Extending the time window for thrombolysis: evidence from acute stroke trials.
Data from intravenous tissue plasminogen activator studies have shown rapidly diminishing clinical benefit beyond 3 hours when noncontrast CT is used for treatment triage. Newer trials, such as the Desmoteplase in Acute Ischemic Stroke trial, have now successfully pushed the time window out to 9 hours using the concept of penumbral imaging and treatment of the perfusion-diffusion mismatch. Advanced imaging with CT or MR imaging protocols is providing a means for rational physiologic selection and outcomes assessment in stroke treatment.
Rowley
Howard A
HA
Department of Radiology, University of Wisconsin, Madison, WI 53792, USA. ha.rowley@hosp.wisc.edu
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002986:Clinical Trials as Topic / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods