Interventional management of stroke

The effectiveness of catheter-based intra-arterial therapy to remove residual thrombus after IV rt-PA treatment is being tested in the Interventional Management of Stroke study (IMS-Ill). This study will randomize patients to 0.6 mg/kg IV rt-PA, followed by angiography with additional intra-arterial therapy as indicated, or IV full-dose rt-PA (0.9 mg/kg). A nonrandomized safety study suggested that intraarterial therapy, after 0.6 mg/kg IV rt-PA, could be accomphshed with acceptable rates of sICH. ° ... 

IMS Study Investigators. Combined intravenous and intra-arterial recanalization for acute ischemic stroke the Interventional Management of Stroke study. Stroke. 2004 35 904-911. 

The Interventional Management of Stroke (IMS I) Study was a multicenter, open-labeled, single-arm pilot study in which 80 patients (median NIHSS 18) were enrolled to receive IV rt-PA (0.6 mg/kg, 60 mg maximum, 15% of the dose as a bolus with the remainder administered over 30 minutes) within 3 hours of stroke onset (median time to initiation 140 minutes). " Additional rt-PA was subsequently administered via a microcatheter at the site of the thrombus in 62 of the 80 patients, up to a total dose of 22 mg over 2 hours of infusion or until complete recanalization. Primary comparisons were with similar subsets of the placebo and rt-PA-treated subjects from the NINDS rt-PA Stroke Trial. The 3-month mortality in IMS I subjects (16%) was numerically lower but not statistically different than the mortality of the placebo (24%) or rt-PA-treated subjects (21%) in the NINDS rt-PA Stroke Trial. The rate of symptomatic ICH (6.3%) in IMS I subjects was similar to that of the rt-PA-treated subjects (6.6%) but higher than the rate in the... 

The Interventional Management of Stroke (IMS I) Study was a multicenter, open-label, single-arm pilot study with the aim of investigating the feasibiUty and safety of a combined IV and lA approach to recanaUza-tion in patients with ischemic stroke. A total of 80... 

TomsickT, Broderick J, Carrozella J et al. Revascularization results in the Interventional Management of Stroke 11 trial. AJNR Am J Neuroradiol. 2008 29 582-587... 

Acute coronary syndrome For patients with acute coronary syndrome (unstable angina/non-Q-wave Ml) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or coronary artery bypass graft (CABG), clopidogrel has been shown to decrease the rate of a combined endpoint of cardiovascular death. Ml, or stroke, as well as the rate of a combined endpoint of cardiovascular death. Ml, stroke, or refractory ischemia. 

The Vitamin Intervention for Stroke Prevention (VISP) study is a double-masked, randomised, multicentre elinical trial designed to determine if, in addition to best medical/surgieal management, high-dose folic add, vitamin Bg and vitamin B12 supplements will reduee reeurrent stroke compared to lower doses of these vitamins. 

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