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Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke

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Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke. / Mair, Grant; von Kummer, Rüdiger; Morris, Zoe et al.
In: Neurology, Vol. 86, No. 2, 12.01.2016, p. 118-125.

Research output: Contribution to Journal/MagazineJournal articlepeer-review

Harvard

Mair, G, von Kummer, R, Morris, Z, von Heijne, A, Bradey, N, Cala, L, Peeters, A, Farrall, AJ, Adami, A, Potter, G, Cohen, G, Sandercock, PAG, Lindley, RI, Wardlaw, JM, Emsley, H & IST-3 Collaborative Group 2016, 'Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke', Neurology, vol. 86, no. 2, pp. 118-125. https://doi.org/10.1212/WNL.0000000000002236

APA

Mair, G., von Kummer, R., Morris, Z., von Heijne, A., Bradey, N., Cala, L., Peeters, A., Farrall, A. J., Adami, A., Potter, G., Cohen, G., Sandercock, P. A. G., Lindley, R. I., Wardlaw, J. M., Emsley, H., & IST-3 Collaborative Group (2016). Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke. Neurology, 86(2), 118-125. https://doi.org/10.1212/WNL.0000000000002236

Vancouver

Mair G, von Kummer R, Morris Z, von Heijne A, Bradey N, Cala L et al. Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke. Neurology. 2016 Jan 12;86(2):118-125. Epub 2015 Dec 9. doi: 10.1212/WNL.0000000000002236

Author

Mair, Grant ; von Kummer, Rüdiger ; Morris, Zoe et al. / Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke. In: Neurology. 2016 ; Vol. 86, No. 2. pp. 118-125.

Bibtex

@article{2f96666ad2b04592b8aa8878c33807fe,
title = "Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke",
abstract = "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.",
keywords = "Aged, Aged, 80 and over, Arteries, Brain Ischemia, Female, Fibrinolytic Agents, Follow-Up Studies, Humans, Male, Stroke, Tissue Plasminogen Activator, Tomography, X-Ray Computed, Treatment Outcome, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",
author = "Grant Mair and {von Kummer}, R{\"u}diger and Zoe Morris and {von Heijne}, Anders and Nick Bradey and Lesley Cala and Andr{\'e} Peeters and Farrall, {Andrew J} and Alessandro Adami and Gillian Potter and Geoff Cohen and Sandercock, {Peter A G} and Lindley, {Richard I} and Wardlaw, {Joanna M} and Hedley Emsley and {IST-3 Collaborative Group}",
note = "{\textcopyright} 2015 American Academy of Neurology.",
year = "2016",
month = jan,
day = "12",
doi = "10.1212/WNL.0000000000002236",
language = "English",
volume = "86",
pages = "118--125",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

RIS

TY - JOUR

T1 - Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke

AU - Mair, Grant

AU - von Kummer, Rüdiger

AU - Morris, Zoe

AU - von Heijne, Anders

AU - Bradey, Nick

AU - Cala, Lesley

AU - Peeters, André

AU - Farrall, Andrew J

AU - Adami, Alessandro

AU - Potter, Gillian

AU - Cohen, Geoff

AU - Sandercock, Peter A G

AU - Lindley, Richard I

AU - Wardlaw, Joanna M

AU - Emsley, Hedley

AU - IST-3 Collaborative Group

N1 - © 2015 American Academy of Neurology.

PY - 2016/1/12

Y1 - 2016/1/12

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Arteries

KW - Brain Ischemia

KW - Female

KW - Fibrinolytic Agents

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Stroke

KW - Tissue Plasminogen Activator

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1212/WNL.0000000000002236

DO - 10.1212/WNL.0000000000002236

M3 - Journal article

C2 - 26658907

VL - 86

SP - 118

EP - 125

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 2

ER -