evidence-based approach to imaging-based thrombolysis beyond the 4.5hours window heart vessels...
TRANSCRIPT
Evidence-based approach to imaging-based thrombolysis
beyond the 4.5hours window
Heart Vessels StrokeΑthens, 27-01-2013
Γ ε ώ ρ γ ι ο ς Ν τ ά ι ο ς
Π α θ ο λ ο γ ι κ ή Κ λ ι ν ι κ ή & Ο μ ώ ν υ μ ο Ε ρ ε υ ν η τ ι κ ό Ε ρ γ α σ τ ή ρ ι ο
Ι α τ ρ ι κ ή Σ χ ο λ ή Π α ν ε π ι σ τ η μ ί ο υ Θ ε σ σ α λ ί α ς
Disclosures
• Support to attend conferences: Bayer; Sanofi-Aventis; Pfizer; Lundbeck; Boehringer-Ingelheim; Bristol Myers Squibb; Galenica.
• Honoraria: Quintiles; CHUV.
• Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis.
• National coordinator (Greece) for the ENOS trial.
Patient P. M., 77years-old
- 77 years old man found in bed with aphasia and right hemisyndrome
- Admission: 7.5 hours after last-well time
- NIHSS score = 20
Patient P. M., 77years-old
«Intravenous rtPA is recommended within 4.5 hours
of onset of ischaemic stroke (Class I, Level A)»
Patient P. M., 77years-old
The ischemic penumbra
The sooner, the better
**
Lancet 2004; 363: 768–74
4.5 hours
Patient P. M., 77years-old
Penumbra: 207.8ml
Initial infarct: 14.1ml
Patient P. M., 77years-old
Patient P. M., 77years-old
5-days DWI-MRI
Final infarct: 15.7ml
Initial infarct: 14.1ml
Num
ber o
f cas
es
0
50
100
150
200
250
300
3 6 9 12 15 18 21 24
Time (hours)
Known onset(n=1075)
Unknown onset(n=454)
4.5h
Michel P, Ntaios G, et al. Stroke 2010; 41:2491-8.
Outcome
OutcomerTPA
groupn=6
Placebo group
n=6Symptomatic hemorrhagic transformation at 24hours/4 days
0/0 0/0
Asymptomatic hemorrhagic transformations at 24hours (CT)
2 2
Asymptomatic hemorrhagic transformations at 4days (MRI)
3 2
Mortality at 7/90 days 0/0 0/0
Salvaged brain tissue (cm3)* 84 (44-206)
29 (8-105)
Independence at 3 months (Rankin score ≤2)
80%
60%
40%
20%
0%
rtPA Placebo
16.6%
66 %
4/6
1/6
Recanalization
80%
60%
40%
20%
0%
20 %
75 %
3/4
1/5
rtPA Placebo
Recanalization
Symptomatic hemorrhage
Clinical outcome
Mortality
- Επανασυραγγοποιεί τη βλάβη
- Αυξάνει την αιμορραγική μετατροπή
- Δεν βελτιώνει την κλινική έκβαση ή τη θνητότητα
Take home messages