 Advertisement | ||||||||
 | ||||||||
|
||||||||
 |
 |
 |
 |
 |
 |
 |
||
|
Michael Hill and Alastair Buchan are with the Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alta. A list of CASES Investigators and representatives of organizations involved with CASES appears in an online appendix (www.cmaj.ca/cgi/content/full/172/10/1307/DC1).
Correspondence to: Dr. Alastair M. Buchan, Professor of Clinical Geratology, University of Oxford, Acute Stroke Programme, Nuffield Department of Clinical Medicine, Level 7, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; fax +44 (0) 1865 222 901; alastair.buchan{at}ndm.ox.ac.uk
Background: Thrombolysis for acute ischemic stroke has remained controversial. The Canadian Alteplase for Stroke Effectiveness Study, a national prospective cohort study, was conducted to assess the effectiveness of alteplase therapy for ischemic stroke in actual practice.
Methods: The study was mandated by the federal government as a condition of licensure of alteplase for the treatment of stroke in Canada. A registry was established to collect data over 2.5 years for stroke patients receiving such treatment from Feb. 17, 1999, through June 30, 2001. All centres capable of administering thrombolysis therapy according to Canadian guidelines were eligible to submit patient data to the registry. Data collection was prospective, and follow-up was completed at 90 days after stroke. Copies of head CT scans obtained at baseline and at 24–48 hours after the start of treatment were submitted to a central panel for review.
Results: A total of 1135 patients were enrolled at 60 centres in all major hospitals across Canada. The registry collected data for an estimated 84% of all treated ischemic stroke patients in the country. An excellent clinical outcome was observed in 37% of the patients. Symptomatic intracranial hemorrhage occurred in only 4.6% of the patients (95% confidence interval [CI] 3.4%–6.0%); however, 75% of these patients died in hospital. An additional 1.3% (95% CI 0.7%–2.2%) of patients had hemiorolingual angioedema.
Conclusions: The outcomes of stroke patients undergoing thrombolysis in Canada are commensurate with the results of clinical trials. The rate of symptomatic intracranial hemorrhage was low. Stroke thrombolysis is a safe and effective therapy in actual practice.
This article has been cited by other articles:
|
|
 |
|
  K. Toyoda, M. Koga, M. Naganuma, Y. Shiokawa, J. Nakagawara, E. Furui, K. Kimura, H. Yamagami, Y. Okada, Y. Hasegawa, et al. Routine Use of Intravenous Low-Dose Recombinant Tissue Plasminogen Activator in Japanese Patients: General Outcomes and Prognostic Factors From the SAMURAI Register Stroke, November 1, 2009; 40(11): 3591 - 3595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Tsivgoulis, J. L. Frey, M. Flaster, V. K. Sharma, A. Y. Lao, S. L. Hoover, W. Liu, E. Stamboulis, A. W. Alexandrov, M. D. Malkoff, et al. Pre-Tissue Plasminogen Activator Blood Pressure Levels and Risk of Symptomatic Intracerebral Hemorrhage Stroke, November 1, 2009; 40(11): 3631 - 3634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Cucchiara, S. E. Kasner, D. Tanne, S. R. Levine, A. Demchuk, S. R. Messe, L. Sansing, K. R. Lees, P. Lyden, and for the SAINT Investigators Factors Associated With Intracerebral Hemorrhage After Thrombolytic Therapy for Ischemic Stroke: Pooled Analysis of Placebo Data From the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II Trials Stroke, September 1, 2009; 40(9): 3067 - 3072. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Novakovic, G Toth, and P D Purdy Review of current and emerging therapies in acute ischemic stroke JNIS, July 1, 2009; 1(1): 13 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y. Poppe, S. R. Majumdar, T. Jeerakathil, W. Ghali, A. M. Buchan, M. D. Hill, and the Canadian Alteplase for Stroke Effectiveness St Admission Hyperglycemia Predicts a Worse Outcome in Stroke Patients Treated With Intravenous Thrombolysis Diabetes Care, April 1, 2009; 32(4): 617 - 622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Garcia, J. A Egido, M. E Garcia, and P. Simal Thrombolysis for ischaemic stroke and glioblastoma multiforme: a case report BMJ Case Reports, February 22, 2009; 2009(feb22_1): bcr0620080268 - bcr0620080268. [Abstract] [Full Text]
|
|
|
|
 |
|
 Thrombolytic therapy with alteplase for ischaemic stroke DTB, February 1, 2009; 47(2): 14 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sato, T. Uehara, K. Toyoda, N. Yasui, T. Hata, T. Ueda, Y. Okada, A. Toyota, Y. Hasegawa, H. Naritomi, et al. Impact of the Approval of Intravenous Recombinant Tissue Plasminogen Activator Therapy on the Processes of Acute Stroke Management in Japan: The Stroke Unit Multicenter Observational (SUMO) Study Stroke, January 1, 2009; 40(1): 30 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Kent, A. M. Buchan, and M. D. Hill The gender effect in stroke thrombolysis: Of CASES, controls, and treatment-effect modification Neurology, September 30, 2008; 71(14): 1080 - 1083. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B R Thanvi, S Treadwell, and T Robinson Haemorrhagic transformation in acute ischaemic stroke following thrombolysis therapy: classification, pathogenesis and risk factors Postgrad. Med. J., July 1, 2008; 84(993): 361 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Sacchetti Is It Time to Definitely Abandon Neuroprotection in Acute Ischemic Stroke? Stroke, June 1, 2008; 39(6): 1659 - 1660. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Lin, O. Rapalino, M. Law, J.S. Babb, K.A. Siller, and B.K. Pramanik Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 931 - 936. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. McCormick, I. Reeves, T. Baird, I. Bone, and K. W. Muir Implementation of a stroke thrombolysis service within a tertiary neurosciences centre in the United Kingdom QJM, April 1, 2008; 101(4): 291 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Meseguer, J. Labreuche, J. M. Olivot, H. Abboud, P. C. Lavallee, O. Simon, L. Cabrejo, A. Echeverria, I. F. Klein, M. Mazighi, et al. Determinants of outcome and safety of intravenous rt-PA therapy in the very old: a clinical registry study and systematic review Age Ageing, January 1, 2008; 37(1): 107 - 111. [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, G. Thomalla, J. Fiehler, M. Kohrmann, C. A. Molina, T. Neumann-Haefelin, M. Ribo, O. C. Singer, O. Zaro-Weber, and J. Sobesky MRI-Based and CT-Based Thrombolytic Therapy in Acute Stroke Within and Beyond Established Time Windows: An Analysis of 1210 Patients Stroke, October 1, 2007; 38(10): 2640 - 2645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Lansberg, V. N. Thijs, R. Bammer, S. Kemp, C. A.C. Wijman, M. P. Marks, G. W. Albers, and on behalf of the DEFUSE Investigators Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke Stroke, August 1, 2007; 38(8): 2275 - 2278. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kollmar and S. Schwab Ischaemic stroke: acute management, intensive care, and future perspectives Br. J. Anaesth., July 1, 2007; 99(1): 95 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P A Ringleb, C. Schwark, M Kohrmann, S Kulkens, E Juttler, W Hacke, and P D Schellinger Thrombolytic therapy for acute ischaemic stroke in octogenarians: selection by magnetic resonance imaging improves safety but does not improve outcome J. Neurol. Neurosurg. Psychiatry, July 1, 2007; 78(7): 690 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Yip and B. M. Demaerschalk Estimated Cost Savings of Increased Use of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Canada Stroke, June 1, 2007; 38(6): 1952 - 1955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Palumbo, J. M. Boulanger, M. D. Hill, D. Inzitari, A. M. Buchan, and on behalf of the CASES Investigators Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke Neurology, March 27, 2007; 68(13): 1020 - 1024. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S. Butcher, S. B. Lee, M. W. Parsons, L. Allport, J. Fink, B. Tress, G. Donnan, S. M. Davis, and for the EPITHET Investigators Differential Prognosis of Isolated Cortical Swelling and Hypoattenuation on CT in Acute Stroke Stroke, March 1, 2007; 38(3): 941 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Saqqur, K. Uchino, A. M. Demchuk, C. A. Molina, Z. Garami, S. Calleja, N. Akhtar, F. O. Orouk, A. Salam, A. Shuaib, et al. Site of Arterial Occlusion Identified by Transcranial Doppler Predicts the Response to Intravenous Thrombolysis for Stroke Stroke, March 1, 2007; 38(3): 948 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Dzialowski, J. H. W. Pexman, P. A. Barber, A. M. Demchuk, A. M. Buchan, M. D. Hill, and on behalf of the CASES Investigators Asymptomatic Hemorrhage After Thrombolysis May Not Be Benign: Prognosis by Hemorrhage Type in the Canadian Alteplase for Stroke Effectiveness Study Registry Stroke, January 1, 2007; 38(1): 75 - 79. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Buchan Acute stroke treatment: the end of the first decade Practical Neurology, December 1, 2006; 6(6): 338 - 340. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Sattin, S. E. Olson, L. Liu, R. Raman, and P. D. Lyden An Expedited Code Stroke Protocol Is Feasible and Safe Stroke, December 1, 2006; 37(12): 2935 - 2939. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. U. Weir, J. H. W. Pexman, M. D. Hill, A. M. Buchan, and on behalf of the CASES investigators How well does ASPECTS predict the outcome of acute stroke treated with IV tPA? Neurology, August 8, 2006; 67(3): 516 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J A Pettersen, J H W Pexman, P A Barber, A M Demchuk, A M Buchan, and M D Hill Insular cortical ischaemia does not independently predict acute hypertension or hyperglycaemia within 3 h of onset J. Neurol. Neurosurg. Psychiatry, July 1, 2006; 77(7): 885 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P N Sylaja, R. Cote, A. M Buchan, M. D Hill, and on behalf of Canadian Alteplase for Stroke Effecti Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study J. Neurol. Neurosurg. Psychiatry, July 1, 2006; 77(7): 826 - 829. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Audebert, C. Kukla, B. Vatankhah, B. Gotzler, J. Schenkel, S. Hofer, A. Furst, and R. L. Haberl Comparison of Tissue Plasminogen Activator Administration Management Between Telestroke Network Hospitals and Academic Stroke Centers: The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany Stroke, July 1, 2006; 37(7): 1822 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. McCormick, K. W. Muir, G. Thomalla, J. Rother, and J. Berrouschot Referral Bias May Underestimate Number of Very Elderly Patients Eligible for rtPA Stroke, April 1, 2006; 37(4): 942 - 943. [Full Text] [PDF]
|
|
|
|
|
|
C Schwark and P D Schellinger Is old age really a reason to withhold thrombolytic therapy? J. Neurol. Neurosurg. Psychiatry, March 1, 2006; 77(3): 289 - 289. [Full Text] [PDF]
|
|
|
|
|
|
B. T. Bateman, H. C. Schumacher, B. Boden-Albala, M. F. Berman, J.P. Mohr, R. L. Sacco, and J. Pile-Spellman Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients: An Analysis of the Nationwide Inpatient Sample 1999 to 2002 Stroke, February 1, 2006; 37(2): 440 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Part 9: Adult Stroke Circulation, December 13, 2005; 112(24_suppl): IV-111 - IV-120. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent, M. D. Hill, S. I. Savitz, and M. Selim Gender Differences in tPA-Related Arterial Recanalization * Response: Stroke, December 1, 2005; 36(12): 2529 - 2530. [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Hill Diagnostic Biomarkers for Stroke: A Stroke Neurologist's Perspective Clin. Chem., November 1, 2005; 51(11): 2001 - 2002. [Full Text] [PDF]
|
|
|
|
|
|
D.-W. Kang, J. A. Chalela, W. Dunn, S. Warach, and NIH-Suburban Stroke Center Investigators MRI Screening Before Standard Tissue Plasminogen Activator Therapy Is Feasible and Safe Stroke, September 1, 2005; 36(9): 1939 - 1943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 More Evidence in Support of Thrombolysis for Acute Stroke Journal Watch Emergency Medicine, June 28, 2005; 2005(628): 2 - 2. [Full Text]
|
|
|
|
 |
|
 Minerva BMJ, May 28, 2005; 330(7502): 1278 - 1278. [Full Text] [PDF]
|
|
|
|
|
|
B. Kermode-Scott Research suggests thrombolysis is effective for acute ischaemic stroke BMJ, May 21, 2005; 330(7501): 1167 - 1167. [Full Text] [PDF]
|
|
Read all eLetters
| HOME | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | HELP | SEARCH |
|
|||||
|
Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329
(e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. |
|||||
