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Clinical-diffusion mismatch and benefit from thrombolysis 3 to 6 hours after acute stroke.

Stroke; a Journal of Cerebral Circulation

Treatment Outcome, Double-Blind Method, Fibrinolytic Agents, therapeutic use, Humans, Logistic Models, Models, Biological, Models, Statistical, Sensitivity and Specificity, Stroke, diagnosis, drug therapy, Thrombolytic Therapy, Time Factors, Tissue Plasminogen Activator

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      Abstract

      The clinical-diffusion mismatch (CDM) model has been proposed as a simpler tool than perfusion-diffusion mismatch (PDM) to select acute ischemic stroke patients for thrombolytic therapy. We hypothesized that in the 3- to 6-hour time window, the effect of tPA was significantly greater in patients with CDM than in patients without CDM. This is a substudy of EPITHET, a double-blind multi-center study of 100 patients randomized to tPA or placebo 3 to 6 hours after stroke onset. MRI was obtained before treatment, and at 3 to 5 days and 90 days after treatment. Presence of PDM (perfusion deficit/DWI(volume) >1.2 and perfusion deficit at least 10 mL>DWI(volume)) and CDM (NIHSS >or=8 and DWI(volume) or=8 points between baseline and 90 days, or a 90-day NIHSS

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      Journal
      10.1161/STROKEAHA.109.548073
      19407226

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