New findings to change the way stroke is treated

Associate Professor Henry Ma, Head of Stroke in the School of Clinical Sciences at Monash Health, and Director of Neurology and Head of the Stroke Unit at Monash Health, is part of a team of Melbourne researchers who have found the time to treat ischemic stroke in patients can be doubled.

Ischemic stroke, one that is caused by a blood clot, is the most common type of stroke in patients. Previously, the time to initiate intravenous thrombolysis - dissolving of the clot – for acute ischemic stroke was limited to within 4.5 hours following the onset of symptoms.

The study, known as the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits), has found that this window can be pushed out to 9 hours in patients where obstruction of blood supply to the brain tissue has not yet occurred. The trial involved patients with ischemic stroke who had decreased blood flow but ‘salvageable regions of the brain’. It compared the effectiveness of altephase, a thrombolytic drug used to treat ischemic stroke, versus placebo, for reducing disability after stroke in 225 patients worldwide.

The results found that if the patient was administered the altephase between 4.5 and 9 hours after stroke onset, it resulted in a higher percentage of patients with no or minor neurologic deficits than the use of a placebo.

“These results shift the stroke paradigm from using a clock to determine eligibility for clot-dissolving treatment to using brain imaging to identify whether there is brain tissue that can be saved in the individual patient" Associate Professor Ma said.

The findings have been published in the New England Journal of Medicine with Associate Professor Henry Ma as the leading author.