Australian study will change the way stroke is treated around the world

A team of Melbourne researchers have found the time to treat ischemic stroke patients can be doubled. One in five people suffer stroke in their sleep and this will be life changing for them.

The EXTEND randomised clinical trial found the initial window of 4.5 hours from symptom onset could now be pushed to 9 hours given solid evidence of ‘brain to save’ on advanced brain imaging.

EXTEND, led by The Royal Melbourne Hospital, the University of Melbourne and the Monash Medical Centre, compared the effectiveness of altephase, a thrombolytic drug used to treat ischemic stroke, versus placebo, for reducing disability after stroke.

The research found in most cases if the patient was administered the alteplase between 4.5 – 9 hours after stroke onset it resulted in a high percentage of patients with no or minor neurologic defects than the use of placebo.

RMH neurologist, Director of the Melbourne Brain Centre at RMH and study co-principal investigator Professor Stephen Davis said the study, published in the New England Journal of Medicine found the drug alteplase was life changing in treatment of ischemic stroke. “Our study used imaging of brain blood flow to select patients and showed that alteplase increased the number of patients who were able to return to all their usual activities by 44% compared to placebo , an excellent outcome for our patients,” Professor Davis said.

The international trial involved 225 participants from a large multi-centre collaboration across 25 hospitals in Australia, New Zealand, Finland and Taiwan, who either received alteplase or placebo.

Professor Geoffrey Donnan, study co-principal investigator, said the study results were likely to change stroke treatment guidelines and clinical practice.

“This research means that patients who were previously untreatable because they woke up with stroke symptoms or were unavoidably delayed in reaching hospital can now benefit,” Professor Donnan said.

While this breakthrough will lead to sweeping changes in stroke treatment it’s still critical people seek help as soon as possible as Professor Davis warns that every minute counts when it comes to stroke patients.

“It’s still critical that stroke patients are treated as fast as possible and the proportion of patients who have the favourable brain imaging that allows us to treat them drops rapidly with passing time,” Professor Davis said.

Medical co-ordinator for the EXTEND trial Associate Professor Henry Ma from Monash Medical Centre said the research means patients who have a stroke in their sleep will greatly benefit.

“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, A/Prof Ma said.

“This is terrific for patients and will reduce the burden of stroke-related disability in Australia and worldwide.”