Trial supports using clot-busting drug in late window after acute ischemic stroke

The University of Cincinnati's Eva Mistry spoke with TCT MD about new trial data that found administering the clot-busting drug alteplase is beneficial for patients with acute ischemic stroke and salvageable brain tissue on imaging up to 24 hours after symptom onset.

Results of the HOPE trial, published online last week in the journal JAMA, found 40.3% of patients treated with alteplase were functionally independent at 90 days after a stroke, while 26.3% of patients who received standard care were functionally independent. The alteplase group had a higher up-front rate of symptomatic intracranial hemorrhage, but there was no difference in 90-day mortality.

“These findings support extending the therapeutic window for IV thrombolysis in appropriately selected patients when endovascular thrombectomy is not initially planned or indicated,” the researchers concluded.

Mistry said these results are mostly applicable in places where thrombectomy isn't readily available. Thrombectomy is a minimally invasive stroke procedure that uses a catheter to remove a blood clot from a blood vessel in the brain to restore blood flow.

“That still concerns me in terms of generalizability of the results outside of resource-poor settings where thrombectomy isn’t available,” said Mistry, MBBS, associate professor in UC's College of Medicine and a UC Gardner Neuroscience Institute physician. In low-to-middle-income countries with insufficient resources, long transfer times, and/or no thrombectomy services, on the other hand, she said it is encouraging “that now, patients may be considered for a reperfusion therapy based on advanced imaging selection in the extended time window.”

Read the TCT MD article.

Featured photo at top of Mistry, left, and Stacie Demel, DO. Photo/Andrew Higley/UC Marketing + Brand.