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Evidence-based approach to imaging-based thrombolysis beyond the 4.5hours window Heart Vessels Stroke Αthens, 27-01-2013 Γεώργιος Ντάιος Παθολογική Κλινική.

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Presentation on theme: "Evidence-based approach to imaging-based thrombolysis beyond the 4.5hours window Heart Vessels Stroke Αthens, 27-01-2013 Γεώργιος Ντάιος Παθολογική Κλινική."— Presentation transcript:

1 Evidence-based approach to imaging-based thrombolysis beyond the 4.5hours window Heart Vessels Stroke Αthens, Γεώργιος Ντάιος Παθολογική Κλινική & Ομώνυμο Ερευνητικό Εργαστήριο Ιατρική Σχολή Πανεπιστημίου Θεσσαλίας

2 Disclosures Support to attend conferences: Bayer; Sanofi-Aventis; Pfizer; Lundbeck; Boehringer-Ingelheim; Bristol Myers Squibb; Galenica. Honoraria: Quintiles; CHUV. Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis. National coordinator (Greece) for the ENOS trial.

3 Patient P. M., 77years-old - 77 years old man found in bed with aphasia and right hemisyndrome - Admission: 7.5 hours after last-well time - NIHSS score = 20

4 Patient P. M., 77years-old

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7 «Intravenous rtPA is recommended within 4.5 hours of onset of ischaemic stroke (Class I, Level A)»

8 Patient P. M., 77years-old

9 The ischemic penumbra

10 The sooner, the better * * Lancet 2004; 363: 768– hours

11 Patient P. M., 77years-old Penumbra: 207.8ml Initial infarct: 14.1ml

12 Patient P. M., 77years-old

13 5-days DWI-MRI Final infarct: 15.7ml Initial infarct: 14.1ml

14 Number of cases Time (hours) Known onset (n=1075) Unknown onset (n=454) 4.5h Michel P, Ntaios G, et al. Stroke 2010; 41:

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33 Outcome Outcome rTPA group n=6 Placebo group n=6 Symptomatic hemorrhagic transformation at 24hours/4 days0/0 Asymptomatic hemorrhagic transformations at 24hours (CT)22 Asymptomatic hemorrhagic transformations at 4days (MRI)32 Mortality at 7/90 days0/0 Salvaged brain tissue (cm 3 )*84 (44-206)29 (8-105)

34 Independence at 3 months (Rankin score 2) 80% 60% 40% 20% 0% rtPA Placebo 16.6% 66 % 4/6 1/6

35 Recanalization 80% 60% 40% 20% 0% 20 % 75 % 3/4 1/5 rtPA Placebo

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37 Recanalization

38 Symptomatic hemorrhage

39 Clinical outcome

40 Mortality

41 -Επανασυραγγοποιεί τη βλάβη -Αυξάνει την αιμορραγική μετατροπή -Δεν βελτιώνει την κλινική έκβαση ή τη θνητότητα

42 Take home messages

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