Stroke subsets

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... 

Ay H, Oliveira-Filho J, Buonanno FS, Ezzeddine M, Schaefer PW, Rordorf G, Schwamm LF[, Gonzalez RG, Koroshetz WJ (1999b) Diffusion-weighted imaging identifies a subset of lacunar infarction associated with embolic source. Stroke 30 2644-2650... 

The Cervene Stroke Study Investigation Group conducted a phase III study to assess the efficacy and safety of nalmefene (Cervene) in patients with acute ischemic strokes and also the safety of combined recombinant tissue plasminogen activator and nalmefene in a subset of patients (4). It was a randomized, placebo-controlled, double-blind study of a 24-hour infusion of nalmefene on 368 patients who received 60 mg nalmefene administered as 10 mg bolus over 15 minutes and then a 50 mg infusion over 24 hours or placebo. Even though nalmefene appeared safe and well tolerated, the study failed to find any benefit in stroke patients treated with nalmefene within six hours. 

Upstream GP Hb/IIIa blockade + primary PCI. Two hundred fifty-three patients with acute STEMI were randomized to therapy with abciximab + PCI or abciximab + reduced-dose reteplase + PCI. While pre-PCI TIMI grade 3 flow was higher among patients treated with combination therapy (TIMI III flow 40% vs. 18% p < 0.01), scintigraphic infarct size was not reduced in the combination therapy arm versus the abciximab alone (13% vs. 11.5%, respectively p = 0.81) (15). There were nonsignificant increases in death/MI (2.4% vs. 1.6%), death/MI/stroke (3.2% vs. 1.6%), and major bleeding (5.6% vs. 1.6%) with combination therapy. Subset analyses of patients who required transfer for primary PCI and those who had earUer times to revascularization revealed no differences. 

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