BACKGROUND AND PURPOSE: Clinical trials are assessing the efficacy of fibrinolysis in extended time windows for acute ischemic stroke. METHODS: An Internet-based survey was sent to 400 US vascular neurologists affiliated with a university to assess whether there are consensus opinions on how they treat patients beyond 3 hours from symptom onset and which patients they are willing to enroll into clinical trials of fibrinolysis for acute ischemic stroke. RESULTS: We received 161 responses; 81% were male. Ninety-three percent of respondents treat patients with intravenous tissue plasminogen activator beyond 3 hours. More than 80% were treated beyond 3 hours with intra-arterial therapy (IAT). When asked if IAT improves stroke outcome, >50% selected the choice of "yes for middle cerebral artery and basilar occlusions" and only 2% selected the choice that "IAT does not improve outcome." Over half believe that imaging could be used to approximate the penumbra but with improvements to better identify salvageable tissue. Eighty-seven percent were willing to enroll patients into a placebo-controlled intravenous thrombolysis beyond 3 hours. For IAT trials, >80% would randomize beyond 3 hours with or without prior intravenous treatment. CONCLUSIONS: Vascular neurologists have been treating acute ischemic stroke beyond 3 hours with intravenous tissue plasminogen activator even before the American Heart Association guidelines supported extending the therapeutic window. There is a paradox among the respondents willing to enroll patients into trials involving IAT given that a majority is offering IAT as part of their practice. These results suggest that clinical practice may impair enrollment into trials testing reperfusion therapies for acute ischemic stroke.
BACKGROUND AND PURPOSE: Clinical trials are assessing the efficacy of fibrinolysis in extended time windows for acute ischemic stroke. METHODS: An Internet-based survey was sent to 400 US vascular neurologists affiliated with a university to assess whether there are consensus opinions on how they treat patients beyond 3 hours from symptom onset and which patients they are willing to enroll into clinical trials of fibrinolysis for acute ischemic stroke. RESULTS: We received 161 responses; 81% were male. Ninety-three percent of respondents treat patients with intravenous tissue plasminogen activator beyond 3 hours. More than 80% were treated beyond 3 hours with intra-arterial therapy (IAT). When asked if IAT improves stroke outcome, >50% selected the choice of "yes for middle cerebral artery and basilar occlusions" and only 2% selected the choice that "IAT does not improve outcome." Over half believe that imaging could be used to approximate the penumbra but with improvements to better identify salvageable tissue. Eighty-seven percent were willing to enroll patients into a placebo-controlled intravenous thrombolysis beyond 3 hours. For IAT trials, >80% would randomize beyond 3 hours with or without prior intravenous treatment. CONCLUSIONS: Vascular neurologists have been treating acute ischemic stroke beyond 3 hours with intravenous tissue plasminogen activator even before the American Heart Association guidelines supported extending the therapeutic window. There is a paradox among the respondents willing to enroll patients into trials involving IAT given that a majority is offering IAT as part of their practice. These results suggest that clinical practice may impair enrollment into trials testing reperfusion therapies for acute ischemic stroke.
Authors: Natalia S Rost; Eric E Smith; Raul G Nogueira; Kaitlin M Fitzpatrick; Albert J Yoo; Joshua A Hirsch; Lee H Schwamm Journal: J Neurointerv Surg Date: 2012-05-18 Impact factor: 5.836
Authors: Osama O Zaidat; David S Liebeskind; Randall C Edgell; Catherine M Amlie-Lefond; Junaid S Kalia; Andrei V Alexandrov Journal: Neurology Date: 2012-09-25 Impact factor: 9.910
Authors: Clotilde Balucani; Vanessa Arnedo; Jeremy Weedon; Didier Leys; Jean-Louis Mas; Martin Brown; James C Grotta; Nicole R Gonzales; Werner Hacke; Thomas Brott; Steven R Levine Journal: Neurohospitalist Date: 2018-01-17
Authors: Karen C Albright; Sheryl Martin-Schild; H Jeremy Bockholt; George Howard; Andrei Alexandrov; Anne Alexandrov; M Rick Sline; James C Grotta; Sean I Savitz Journal: Cerebrovasc Dis Extra Date: 2011-11-05