Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Saturday, December 3, 2016

Novel Clot Buster Flops Again

So what is the next step  to solve this? Not doing anything is not okay, but that is what will happen since we have NO stroke leadership.

Desmoteplase didn't help late-presenting strokes, the DIAS-3 trial shows.

  • by
    Senior Staff Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:
The investigational thrombolytic desmoteplase didn't improve reperfusion or outcomes compared with placebo in ischemic strokes treated 3 to 9 hours after onset, the DIAS-3 trial showed.
A good functionally independent outcome, marked by a modified Rankin Scale score of 0 to 2, at 90 days occurred in 51% of desmoteplase-treated patients compared with 50% given placebo (P=0.40), Gregory W. Albers, MD, of the Stanford School of Medicine in Stanford, Calif., and colleagues found.
Recanalization at 24 hours, monitored with noninvasive imaging, likewise came out similar between treatment groups (49% and 42%, respectively), they reported in the June issue of Lancet Neurology.
"This factor is key in the neutral results and raises questions about the thrombolytic efficiency of desmoteplase in late time windows," Michael D. Hill, MD, and Bijoy K. Menon, MD, both of the University of Calgary Stroke Program in Alberta, wrote in an accompanying editorial.
The prior phase III DIAS-2 trial with the drug, which is based on the saliva of the vampire bat, had also turned out negative using a different imaging-based selection scheme for enrollment.
DIAS-3 used a "simpler imaging selection paradigm: small core (less than a third of the middle cerebral artery [MCA] or less than a half of the anterior cerebral artery [ACA] or posterior cerebral artery [PCA] territories), plus evidence of a target intracranial arterial occlusion," Hill and Menon noted.
However, imaging protocol violations were common in the trial, with imaging discrepancies in 21% of the 292 acute ischemic stroke patients with occlusion or high-grade stenosis in major cerebral arteries treated at a median 7 hours after onset.
Although serious adverse events, including intracerebral hemorrhage and symptomatic cerebral edema, were similar between groups, another phase III trial, DIAS-4, was stopped based on early indications of futility in DIAS-3.
The researchers pointed to a possible benefit of desmoteplase in small ischemic lesions selected by MRI that might be worth further study.
While that group might have been less prone to imaging measurement error, "this finding would have been more meaningful if increased recanalization early after administration of the thrombolytic agent was also shown in the small core group," the editorialists cautioned.
It may be that late-presenting, small core strokes are just not a good population to target, they suggested.
"We speculate that patients who arrive late without having a large, established core of infarction shown in imaging are more likely to have preserved penumbral tissue because of good intracranial collateral circulation," Hill and Menon wrote. "Such patients could stand to benefit less from thrombolysis, even with reperfusion.
"Further, with time, thrombi mature and fibrin cross-links, resulting in resistance to thrombolysis. Patients who present in later time windows might simply be less amenable to chemical thrombolysis."

1 comment:

  1. The measure of success is the f***ing 59 year old Rankin Scale that begins with no symptoms and ends with dead? Doctors are idiots when it comes to choosing outcome measures.