From July , will be back . Was busy in backend activities and updates since last 2 months .

You can IVT, A meta-analysis pooled individual patient data (n = 414) from three trials (EXTEND, ECASS 4, and EPITHET) of intravenous alteplase that used imaging to identify and treat patients with salvageable brain tissue who had ischemic stroke 4.5 to 9 hours after onset or had wake-up stroke [15]. There was a higher rate of excellent functional outcome (defined by a mRS score 0 of 1) at three months for patients assigned to alteplase compared with those assigned to placebo (36 versus 29 percent, adjusted odds ratio [OR] 1.86, 95% CI 1.15-2.99). Symptomatic intracerebral hemorrhage was more frequent in the alteplase group (5 versus 0.5 percent), but this result did not nullify the overall benefit of alteplase. Limitations to this meta-analysis include small sample size and early stopping of two of the included trials (EXTEND and ECASS 4). Another meta-analysis of four trials (including Wake-Up Stroke, EXTEND, and ECASS 4) with individual patient data from over 843 patients reported similar findings [16]. Although this approach seems promising, additional trials are needed to confirm the efficacy and safety of IVT using imaging selection of patients with a stroke onset time >4.5 hours or an unknown stroke onset time [17]. Advanced imaging with MRI (DWI and FLAIR), MRI perfusion, or CT perfusion appears to be essential to determine if the cerebral infarction is recent and if there is significant salvageable brain tissue. Results of the TWIST trial suggest that selecting patients with noncontrast head CT alone (to exclude hemorrhage or large infarction) is unlikely to identify patients with wake-up stroke who will benefit from IVT and yes its hyperdensity / restricted diffusion. thank you.