Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/20844
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dc.contributor.authorCampbell, Bruce C V-
dc.contributor.authorMa, Henry-
dc.contributor.authorRingleb, Peter A-
dc.contributor.authorParsons, Mark W-
dc.contributor.authorChurilov, Leonid-
dc.contributor.authorBendszus, Martin-
dc.contributor.authorLevi, Christopher R-
dc.contributor.authorHsu, Chung-
dc.contributor.authorKleinig, Timothy J-
dc.contributor.authorFatar, Marc-
dc.contributor.authorLeys, Didier-
dc.contributor.authorMolina, Carlos-
dc.contributor.authorWijeratne, Tissa-
dc.contributor.authorCurtze, Sami-
dc.contributor.authorDewey, Helen M-
dc.contributor.authorBarber, P Alan-
dc.contributor.authorButcher, Kenneth S-
dc.contributor.authorDe Silva, Deidre A-
dc.contributor.authorBladin, Christopher F-
dc.contributor.authorYassi, Nawaf-
dc.contributor.authorPfaff, Johannes A R-
dc.contributor.authorSharma, Gagan-
dc.contributor.authorBivard, Andrew-
dc.contributor.authorDesmond, Patricia M-
dc.contributor.authorSchwab, Stefan-
dc.contributor.authorSchellinger, Peter D-
dc.contributor.authorYan, Bernard-
dc.contributor.authorMitchell, Peter J-
dc.contributor.authorSerena, Joaquín-
dc.contributor.authorToni, Danilo-
dc.contributor.authorThijs, Vincent N-
dc.contributor.authorHacke, Werner-
dc.contributor.authorDavis, Stephen M-
dc.contributor.authorDonnan, Geoffrey A-
dc.date2019-05-21-
dc.date.accessioned2019-06-05T01:28:39Z-
dc.date.available2019-06-05T01:28:39Z-
dc.date.issued2019-07-
dc.identifier.citationLancet 2019; 394(10193): 139-147en
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/20844-
dc.description.abstractStroke thrombolysis with alteplase is currently recommended 0-4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis. In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036. We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15-2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [<1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23-76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81-2·96, p=0·66). Patients with ischaemic stroke 4·5-9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis. None.en
dc.language.isoeng-
dc.titleExtending thrombolysis to 4·5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data.en
dc.typeJournal Articleen_US
dc.identifier.journaltitleLanceten
dc.identifier.affiliationDepartment of Radiology, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Neurology, Sapienza University of Roma, Rome, Italyen
dc.identifier.affiliationDepartment of Neuroradiology, Ruprecht Karls University Heidelberg, Heidelberg, Germanyen
dc.identifier.affiliationGraduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwanen
dc.identifier.affiliationDepartment of Neurology, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germanyen
dc.identifier.affiliationDepartment of Neurology, Hospital CHU Lille, Lille, Franceen
dc.identifier.affiliationDepartment of Neurology, Hospital Vall d'Hebron, University of Barcelona, Barcelona, Spainen
dc.identifier.affiliationDepartment of Neurology, Helsinki University Hospital, Helsinki, Finlanden
dc.identifier.affiliationDepartment of Neurology, Auckland City Hospital, University of Auckland, Auckland, New Zealanden
dc.identifier.affiliationDepartment of Neurology, Singapore General Hospital, National Neuroscience Institute, Singaporeen
dc.identifier.affiliationDepartment of Neurology, University of Erlangen-Nuremberg, Erlangen, Germanyen
dc.identifier.affiliationDepartment of Neurology and Neurogeriatry, Johannes Wesling Medical Centre Minden, University Hospital of Ruhr-University Bochum, Bochum, Germanyen
dc.identifier.affiliationDepartment of Neurology, Girona University Hospital, Biomedical Research Institute of Girona, Girona, Spainen
dc.identifier.affiliationDepartment of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDivision of Neurology, University of Alberta, Edmonton, AB, Canadaen
dc.identifier.affiliationDepartment of Neurology, Ruprecht Karls University Heidelberg, Heidelberg, Germanyen
dc.identifier.affiliationRoyal Melbourne Hospital, and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationPrince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australiaen
dc.identifier.affiliationDepartment of Neurology, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australiaen
dc.identifier.affiliationWestern Hospital, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Neurology, Western Health, Sunshine Hospital, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Medicine, University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Neurology, Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australiaen
dc.identifier.affiliationDepartment of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australiaen
dc.identifier.affiliationMedicine (University of Melbourne)en
dc.identifier.doi10.1016/S0140-6736(19)31053-0en
dc.type.contentTexten_US
dc.identifier.orcid0000-0002-6614-8417en
dc.identifier.pubmedid31128925-
dc.type.austinJournal Article-
local.name.researcherChurilov, Leonid
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.languageiso639-1en-
item.grantfulltextnone-
item.openairetypeJournal Article-
crisitem.author.deptMedicine (University of Melbourne)-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
crisitem.author.deptNeurology-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
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