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| Late infusion of t-PA after stroke associated with significant success rate |
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10 March 2006
Administration of tissue-type plasminogen activator (t-PA) 3 to 6 hours after onset of stroke symptoms has a recanalisation rate of 27%. The findings indicate that the standard therapeutic window of t-PA administration of no more than 3 hours after symptom onset can be successfully widened in some cases.
Investigators with the Diffusion-weighted imaging Evaluation For Understanding Stroke Evolution (DEFUSE) trial reported their findings at the American Stroke Association's International Stroke Conference 2006 here.
DEFUSE involved 64 consecutive patients with acute ischaemic strokes presenting at seven centres. There were 44 complete or partial occlusions of an intracranial artery among the 64 patients. Mean time from symptom onset to i.v. bolus of t-PA was 4.5 hours.
Principal investigator Dr Michael P. Marks of the Stanford Stroke Center in Palo Alto, California, USA, told meeting attendees that complete early recanalisation occurred in 12 patients (27%) and partial recanalisation in seven patients (15%). There was a 60% reduction in ischaemic area with recanalisation. Patients with early recanalisation had a mean age of 76 compared with a mean age of 65 years for the total population and had slightly higher baseline disability scores at 14 on the NIH Stroke Severity scale compared with a score of 13 overall. Early return of blood flow was associated with an improvement in disability score of 37% compared with 28% in those with late recanalisation. Recanalisation in the M1 segment of the middle cerebral artery was better than with other intracerebral arteries.
"There is a certain subset that we made worse," Dr Marks acknowledged, calling the overall rate of complete recanalisation of 27% "modest."
Reference:
ISC 2006
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