A series of studies that spanned 13 years have all concluded the time to treat ischemic stroke patients can be doubled.
A meta-analysis that combined individual patient data from three separate trials, EXTEND, ECASS4-EXTEND and EPITHET has confirmed the current time window of 4.5 hours can be pushed to 9 hours using advanced brain imaging to identify patients with salvageable brain tissue.
The three studies found that patients who had evidence of brain to save using advanced CT or MRI imaging of brain blood flow were more likely to return to independent function and all their usual activities when alteplase, a thrombolytic drug used to treat ischemic stroke, was administered between 4.5 – 9 hours after stroke onset or after patient awoke with stroke symptoms, compared to a placebo.
414 patients were part of the three trials, 213 were assigned to alteplase versus 201 who were given a placebo.
Royal Melbourne Hospital Neurologist Professor Bruce Campbell and author of the article published in the prestigious journal The Lancet, said the results are life changing in the treatment of ischemic stroke.
“This gives patients who we were previously unable to treat access to a therapy that can reduce disability. Particularly for the one in five people that suffer stroke in their sleep this research means that we can use brain imaging to work out which patients have brain to save and are likely to benefit from treatment,” Prof Campbell said.
RMH neurologist, Director of the Melbourne Brain Centre at RMH and joint senior author of the meta-analysis Professor Stephen Davis said the study results were likely to change stroke treatment guidelines and clinical practice.
“Our study used imaging of brain blood flow to select patients and showed that alteplase more than doubled the odds of being able to return to all their usual activities compared to placebo, an excellent outcome for our patients.”
University of Melbourne Professor Geoffrey Donnan, joint senior author of the meta-analysis said the research means patients who have a stroke in their sleep will greatly benefit.
“These results shift the stroke paradigm from using a clock to determine eligibility for clot-dissolving treatment to using brain imaging to identify whether there is brain tissue that can be saved in the individual patient, Professor Donnan said.
“This is terrific for patients and will reduce the burden of stroke-related disability in Australia and worldwide.”
Professor Campbell says despite the window opening to double the time, when it comes to stroke time is always critical.
“I'd like everyone reading this to ensure that they and their friends and relatives are aware of the signs of stroke. Too many people mix up stroke and heart attack, call a friend rather than the ambulance or wait around to see if symptoms get better.”
“The Stroke Foundation FAST campaign is an excellent message - any Facial weakness, Arm weakness, Speech difficulty = Time to call 000! Strokes are often treatable but every minute counts,” Prof Campbell said.