Journal article

Association of Reperfusion After Thrombolysis With Clinical Outcome Across the 4.5-to 9-Hours and Wake-Up Stroke Time Window A Meta-Analysis of the EXTEND and EPITHET Randomized Clinical Trials

Bruce CV Campbell, Henry Ma, Mark W Parsons, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Chung Y Hsu, Helen M Dewey, Kenneth S Butcher, Bernard Yan, Patricia M Desmond, Tissa Wijeratne, Sami Curtze, P Alan Barber, Deidre A De Silva, Vincent Thijs, Christopher R Levi, Christopher F Bladin, Gagan Sharma, Andrew Bivard Show all

JAMA Neurology | AMER MEDICAL ASSOC | Published : 2020

Abstract

Importance: Intravenous alteplase reduces disability after ischemic stroke in patients 4.5 to 9 hours after onset and with wake-up onset stroke selected using perfusion imaging mismatch. However, whether the benefit is consistent across the 4.5- to 6-hours, 6- to 9-hours, and wake-up stroke epochs is uncertain. Objective: To examine the association of reperfusion with reduced disability, including by onset-to-randomization time strata in the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) and Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) randomized clinical trials. Design, Setting, and Participants: Individual patient meta-analysis of randomized c..

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Grants

Awarded by Ministry of Health andWelfare


Awarded by Ministry of Science and Technology Taiwan Clinical Trial Consortium for Stroke


Awarded by Australian National Health and Medical Research Council


Funding Acknowledgements

The EXTEND trial was funded by the Australian National Health and Medical Research Council through the Commonwealth Scientific and Industrial Research Organization Flagship program. The EXTEND trial sites in Taiwan were supported in part by the Ministry of Health andWelfare (grant MOHW108-TDU-B-212-133004) and the Ministry of Science and Technology Taiwan Clinical Trial Consortium for Stroke (grant MOST107-2321-B-039-004). EPITHET was funded by the Australian National Health and Medical Research Council. Investigational product for both trials was supplied by Boehringer Ingelheim. RAPID imaging software was provided by iSchemaView. Dr Campbell reports research support from the Australian National Health and Medical Research Council (grants GNT1043242 and GNT1035688).