Members of the EPITHET-DEFUSE Investigators are listed in the Appendix on page xx.
Greater effect of stroke thrombolysis in the presence of arterial obstruction†
Article first published online: 25 OCT 2011
Copyright © 2011 American Neurological Association
Annals of Neurology
Volume 70, Issue 4, pages 601–605, October 2011
How to Cite
De Silva, D. A., Churilov, L., Olivot, J.-M., Christensen, S., Lansberg, M. G., Mlynash, M., Campbell, B. C.V., Desmond, P., Straka, M., Bammer, R., Albers, G. W., Davis, S. M., Donnan, G. A. and on behalf of the EPITHET-DEFUSE Investigators (2011), Greater effect of stroke thrombolysis in the presence of arterial obstruction. Ann Neurol., 70: 601–605. doi: 10.1002/ana.22444
- Issue published online: 25 OCT 2011
- Article first published online: 25 OCT 2011
- Accepted manuscript online: 7 APR 2011 02:15PM EST
- Manuscript Accepted: 1 APR 2011
- Manuscript Revised: 23 MAR 2011
- Manuscript Received: 27 SEP 2010
Recanalization of arterial obstruction is associated with improved clinical outcomes. There are no controlled data demonstrating whether arterial obstruction status predicts the treatment effect of intravenous (IV) tissue plasminogen activator (tPA). We aimed to determine if the presence of arterial obstruction improves the treatment effect of IV tPA over placebo in attenuating infarct growth.
We analyzed 175 ischemic stroke patients treated in the 3–6 hour time window from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) trial (randomized to IV tPA or placebo) and Diffusion and perfusion imaging Evaluation For Understanding Stroke Evolution (DEFUSE) study (all treated with IV tPA). Infarct growth was calculated as the difference between baseline diffusion-weighted imaging (DWI) and final T2 lesion volumes. Baseline arterial obstruction of large intracranial arteries was graded on magnetic resonance angiography (MRA).
Among the 116 patients with adequate baseline MRA and final lesion assessment, 72 had arterial obstruction (48 tPA, 24 placebo) and 44 no arterial obstruction (33 tPA, 11 placebo). Infarct growth was lower in the tPA than placebo group (median difference 26ml, 95% confidence interval [CI], 1–50) in patients with arterial obstruction, but was similar in patients with no arterial obstruction (median difference 5ml, 95%CI, −3 to 9). Infarct growth attenuation with tPA over placebo treatment was greater among patients with arterial obstruction than those without arterial obstruction by a median of 32ml (95%CI, 21–43, p < 0.001).
The treatment effect of IV tPA over placebo was greater with baseline arterial obstruction, supporting arterial obstruction status as a consideration in selecting patients more likely to benefit from IV thrombolysis. ANN NEUROL 2011;70:601–605