on March 11, 2004
Stroke. 2004
Published online before print March 11, 2004, doi: 10.1161/01.STR.0000121641.77121.98
Published online before print March 11, 2004, doi: 10.1161/01.STR.0000121641.77121.98
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Background and Purpose--To investigate the feasibility and safety of a combined intravenous (IV) and intra-arterial (IA) approach to recanalization in patients with ischemic stroke. Materials and Methods--Subjects ages 18 to 80 with an NIH Stroke Scale (NIHSS) Results--The 80 subjects had a median baseline NIHSS score of 18. The median time to initiation of IV rt-PA was 140 minutes as compared with 108 minutes for placebo and 90 minutes for rt-PA-treated subjects in the NINDS rt-PA Stroke Trial. The 3-month mortality in Interventional Management Study (IMS) subjects (16%) was numerically lower but not statistically different than the mortality of placebo (24%) and rt-PA-treated subjects (21%) in the NINDS rt-PA Stroke Trial. The rate of symptomatic intracerebral hemorrhage (6.3%) in IMS subjects was similar to that of rt-PA-treated subjects (6.6%) but higher than the rate in placebo-treated subjects (1.0%, P=0.018) in the NINDS rt-PA Stroke Trial. IMS subjects had a significantly better outcome at 3 months than NINDS placebo-treated subjects for all outcome measures (odds ratios Conclusions--A randomized trial of standard IV rt-PA as compared with a combined IV and IA approach is needed.
Combined Intravenous and Intra-arterial Recanalization for Acute Ischemic Stroke: The Interventional Management of Stroke Study
The IMS Study Investigators
10 at baseline had IV recombinant tissue plasminogen activator (rt-PA) started (0.6 mg/kg, 60 mg maximum over 30 minutes) within 3 hours of onset. Additional rt-PA was then administered via microcatheter at the site of the thrombus up to a total dose of 22 mg over 2 hours of infusion or until thrombolysis. Primary comparisons were with similar subsets of placebo and rt-PA-treated subjects from the NINDS rt-PA Stroke Trial.2).
Key words: tissue plasminogen activator • thrombolytic therapy • controlled clinical trials
Related Article:
Stroke 2004 35: 911-912.
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B. C. Tilley, Y. Y. Palesch, K. Kieburtz, B. Ravina, P. Huang, J. J. Elm, K. Shannon, G. F. Wooten, C. M. Tanner, G. C. Goetz, et al. Optimizing the ongoing search for new treatments for Parkinson disease: Using futility designs Neurology, March 14, 2006; 66(5): 628 - 633. [Abstract] [Full Text] [PDF]
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R. Gupta, T.G. Jovin, A. Tayal, and M.B. Horowitz Urgent Stenting of the M2 (Superior) Division of the Middle Cerebral Artery after Systemic Thrombolysis in Acute Stroke AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 521 - 523. [Abstract] [Full Text] [PDF]
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The IMS Study Investigators Hemorrhage in the Interventional Management of Stroke Study Stroke, March 1, 2006; 37(3): 847 - 851. [Abstract] [Full Text] [PDF]
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J. H. Choi, B. T. Bateman, S. Mangla, R. S. Marshall, S. Prabhakaran, J. Chong, J. P. Mohr, H. Mast, and J. Pile-Spellman Endovascular Recanalization Therapy in Acute Ischemic Stroke Stroke, February 1, 2006; 37(2): 419 - 424. [Abstract] [Full Text] [PDF]
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Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]
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Part 9: Stroke Circulation, November 29, 2005; 112(22_suppl): III-110 - III-104. [Full Text] [PDF]
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S. Mangiafico, M. Cellerini, P. Nencini, G. Gensini, and D. Inzitari Intravenous Glycoprotein IIb/IIIa Inhibitor (Tirofiban) followed by Intra-Arterial Urokinase and Mechanical Thrombolysis in Stroke AJNR Am. J. Neuroradiol., November 1, 2005; 26(10): 2595 - 2601. [Abstract] [Full Text] [PDF]
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M. G. Lansberg, J. D. Fields, G. W. Albers, M. V. Jayaraman, H. M. Do, and M. P. Marks Mechanical Thrombectomy Following Intravenous Thrombolysis in the Treatment of Acute Stroke Arch Neurol, November 1, 2005; 62(11): 1763 - 1765. [Abstract] [Full Text] [PDF]
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Y. Y. Palesch, B. C. Tilley, D. L. Sackett, K. C. Johnston, and R. Woolson Applying a Phase II Futility Study Design to Therapeutic Stroke Trials Stroke, November 1, 2005; 36(11): 2410 - 2414. [Abstract] [Full Text] [PDF]
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P. Khatri, J. Neff, J. P. Broderick, J. C. Khoury, J. Carrozzella, T. Tomsick, and for the IMS-I Investigators Revascularization End Points in Stroke Interventional Trials: Recanalization Versus Reperfusion in IMS-I Stroke, November 1, 2005; 36(11): 2400 - 2403. [Abstract] [Full Text] [PDF]
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U. Fischer, M. Arnold, K. Nedeltchev, C. Brekenfeld, P. Ballinari, L. Remonda, G. Schroth, and H. P. Mattle NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke Stroke, October 1, 2005; 36(10): 2121 - 2125. [Abstract] [Full Text] [PDF]
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C. A. Molina and J. L. Saver Extending Reperfusion Therapy for Acute Ischemic Stroke: Emerging Pharmacological, Mechanical, and Imaging Strategies Stroke, October 1, 2005; 36(10): 2311 - 2320. [Abstract] [Full Text] [PDF]
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J. Marti-Fabregas, M. Borrell, D. Cocho, R. Belvis, M. Castellanos, J. Montaner, J. Pagonabarraga, A. Aleu, L. Molina-Porcel, J. Diaz-Manera, et al. Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA Neurology, August 9, 2005; 65(3): 366 - 370. [Abstract] [Full Text] [PDF]
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M. Fisher and for the Stroke Therapy Academic Industry Roundtabl Enhancing the Development and Approval of Acute Stroke Therapies: Stroke Therapy Academic Industry Roundtable Stroke, August 1, 2005; 36(8): 1808 - 1813. [Abstract] [Full Text] [PDF]
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T. A. Tomsick Editorial Comment--Mechanical Embolus Removal: A New Day Dawning Stroke, July 1, 2005; 36(7): 1439 - 1440. [Full Text] [PDF]
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W. S. Smith, G. Sung, S. Starkman, J. L. Saver, C. S. Kidwell, Y.P. Gobin, H. L. Lutsep, G. M. Nesbit, T. Grobelny, M. M. Rymer, et al. Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke: Results of the MERCI Trial Stroke, July 1, 2005; 36(7): 1432 - 1438. [Abstract] [Full Text] [PDF]
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 M. D. Hill, A. M. Buchan, and for The Canadian Alteplase for Stroke Effectivenes Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study Can. Med. Assoc. J., May 10, 2005; 172(10): 1307 - 1312. [Abstract] [Full Text] [PDF]
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O. O. Zaidat, A. P. Slivka, Y. Mohammad, C. Graffagnino, T. P. Smith, D. S. Enterline, G. A. Christoforidis, M. J. Alexander, D. M.D. Landis, and J. I. Suarez Intra-Arterial Thrombolytic Therapy in Peri-Coronary Angiography Ischemic Stroke Stroke, May 1, 2005; 36(5): 1083 - 1084. [Abstract] [Full Text] [PDF]
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O. O. Zaidat, J. I. Suarez, J. L. Sunshine, R. W. Tarr, M. J. Alexander, T. P. Smith, D. S. Enterline, W. R. Selman, and D. M. D. Landis Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 880 - 884. [Abstract] [Full Text] [PDF]
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M. Saqqur, A. Shuaib, A. V. Alexandrov, M. D. Hill, S. Calleja, T. Tomsick, J. Broderick, and A. M. Demchuk Derivation of Transcranial Doppler Criteria for Rescue Intra-arterial Thrombolysis: Multicenter Experience From the Interventional Management of Stroke Study Stroke, April 1, 2005; 36(4): 865 - 868. [Abstract] [Full Text] [PDF]
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D. Pelz, T. Andersson, P. Lylyk, M. Negoro, and M. Soderman Stroke Review: Advances in Interventional Neuroradiology 2004 Stroke, February 1, 2005; 36(2): 211 - 214. [Full Text] [PDF]
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E. A. Noser, H. M. Shaltoni, C. E. Hall, A. V. Alexandrov, Z. Garami, E. D. Cacayorin, J. K. Song, J. C. Grotta, and M. S. Campbell III Aggressive Mechanical Clot Disruption: A Safe Adjunct to Thrombolytic Therapy in Acute Stroke? Stroke, February 1, 2005; 36(2): 292 - 296. [Abstract] [Full Text] [PDF]
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M. L. Flaherty, D. Woo, B. Kissela, E. Jauch, A. Pancioli, J. Carrozzella, J. Spilker, P. Sekar, J. Broderick, and T. Tomsick Combined IV and intra-arterial thrombolysis for acute ischemic stroke Neurology, January 25, 2005; 64(2): 386 - 388. [Abstract] [Full Text] [PDF]
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O. Y. Chernyshev, Z. Garami, S. Calleja, J. Song, M. S. Campbell, E. A. Noser, H. Shaltoni, C.-I Chen, Y. Iguchi, J. C. Grotta, et al. Yield and Accuracy of Urgent Combined Carotid/Transcranial Ultrasound Testing in Acute Cerebral Ischemia Stroke, January 1, 2005; 36(1): 32 - 37. [Abstract] [Full Text] [PDF]
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L. Zhang, Z. G. Zhang, C. Zhang, R. L. Zhang, and M. Chopp Intravenous Administration of a GPIIb/IIIa Receptor Antagonist Extends the Therapeutic Window of Intra-Arterial Tenecteplase-Tissue Plasminogen Activator in a Rat Stroke Model Stroke, December 1, 2004; 35(12): 2890 - 2895. [Abstract] [Full Text] [PDF]
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A. V. Alexandrov Ultrasound Identification and Lysis of Clots Stroke, November 1, 2004; 35(11_suppl_1): 2722 - 2725. [Abstract] [Full Text] [PDF]
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K. Y. Lee, D. I. Kim, S. H. Kim, S. I. Lee, H. W. Chung, Y. W. Shim, S. M. Kim, and J. H. Heo Sequential Combination of Intravenous Recombinant Tissue Plasminogen Activator and Intra-Arterial Urokinase in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., October 1, 2004; 25(9): 1470 - 1475. [Abstract] [Full Text] [PDF]
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