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Effect of alteplase on the CT hyperdense artery sign and outcome 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, Cohen, G, Sandercock, P A G, Lindley, R I and Wardlaw, J M 2016, Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke, Neurology, vol. 86, no. 2, pp. 118-125, doi: 10.1212/WNL.0000000000002236.

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Title Effect of alteplase on the CT hyperdense artery sign and outcome 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
Cohen, G
Sandercock, P A G
Lindley, R I
Wardlaw, J M
Journal name Neurology
Volume number 86
Issue number 2
Start page 118
End page 125
Total pages 8
Publisher Lippincott Williams & Wilkins
Place of publication Philadelphia, Pa.
Publication date 2016-01
ISSN 0028-3878
1526-632X
Keyword(s) IST-3 Collaborative Group
Summary Objective: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3). Methods: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518). Results: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p < 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p 0.027) but not in proximal (vs distal) HAS (p 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p 0.516 and p 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p 0.167). Conclusions: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS. Classification of evidence: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.
Language eng
DOI 10.1212/WNL.0000000000002236
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:30152617

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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.