Document Detail


Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke.
MedLine Citation:
PMID:  15548777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transcranial Doppler ultrasonography that is aimed at residual obstructive intracranial blood flow may help expose thrombi to tissue plasminogen activator (t-PA). Our objective was to determine whether ultrasonography can safely enhance the thrombolytic activity of t-PA. METHODS: We treated all patients who had acute ischemic stroke due to occlusion of the middle cerebral artery with intravenous t-PA within three hours after the onset of symptoms. The patients were randomly assigned to receive continuous 2-MHz transcranial Doppler ultrasonography (the target group) or placebo (the control group). The primary combined end point was complete recanalization as assessed by transcranial Doppler ultrasonography or dramatic clinical recovery. Secondary end points included recovery at 24 hours, a favorable outcome at three months, and death at three months. RESULTS: A total of 126 patients were randomly assigned to receive continuous ultrasonography (63 patients) or placebo (63 patients). Symptomatic intracerebral hemorrhage occurred in three patients in the target group and in three in the control group. Complete recanalization or dramatic clinical recovery within two hours after the administration of a t-PA bolus occurred in 31 patients in the target group (49 percent), as compared with 19 patients in the control group (30 percent; P=0.03). Twenty-four hours after treatment of the patients eligible for follow-up, 24 in the target group (44 percent) and 21 in the control group (40 percent) had dramatic clinical recovery (P=0.7). At three months, 22 of 53 patients in the target group who were eligible for follow-up analysis (42 percent) and 14 of 49 in the control group (29 percent) had favorable outcomes (as indicated by a score of 0 to 1 on the modified Rankin scale) (P=0.20). CONCLUSIONS: In patients with acute ischemic stroke, continuous transcranial Doppler augments t-PA-induced arterial recanalization, with a nonsignificant trend toward an increased rate of recovery from stroke, as compared with placebo.
Authors:
Andrei V Alexandrov; Carlos A Molina; James C Grotta; Zsolt Garami; Shiela R Ford; Jose Alvarez-Sabin; Joan Montaner; Maher Saqqur; Andrew M Demchuk; Lemuel A Moyé; Michael D Hill; Anne W Wojner;
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Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase II; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  351     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2004-11-23     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2170-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2004 Massachusetts Medical Society.
Affiliation:
Stroke Treatment Team, University of Texas-Houston Medical School, Houston 77030, USA. avalexandrov@att.net
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Brain Ischemia / drug therapy,  therapy*,  ultrasonography
Combined Modality Therapy
Fibrinolytic Agents / therapeutic use*
Humans
Infarction, Middle Cerebral Artery / drug therapy,  therapy*,  ultrasonography
Injections, Intravenous
Thrombolytic Therapy / methods*
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Ultrasonic Therapy*
Ultrasonography, Doppler, Transcranial
Grant Support
ID/Acronym/Agency:
1K23NS02229-01/NS/NINDS NIH HHS; 1P50NS044227/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
N Engl J Med. 2004 Nov 18;351(21):2154-5   [PMID:  15548774 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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