagnostic work up including a clinical neurological examination using the National Institutes of Health Stroke Scale (NIHSS) score on admission, laboratory examination, brain and neurovascular imaging, echocardiography, 24-hours ECG to determine stroke etiology using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The treating physician will initiate secondary prevention of stroke as soon as possible. All patients will be examined by CT and CTA or MRI and MRA on day 1 and in any case of clinical deterioration to exclude intracranial haemorrhage and to assess recanalization of the occluded vessel (using the thrombolysis in myocardial infarction (TIMI) grading system). Clinical outcome will be evaluated on day 1 and at 3 months using the National Institute of Health Stroke Scale (NIHSS) score, modified Rankin Scale score (mRS), Barthel Index (BI), and assessing adverse events and quality of life. The proportion of patients with favourable outcome (mRS 0 to 2) at 3 months after IVT and IAT will serve as the primary outcome measure. In addition, subgroup analyses will be performed stratified by NIHSS, location of vessel occlusion, time to hospital admission and time to treatment. Secondary outcome measures will include quality of life and the proportion of patients with an excellent outcome (mRS 0 or 1) at 3 months, BI 75 to 100 at 3 months, mortality at 3 months, rapid neurological improvement during the first 24 hours, complete or partial recanalization, and symptomatic intracranial haemorrhage.
Observational Model: Cohort, Time Perspective: Prospective
Intravenous Thrombolysis, Intraarterial Thrombolysis
Dep. of Neurology, Bern University Hospital
University Hospital Inselspital, Berne
Published on BioPortfolio: 2014-08-27T03:25:31-0400
The purpose of this study is to determine whether intra-arterial rt-PA within 6 hours from an ischemic stroke onset, compared with intravenous infusion of the same drug within 3 hours, inc...
PROMISE is a prospective, nationwide, multicenter, longitudinal cohort study, focusing on hospital intravenous thrombolysis process reengineering for acute ischemic stroke (AIS). With a pr...
Ischemic stroke is the leading cause of acquired disability among adults, and one of the main causes of death. In Switzerland, the approved time window for stroke treatment with intravenou...
The current management of ischemic stroke is based on different strategies that may be combined: intravenous thrombolysis in a stroke ICU, intravenous thrombolysis in a telemedicine proced...
The principle research question is: in patients with acute ischaemic stroke eligible for IV thrombolysis, is tenecteplase superior in efficacy to alteplase, based on functional outcome as ...
Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT f...
Recognizing new-territory ischemic stroke as an uncommon complication of intravenous thrombolysis is very important as it can lead to neurological deterioration during tissue-plasminogen-activator inf...
Inconsistent evidence supports better outcome in smokers after stroke. Our study examines this association in a large sample of ischemic stroke treated with intravenous thrombolysis.
A large number of suspected stroke patients undergoing intravenous thrombolysis are stroke mimics (SMs). In this study, we sought to revise the FABS scale for screening and stratifying SMs from acute ...
Intravenous thrombolysis (ivT) with recombinant tissue plasminogen activator is established in acute ischaemic stroke. Little is known, however, about its efficacy in different stroke subtypes.
Damage to the MYOCARDIUM resulting from MYOCARDIAL REPERFUSION (restoration of blood flow to ischemic areas of the HEART.) Reperfusion takes place when there is spontaneous thrombolysis, THROMBOLYTIC THERAPY, collateral flow from other coronary vascular beds, or reversal of vasospasm.
Procedures to cause the disintegration of THROMBI by physical interventions.
The application of repeated, brief periods of vascular occlusion at the onset of REPERFUSION to reduce REPERFUSION INJURY that follows a prolonged ischemic event. The techniques are similar to ISCHEMIC PRECONDITIONING but the time of application is after the ischemic event instead of before.
A drug combination of aspirin and dipyridamole that functions as a PLATELET AGGREGATION INHIBITOR, used to prevent THROMBOSIS and STROKE in TRANSIENT ISCHEMIC ATTACK patients.
Ischemic injury to the OPTIC NERVE which usually affects the OPTIC DISK (optic neuropathy, anterior ischemic) and less frequently the retrobulbar portion of the nerve (optic neuropathy, posterior ischemic). The injury results from occlusion of arterial blood supply which may result from TEMPORAL ARTERITIS; ATHEROSCLEROSIS; COLLAGEN DISEASES; EMBOLISM; DIABETES MELLITUS; and other conditions. The disease primarily occurs in the sixth decade or later and presents with the sudden onset of painless and usually severe monocular visual loss. Anterior ischemic optic neuropathy also features optic disk edema with microhemorrhages. The optic disk appears normal in posterior ischemic optic neuropathy. (Glaser, Neuro-Ophthalmology, 2nd ed, p135)
Neurology - Central Nervous System (CNS)
Alzheimer's Disease Anesthesia Anxiety Disorders Autism Bipolar Disorders Dementia Epilepsy Multiple Sclerosis (MS) Neurology Pain Parkinson's Disease Sleep Disorders Neurology is the branch of me...
Stroke - Cerebrovascular Disease (CVA)
A stroke is a serious medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is ...
Women's Health - key topics include breast cancer, pregnancy, menopause, stroke Follow and track Women's Health News on BioPortfolio: Women's Health News RSS Women'...