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Imaging acute ischemic stroke patients' brains did not lead to improved outcomes
Date:2/8/2013

The use of advanced imaging shortly after the onset of acute stroke failed to identify a subgroup of patients who could benefit from a clot-removal procedure, a study has found.

The randomized controlled trial known as Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) was funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, and was published online Feb. 8 in the New England Journal of Medicine.

In patients with ischemic stroke (caused by a blockage in an artery), brain cells deprived of blood die within minutes to hours. Rapidly opening the artery can halt brain cell death. Intravenous tissue plasminogen activator (t-PA), a drug that dissolves clots has been shown to improve outcomes in such stroke patients. However intravenous t-PA is not effective in many patients with large clots blocking the major brain arteries that cause the most devastating strokes. MR RESCUE investigators tested an invasive clot removal strategy designed to remove clots from these large arteries. Patients in the study were enrolled at 22 centers in the United States within approximately 5.5 hours of their stroke onset. Their ability to function independently was assessed at 90 days.

All MR-RESCUE patients underwent emergency computed tomography (CT) or magnetic resonance (MRI) perfusion imaging to identify regions of the brain with decreased blood flow, as well as regions that could not be salvaged.

The investigators hypothesized that patients in whom the scan suggested that less than 70 percent of the brain with decreased blood flow had already died would benefit from the clot-removal procedures. Based on the imaging results, the 118 study patients were randomly assigned to receive a clot-removal procedure within eight hours of symptom onset (64 patients) or standard therapy (54 patients) according to medical protocols. The procedure
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Contact: Kathryn DeMott
nindspressteam@ninds.nih.gov
301-496-5751
NIH/National Institute of Neurological Disorders and Stroke
Source:Eurekalert

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