European Cooperative Acute Stroke Study ECASS

Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boy sen G, Bluhmki E, Hoxter G, Mahagne MH. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995 274 1017-1025. 

Three large randomized trials, the European Cooperative Acute Stroke Study (ECASS) parts I and II, and the Alteplase Thrombolysis for Acute Noninterven-tional Therapy in Ischemic Stroke (ATLANTIS), have investigated the efficacy of IV rt-PA in acute stroke beyond the 3-hour window. All three studies showed high rates of sICH complicating rt-PA treatment, and no overall efficacy of rt-PA. 

OR 1.81, 95% Cl 1.46-2.24), most of which were related to symptomatic intracranial hemorrhage (OR 3.37, 95% Cl 2.68. 22). In addition, a pooled analysis of six major randomized placebo-controlled IV rt-PA stroke trials (Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) I and II, European Cooperative Acute Stroke Study (ECASS) I and II, and NINDS I and II), including 2775 patients who were treated with IV rt-PA or placebo within 360 minutes of stroke onset, confirmed the beneht up to 3 hours and suggested a potential beneht beyond 3 hours for some patients. The pattern of a decreasing chance of a favorable 3-month outcome as the time interval from stroke onset to start of treatment increased was consistent with the findings of the original NINDS study. ... 

European Cooperative Acute Stroke Study (ECASS). JAMA... 

The results of the 2008 European Cooperative Acute Stroke Study (ECASS 111) expanded the 3-h time window for IV thrombolysis and revealed that although safe and effective up to 4.5 h after stroke onset, treatment benefits roughly one-half as many patients as those treated within 3 h [2, 158, 159]. Hence, the ratio between the hemorrhagic risk of treatment and the potential clinical benefit of treatment becomes a more critical consideration as the time window for therapy is expanded with newer IV and lA techniques. It is the mismatch between the size of the infarct core (proportional to hemorrhagic risk) and the size of the ischemic penumbra (proportional to potentially salvageable tissue), as determined by CTP, that provides an imaging measure of this risk-to-benefit ratio. Evidence suggests that core/penumbra mismatch may persist up to 24 h in some patients [160,161]. 

ECASS /-// and ATLANTIS A-B trials The European Cooperative Acute Stroke Study (ECASS-I) enrolled 620 patients with acute ischemic stroke in whom treatment could be initiated within 6 h of stroke onset [42]. Patients were excluded if pretreatment CT showed signs of hemorrhage or major early infarction involving more than one-third of the MCA territory (diffuse sulcal effacement, poor differentiation between gray-white matter, and diffuse hypodensity). In a randomized double-blind study, patients either received placebo or IV t-PA (1.1 mg/kg to a maximum dose 100 mg 10% bolus followed by infusion over 1 h) and could not receive anticoagulants, antiplatelet, cerebroprotective. 

Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L. Hemorrhagic transformation within 36 hours of a cerebral infarct Relationships with early clinical deterioration and 3-month outcome in the european cooperative acute stroke study i (ECASS i) cohort. Stroke. 1999 30 2280-2284. 

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