European Cooperative Acute Stroke Study-4: Extending the time for thrombolysis in emergency neurological deficits ECASS-4: ExTEND

International Journal of Stroke : Official Journal of the International Stroke Society
H AmiriW Hacke

Abstract

Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is an effective and approved therapy for acute ischemic stroke within 4.5 h of onset except for USA, Canada, Croatia, and Moldovia with a current 3 h label. We hypothesized that ischemic stroke patients selected with significant penumbral mismatch on magnetic resonance imaging (MRI) at 4.5-9 h after onset of stroke will have improved clinical outcomes when given intravenous rt-PA (alteplase) compared to placebo. ECASS-4: ExTEND is an investigator driven, phase 3, randomized, multi-center, double-blind, placebo-controlled study. Ischemic stroke patients presenting within 4.5 and 9 h of stroke onset, who fulfil clinical requirements (National Institutes of Health Stroke Score (NIHSS) 4-26 and pre-stroke modified Rankin Scale (mRS) 0-1) will undergo MRI. Patients who meet imaging criteria (infarct core volume <100 ml, perfusion lesion: infarct core mismatch ratio >1.2 and perfusion lesion minimum volume of 20 ml) additionally will be randomized to either rt-PA or placebo. The primary outcome measure will be the categorical shift in the mRS at day 90. Clinical secondary outcomes will be disability at day 90 dichotomized as favorable outcome mRS 0-1 at day 90...Continue Reading

References

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Citations

Dec 13, 2016·Journal of Cardiovascular Medicine·Danilo Toni, Alessio Pieroni
Dec 29, 2016·Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism·Olivier Zaro-WeberJan Sobesky
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May 8, 2018·Current Cardiology Reports·Rakesh KhatriGustavo J Rodriguez
May 23, 2019·Current Opinion in Neurology·Götz Thomalla, Christian Gerloff
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Jul 17, 2020·Journal of Neurology·Yu-Lei ZhangYun-Cheng Wu
Oct 26, 2018·Stroke; a Journal of Cerebral Circulation·Achala VagalPooja Khatri
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Oct 26, 2018·Stroke; a Journal of Cerebral Circulation·Peter SommerUNKNOWN Austrian Stroke Unit Registry Collaborators
Apr 6, 2019·International Journal of Stroke : Official Journal of the International Stroke Society·Peter RinglebUNKNOWN ECASS-4 study group
Oct 8, 2019·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Kambiz NaelAchala Vagal
May 18, 2020·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Simon NagelPeter A Ringleb
Jan 15, 2021·Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism·Adam E Goldman-YassenSeena Dehkharghani
Feb 19, 2021·European Stroke Journal·Johannes Ar PfaffPeter Arthur Ringleb
Mar 19, 2021·Frontiers in Neurology·Yuanmei Pan, Guowen Shi
Sep 11, 2019·Radiology. Artificial Intelligence·Raphael MeierJohannes Kaesmacher
Nov 24, 2016·Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine·Wolf-Dieter Heiss, Olivier Zaro Weber
Jul 6, 2021·Aging and Disease·Mary HollistBatool F Kirmani
Jul 25, 2021·International Journal of Molecular Sciences·Milton H Hamblin, Jean-Pyo Lee
Aug 1, 2021·The Lancet Child & Adolescent Health·Peter B SpornsMoritz Wildgruber
Aug 17, 2021·Frontiers in Neurology·Christian HerwehSimon Nagel
Sep 3, 2021·Therapeutic Advances in Neurological Disorders·Katharina AlthausAlbert C Ludolph

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Software Mentioned

EPITHET
SAS
SAS®
Olea Sphere®
ExTEND

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