Trial reportNeuroradiology2012
Perfusion-CT guided intravenous thrombolysis in patients with unknown-onset stroke: a randomized, double-blind, placebo-controlled, pilot feasibility trial.
Trial report in Neuroradiology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke.The Cochrane database of systematic reviews · 2021Pooled it
- Safety of intravenous thrombolysis in stroke of unknown time of onset: A systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2021Pooled it
- Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis.Behavioural neurology · 2019Pooled it
- Recanalisation therapies for wake-up stroke.The Cochrane database of systematic reviews · 2018Pooled it
- Thrombolysis for acute ischaemic stroke.The Cochrane database of systematic reviews · 2014Pooled it
- Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results.Annals of neurology · 2018Trial
- Performance of automated CT ASPECTS in comparison to physicians at different levels on evaluating acute ischemic stroke at a single institution in China.Chinese neurosurgical journal · 2021Article
- European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.European stroke journal · 2021Article
- Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach.Therapeutic advances in neurological disorders · 2021Review
- Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence.Therapeutic advances in neurological disorders · 2021Review
- Endovascular Thrombectomy in Wake-Up Stroke and Stroke with Unknown Symptom Onset.AJNR. American journal of neuroradiology · 2018Article
- CT Permeability Imaging Predicts Clinical Outcomes in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolytic Therapy.Molecular neurobiology · 2017Article
- Reasons and evolution of non-thrombolysis in acute ischaemic stroke.Emergency medicine journal : EMJ · 2017Article
- Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis.Neural regeneration research · 2017Article
- What to do With Wake-Up Stroke.The Neurohospitalist · 2015Review
- Wake-up stroke and stroke of unknown onset: a critical review.Frontiers in neurology · 2014Review
- Stroke treatment using intravenous and intra-arterial tissue plasminogen activator.Current treatment options in cardiovascular medicine · 2012Article
- Standardization of Stroke Perfusion CT for Reperfusion Therapy.Translational stroke research · 2012Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
introductionPatients with unknown stroke onset are generally excluded from acute recanalisation treatments. We designed a pilot study to assess feasibility of a trial of perfusion computed tomography (PCT)-guided thrombolysis in patients with ischemic tissue at risk of infarction and unknown stroke onset.
methodsPatients with a supratentorial stroke of unknown onset in the middle cerebral artery territory and significant volume of at-risk tissue on PCT were randomized to intravenous thrombolysis with alteplase (0.9 mg/kg) or placebo. Feasibility endpoints were randomization and blinded treatment of patients within 2 h after hospital arrival, and the correct application (estimation) of the perfusion imaging criteria.
resultsAt baseline, there was a trend towards older age [69.5 (57-78) vs. 49 (44-78) years] in the thrombolysis group (n = 6) compared to placebo (n = 6). Regarding feasibility, hospital arrival to treatment delay was above the allowed 2 h in three patients (25%). There were two protocol violations (17%) regarding PCT, both underestimating the predicted infarct in patients randomized in the placebo group. No symptomatic hemorrhage or death occurred during the first 7 days. Three of the four (75%) and one of the five (20%) patients were recanalized in the thrombolysis and placebo group respectively. The volume of non-infarcted at-risk tissue was 84 (44-206) cm(3) in the treatment arm and 29 (8-105) cm(3) in the placebo arm.
conclusionsThis pilot study shows that a randomized PCT-guided thrombolysis trial in patients with stroke of unknown onset may be feasible if issues such as treatment delays and reliable identification of tissue at risk of infarction tissue are resolved. Safety and efficiency of such an approach need to be established.
Indexed as
Identifiers
21808985What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.