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dc.contributor.authorDonnan, Geoffrey Aen
dc.contributor.authorBaron, Jean-Claudeen
dc.contributor.authorMa, Henry Ken
dc.contributor.authorDavis, Stephen Men
dc.identifier.citationThe Lancet. Neurology; 8(3): 261-9en
dc.description.abstractAfter ischaemic stroke onset, potentially viable (ie, penumbral) tissue might be salvageble for as long as 48 h. By increasing the therapeutic time window for treatment of stroke with intravenous alteplase from 3-4.5 h to 9 h, many more patients could be treated. Use of a combination of diffusion-weighted and perfusion-weighted MRI or perfusion CT might improve selection of patients with penumbral tissue. Several phase II trials of alteplase lend strong biological support to the use of this strategy for up to 6 h after stroke. However, the negative results of the phase III Desmoteplase In Acute ischaemic Stroke trial (DIAS-2) with desmoteplase given up to 9 h after stroke suggest that some refinements are needed. For trials of neuroprotection, the concept of freezing the penumbra (ie, preventing further deterioration of the vulnerable tissue) might be a more realistic expectation. Recent advances in penumbral imaging technology should enable a phase III alteplase trial to be done beyond 4.5 h by use of techniques to select patients with penumbral tissue.en
dc.subject.otherClinical Trials as Topicen
dc.subject.otherFibrinolytic Agents.therapeutic useen
dc.subject.otherMagnetic Resonance Imagingen
dc.subject.otherPatient Selectionen
dc.subject.otherPlasminogen Activators.therapeutic useen
dc.subject.otherStroke.drug therapy.pathologyen
dc.subject.otherTime Factorsen
dc.subject.otherTissue Plasminogen Activator.therapeutic useen
dc.subject.otherTomography, X-Ray Computeden
dc.titlePenumbral selection of patients for trials of acute stroke therapy.en
dc.typeJournal Articleen
dc.identifier.journaltitleThe Lancet. Neurologyen
dc.identifier.affiliationNational Stroke Research Institute, Austin Health, University of Melbourne, Australiaen
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