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Effect of IV alteplase on the ischemic brain lesion at 24-48 hours after ischemic stroke

Mair, G, Von Kummer, R, Morris, Z, Von Heijne, A, Bradey, N, Cala, L, Peeters, Anna, Farrall, A J, Adami, A, Potter, G, Sandercock, P A G, Lindley, R I and Wardlaw, J M 2018, Effect of IV alteplase on the ischemic brain lesion at 24-48 hours after ischemic stroke, Neurology, vol. 91, pp. E2067-E2077, doi: 10.1212/WNL.0000000000006575.

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Title Effect of IV alteplase on the ischemic brain lesion at 24-48 hours after ischemic stroke
Author(s) Mair, G
Von Kummer, R
Morris, Z
Von Heijne, A
Bradey, N
Cala, L
Peeters, AnnaORCID iD for Peeters, Anna orcid.org/0000-0003-4340-9132
Farrall, A J
Adami, A
Potter, G
Sandercock, P A G
Lindley, R I
Wardlaw, J M
Journal name Neurology
Volume number 91
Article ID 22
Start page E2067
End page E2077
Total pages 12
Publisher Lippincott Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2018
ISSN 0028-3878
1526-632X
Keyword(s) IST-3 Collaborative Group
Summary Objective To determine whether alteplase alters the development of ischemic lesions on brain imaging after stroke. Methods The Third International Stroke Trial (IST-3) was a randomized controlled trial of IV alteplase for ischemic stroke. We assessed CT or brain MRI at baseline (pretreatment) and 24 to 48 hours posttreatment for acute lesion visibility, extent, and swelling, masked to all other data. We analyzed associations between treatment allocation, change in brain tissue appearances between baseline and follow-up imaging, and 6-month functional outcome in IST-3. We performed a meta-analysis of randomized trials of alteplase vs control with pre- and post-randomization imaging. Results Of 3,035 patients recruited in IST-3, 2,916 had baseline and follow-up brain imaging. Progression in either lesion extent or swelling independently predicted poorer 6-month outcome (adjusted odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.88-0.96, p < 0.001; OR = 0.73, 95% CI 0.66-0.79, p < 0.001, respectively). Patients allocated alteplase were less likely than controls to develop increased lesion visibility at follow-up (OR = 0.77, 95% CI 0.67-0.89, p < 0.001), but there was no evidence that alteplase reduced progression of lesion extent or swelling. In meta-analysis of 6 trials including IST-3 (n = 4,757), allocation to alteplase was associated with a reduction in ischemic lesion extent on follow-up imaging (OR = 0.85, 95% CI 0.76-0.95, p = 0.004). Conclusion Alteplase was associated with reduced short-term progression in lesion visibility. In meta-analysis, alteplase reduced lesion extent. These findings may indicate that alteplase improves functional outcome by reducing tissue damage. Classification of evidence This study provides Class II evidence that IV alteplase impedes the progression of ischemic brain lesions on imaging after stroke.
Language eng
DOI 10.1212/WNL.0000000000006575
Indigenous content off
Field of Research 1103 Clinical Sciences
1109 Neurosciences
1702 Cognitive Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30152597

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.