BACKGROUND AND PURPOSE: The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population-based study. METHODS: All patients with an ischemic stroke presenting to an emergency department during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati/Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded timeframes with varying door-to-needle times. RESULTS: During the study period, 1838 ischemic strokes presenting to an emergency department were identified. A small proportion of them arrived in the expanded time window (3.4%) compared with the standard time window (22%). Only 0.5% of those who arrived in this timeframe met eligibility criteria for thrombolysis compared with 5.9% using standard eligibility criteria in the standard timeframe. These results did not vary significantly by repeated analysis varying the door-to-needle time or the expanded time window's exclusion criteria. CONCLUSIONS: In reality, the expanded time window for thrombolysis in acute ischemic stroke benefits few patients. If we are to improve recombinant tissue-type plasminogen activator administration rates, our focus should be on improving stroke awareness, transport to facilities with ability to administer thrombolysis, and familiarity of physicians with acute stroke treatment guidelines.
BACKGROUND AND PURPOSE: The publication of the European Cooperative Acute Stroke Study (ECASS III) expanded the treatment time to thrombolysis for acute ischemic stroke from 3 to 4.5 hours from symptom onset. The impact of the expanded time window on treatment rates has not been comprehensively evaluated in a population-based study. METHODS: All patients with an ischemic stroke presenting to an emergency department during calendar year 2005 in the 17 hospitals that compromise the large 1.3 million Greater Cincinnati/Northern Kentucky population were included in the analysis. Criteria for exclusion from thrombolytic therapy are analyzed retrospectively for both the standard and expanded timeframes with varying door-to-needle times. RESULTS: During the study period, 1838 ischemic strokes presenting to an emergency department were identified. A small proportion of them arrived in the expanded time window (3.4%) compared with the standard time window (22%). Only 0.5% of those who arrived in this timeframe met eligibility criteria for thrombolysis compared with 5.9% using standard eligibility criteria in the standard timeframe. These results did not vary significantly by repeated analysis varying the door-to-needle time or the expanded time window's exclusion criteria. CONCLUSIONS: In reality, the expanded time window for thrombolysis in acute ischemic stroke benefits few patients. If we are to improve recombinant tissue-type plasminogen activator administration rates, our focus should be on improving stroke awareness, transport to facilities with ability to administer thrombolysis, and familiarity of physicians with acute stroke treatment guidelines.
Authors: Gregg C Fonarow; Eric E Smith; Jeffrey L Saver; Mathew J Reeves; Deepak L Bhatt; Maria V Grau-Sepulveda; DaiWai M Olson; Adrian F Hernandez; Eric D Peterson; Lee H Schwamm Journal: Circulation Date: 2011-02-10 Impact factor: 29.690
Authors: Harold P Adams; Gregory del Zoppo; Mark J Alberts; Deepak L Bhatt; Lawrence Brass; Anthony Furlan; Robert L Grubb; Randall T Higashida; Edward C Jauch; Chelsea Kidwell; Patrick D Lyden; Lewis B Morgenstern; Adnan I Qureshi; Robert H Rosenwasser; Phillip A Scott; Eelco F M Wijdicks Journal: Stroke Date: 2007-04-12 Impact factor: 7.914
Authors: Werner Hacke; Markku Kaste; Erich Bluhmki; Miroslav Brozman; Antoni Dávalos; Donata Guidetti; Vincent Larrue; Kennedy R Lees; Zakaria Medeghri; Thomas Machnig; Dietmar Schneider; Rüdiger von Kummer; Nils Wahlgren; Danilo Toni Journal: N Engl J Med Date: 2008-09-25 Impact factor: 91.245
Authors: Dawn Kleindorfer; Jane Khoury; Joseph P Broderick; Eric Rademacher; Daniel Woo; Matthew L Flaherty; Kathleen Alwell; Charles J Moomaw; Alex Schneider; Arthur Pancioli; Rosie Miller; Brett M Kissela Journal: Stroke Date: 2009-06-04 Impact factor: 7.914
Authors: Ganesh Asaithambi; Xin Tong; Mary G George; Albert W Tsai; James M Peacock; Russell V Luepker; Kamakshi Lakshminarayan Journal: J Stroke Cerebrovasc Dis Date: 2014-08-23 Impact factor: 2.136
Authors: Tracy E Madsen; Jane C Khoury; Kathleen A Alwell; Charles J Moomaw; Brett M Kissela; Felipe De Los Rios La Rosa; Daniel Woo; Opeolu Adeoye; Matthew L Flaherty; Pooja Khatri; Simona Ferioli; Dawn Kleindorfer Journal: Stroke Date: 2015-01-27 Impact factor: 7.914
Authors: Colin J Przybylowski; Dale Ding; Robert M Starke; Christopher R Durst; R Webster Crowley; Kenneth C Liu Journal: World J Clin Cases Date: 2014-11-16 Impact factor: 1.337
Authors: Giorgio Battista Boncoraglio; Michela Ranieri; Anna Bersano; Eugenio A Parati; Cinzia Del Giovane Journal: Cochrane Database Syst Rev Date: 2019-05-05
Authors: Dawn Kleindorfer; Felipe de los Rios La Rosa; Pooja Khatri; Brett Kissela; Jason Mackey; Opeolu Adeoye Journal: Stroke Date: 2013-06 Impact factor: 7.914