Effective therapy was not available for treatment of acute stroke until 1995 when tissue plasminogen activator (tPA) was shown to improve neurologic and functional outcome in stroke patients who were treated within three hours of symptom onset. Currently, many patients do not qualify for tPA therapy because the present for evaluation beyond 3 hours after stroke onset. Attempts to expand the treatment window to 6 hours, using computerized tomography (CT) to select patients have been successful. Preliminary data suggest that new magnetic resonance imaging (MRI) techniques are likely to be more effective than CT for identifying patients who may respond favorably to tPA therapy. Investigators propose to apply robust new MRI techniques to investigate whether specific MRI profiles predict a favorable clinical response to intravenous tPA therapy administered between 3 and 6 hours after stroke onset. They hypothesize that patient subgroups who are likely to benefit from thrombolytic therapy can be identified based on a combination of blood flow parameters and an assessment of the degree of early ischemic brain injury - variables for which new MRI techniques, unlike CT, are extremely sensitive. In this multicenter, open-label, pilot clinical trial, 80 patients will receive an MRI scan with diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance angiography, immediately prior to receiving tPA therapy 3-6 hours after stroke onset. Two follow-up MRI scans will assess whether early reperfusion occurs and establish the final infarct volume. The clinical response to therapy will be determined both by the amount of improvement between the baseline NIH Stroke Scale (NIHSS) score and the 30-day score and the rate of achieving a """"""""favorable clinical response"""""""" ((8 point improvement or complete recovery in the NIHSS score between baseline and 30 days) to tPA therapy. Three-month outcomes will be assessed with the Barthel Index and the Modified Rankin Scale. This study will provide important data needed to plan a randomized, placebo-controlled, clinical trial designed to determine whether stroke patients with specific MRI characteristics benefit from tPA therapy administered between 3-6 hours after stroke onset.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS039325-03
Application #
6540185
Study Section
National Institute of Neurological Disorders and Stroke Initial Review Group (NSD)
Program Officer
Moy, Claudia S
Project Start
2000-09-30
Project End
2006-06-30
Budget Start
2002-07-01
Budget End
2006-06-30
Support Year
3
Fiscal Year
2002
Total Cost
$381,065
Indirect Cost
Name
Stanford University
Department
Neurology
Type
Schools of Medicine
DUNS #
800771545
City
Stanford
State
CA
Country
United States
Zip Code
94305
Wouters, Anke; Dupont, Patrick; Christensen, Soren et al. (2016) Association Between Time From Stroke Onset and Fluid-Attenuated Inversion Recovery Lesion Intensity Is Modified by Status of Collateral Circulation. Stroke 47:1018-22
Tu, Hans T H; Campbell, Bruce C V; Christensen, Soren et al. (2015) Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation. Int J Stroke 10:534-40
Yassi, Nawaf; Churilov, Leonid; Campbell, Bruce C V et al. (2015) The association between lesion location and functional outcome after ischemic stroke. Int J Stroke 10:1270-6
Wheeler, Hayley M; Mlynash, Michael; Inoue, Manabu et al. (2015) The growth rate of early DWI lesions is highly variable and associated with penumbral salvage and clinical outcomes following endovascular reperfusion. Int J Stroke 10:723-9
Purushotham, Archana; Campbell, Bruce C V; Straka, Matus et al. (2015) Apparent diffusion coefficient threshold for delineation of ischemic core. Int J Stroke 10:348-53
Mishra, Nishant K; Albers, Gregory W; Christensen, Søren et al. (2014) Comparison of magnetic resonance imaging mismatch criteria to select patients for endovascular stroke therapy. Stroke 45:1369-74
Lemmens, Robin; Christensen, Søren; Straka, Matus et al. (2014) Patients with single distal MCA perfusion lesions have a high rate of good outcome with or without reperfusion. Int J Stroke 9:156-9
Inoue, Manabu; Mlynash, Michael; Straka, Matus et al. (2013) Clinical outcomes strongly associated with the degree of reperfusion achieved in target mismatch patients: pooled data from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution studies. Stroke 44:1885-90
Campbell, Bruce C V; Christensen, Søren; Parsons, Mark W et al. (2013) Advanced imaging improves prediction of hemorrhage after stroke thrombolysis. Ann Neurol 73:510-9
Wheeler, Hayley M; Mlynash, Michael; Inoue, Manabu et al. (2013) Early diffusion-weighted imaging and perfusion-weighted imaging lesion volumes forecast final infarct size in DEFUSE 2. Stroke 44:681-5

Showing the most recent 10 out of 37 publications