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Review
. 2019 Dec;39(12):2539-2540.
doi: 10.1177/0271678X19882782. Epub 2019 Oct 14.

Opening the time window

Klaus van Leyen  1 , Xiaoying Wang  1 , Magdy Selim  2 , Eng H Lo  1
Affiliations
Review

Opening the time window

Klaus van Leyen et al. J Cereb Blood Flow Metab. 2019 Dec.

Abstract

The recently completed EXTEND trial tested the idea that tissue plasminogen activator thrombolysis can be safely extended up to 9 h after stroke onset if automated perfusion imaging indicates the presence of a salvageable penumbra. This important trial contributes to an ongoing paradigm shift for stroke therapy. Combined with the introduction of endovascular therapy, image-guided patient selection is expanding the toolbox of the stroke practitioner. At the same time, pushing the limits of reperfusion has raised important questions about mechanisms to pursue for combination therapy as well as potential approaches to mitigate side effects and optimize treatments for patients with various co-morbidities.

Keywords: Thrombolysis; acute stroke; brain imaging; clinical trials; neuroprotection.

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References

    1. Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med 2019; 380: 1795–1803. - PubMed
    1. Campbell BCV, Ma H, Ringleb PA, et al. Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet 2019; 394: 139–147. - PubMed
    1. Henninger N, Fisher M. Extending the time window for endovascular and pharmacological reperfusion. Transl Stroke Res 2016; 7: 284–293. - PubMed
    1. Leigh R, Knutsson L, Zhou J, et al. Imaging the physiological evolution of the ischemic penumbra in acute ischemic stroke. J Cereb Blood Flow Metab 2018; 38: 1500–1516. - PMC - PubMed
    1. Wu C, Zhao W, An H, et al. Safety, feasibility, and potential efficacy of intraarterial selective cooling infusion for stroke patients treated with mechanical thrombectomy. J Cereb Blood Flow Metab 2018; 38: 2251–2260. - PMC - PubMed

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