Stroke Clinical Trial
Official title:
REperfusion Therapy in Acute Ischemic STroke With Unclear Onset by MRI Evaluation
This study will test the hypothesis whether patients with unclear-onset stroke (UnCLOS) treated with thrombolysis could achieve a prespecified rate of good clinical outcome. The secondary hypothesis is that the efficacy outcomes in UnCLOS group would be superior to those in historical UnCLOS group from prospective stroke registries.
1. Study design: A prospective multicenter trial
2. Study centers: 6 participating medical centers in South Korea
3. Participants: Consecutive patients with acute ischemic stroke visiting the emergency
room within 6 hours of the detection of stroke symptoms
4. Methods
- 3 thrombolysis protocols applicable to UnCLOS patients
1. IV tissue plasminogen activator (tPA) : Conventional intravenous tPA (0.9
mg/kg, 10% of the dose as a bolus and the remainder over 60 minutes) will be
administered to patients within 3 hours of first found abnormal time who had
no arterial occlusion or catheter-inaccessible occlusion.
2. IV tPA + IA urokinase protocol : Combined intravenous tPA (0.6 mg/kg, 10% of
the dose as a bolus and the remainder over 30 minutes) with intra-arterial
urokinase will be administered to those within 3 hours from first found
abnormal time who had catheter-accessible arterial occlusion.
3. IA UK protocol : Intra-arterial urokinase will be given to those between 3
and 6 hours after first found abnormal time who had catheter-accessible
arterial occlusion.
5. Outcome variables
- Safety outcomes Symptomatic intracranial hemorrhage (ICH) within 48 hours from
thrombolytic therapy.
- Efficacy outcomes
1. Long-term clinical outcomes (modified Rankin Scale) at 3 months
2. Secondary efficacy outcomes : Good vs. Poor outcomes according to mRS
responder analysis, Early neurological improvement, Immediate and 5-day
recanalization on MRA or CTA
;
Observational Model: Case-Only, Time Perspective: Prospective
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