Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol

El-Tawil, S., Wardlaw, J., Ford, I. , Mair, G., Robinson, T., Kalra, L. and Muir, K. W. (2017) Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol. International Journal of Stroke, 12(6), pp. 671-678. (doi:10.1177/1747493017696099) (PMID:28730951)

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Abstract

Rationale: Multimodal imaging, including computed tomography angiography and computed tomography perfusion imaging, yields additional information on intracranial vessels and brain perfusion and can differentiate between ischemic core and penumbra which may affect patient selection for intravenous thrombolysis. Hypothesis: The use of multimodal imaging will increase the number of patients receiving intravenous thrombolysis and lead to better treatment outcomes. Sample size: 400 patients. Methods and design: PRACTISE is a prospective, multicenter, randomized, controlled trial in which patients presenting within 4.5 h of symptom onset are randomized to either the current evidence-based imaging (NCCT alone) or additional multimodal computed tomography imaging (NCCT + computed tomography angiography + computed tomography perfusion). Clinical decisions on intravenous recombinant tissue plasminogen activator are documented. Total imaging time in both arms and time to initiation of treatment delivery in those treated with intravenous recombinant tissue plasminogen activator, is recorded. Follow-up will include brain imaging at 24 h to document infarct size, the presence of edema and the presence of intra-cerebral hemorrhage. Clinical evaluations include NIHSS score at baseline, 24 h and day 7 ± 2, and mRS at day 90 to define functional outcomes. Study outcomes: The primary outcome is the proportion of patients receiving intravenous recombinant tissue plasminogen activator. Secondary end-points evaluate times to decision-making, comparison of different image processing software and clinical outcomes at three months. Discussion: Multimodal computed tomography is a widely available tool for patient selection for revascularization therapy, but it is currently unknown whether the use of additional imaging in all stroke patients is beneficial. The study opened for recruitment in March 2015 and will provide data on the value of multimodal imaging in treatment decisions for acute stroke.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:El Tawil, Dr Salwa and Muir, Professor Keith and Ford, Professor Ian
Authors: El-Tawil, S., Wardlaw, J., Ford, I., Mair, G., Robinson, T., Kalra, L., and Muir, K. W.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:International Journal of Stroke
Publisher:SAGE Publications
ISSN:1747-4930
ISSN (Online):1747-4949
Published Online:14 March 2017
Copyright Holders:Copyright © 2017 World Stroke Organization
First Published:First published in International Journal of Stroke 12(6): 671-678
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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