Skip to main content
SpringerLink
Log in

An Outcome Model for Intravenous rt-PA in Acute Ischemic Stroke

  • Original Article
  • Published:
Translational Stroke Research Aims and scope Submit manuscript

Abstract

Most early phase trials in stroke and brain trauma have failed in phase 3, including efforts to improve acute ischemic stroke outcomes beyond that achieved by intravenous recombinant tissue plasminogen activator (t-PA) (IVT). With the exception of more recent stent retriever trials, most subsequent phase 3 trials failed. We previously showed that baseline imbalances, non-linear relationships of these factors to outcome, and unrepresentative control populations invalidate traditional statistical analysis in early trials of heterogeneous diseases such as stroke. We developed an alternative approach using a pooled outcome model derived from control arms of randomized clinical trial (RCTs). This model then permits comparing treatment trials to an expected outcome of a pooled population. Here, we hypothesized we could develop such a model for IVT and tested it against outcomes without IVT. We surveyed literature for all trials involving one arm with IVT reporting baseline National Institute Stroke Scale (NIHSS), age, and outcome. A non-linear fit was performed including multi-dimensional statistical intervals (±95 %) permitting visual comparison of outcomes at their own baselines. We compared models derived from non-IVT control arms. Models from 24 IVT RCTs representing 3195 subjects were successfully generated for functional outcome, modified Rankin Scale (mRS) 0–2 (r 2 = 0. 83, p < 0.001), and mortality (r 2 = 0.54; p = 0.001). We confirmed better outcomes compared to no IVT and mixed use IVT models across the range of baseline factors. It was possible to generate an expected outcome model for IVT from existing literature. We confirmed benefit compared to placebo. This model should be useful to compare to new agents without the need for statistical manipulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. Epub 2014/12/18.

    Article  PubMed  Google Scholar 

  2. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. Epub 2015/02/12.

    Article  CAS  PubMed  Google Scholar 

  3. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. Epub 2015/02/12.

    Article  CAS  PubMed  Google Scholar 

  4. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. Epub 2015/04/18.

    Article  CAS  PubMed  Google Scholar 

  5. Fugate JE, Rabinstein AA. Update on intravenous recombinant tissue plasminogen activator for acute ischemic stroke. Mayo Clin Proc. 2014. Epub 2014/04/30.

  6. Kent TA, Shah SD, Mandava P. Improving early clinical trial phase identification of promising therapeutics. Neurology. 2015;85(3):274–83.

  7. Lapchak PA. Fast neuroprotection (fast-NPRX) for acute ischemic stroke victims: the time for treatment is now. Transl Stroke Res. 2013;4(6):704–9. Epub 2013/12/11.

    Article  PubMed  Google Scholar 

  8. Lapchak PA, Zhang JH. Resolving the negative data publication dilemma in translational stroke research. Transl Stroke Res. 2011;2(1):1–6. Epub 2011/06/15.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mandava P, Kent TA. A method to determine stroke trial success using multidimensional pooled control functions. Stroke. 2009;40(5):1803–10. Epub 2009/03/17.

    Article  PubMed  Google Scholar 

  10. Uchino K, Billheimer D, Cramer SC. Entry criteria and baseline characteristics predict outcome in acute stroke trials. Stroke. 2001;32(4):909–16. Epub 2001/04/03.

    Article  CAS  PubMed  Google Scholar 

  11. Crager MR. Analysis of covariance in parallel-group clinical trials with pretreatment baselines. Biometrics. 1987;43(4):895–901. Epub 1987/12/01.

    Article  CAS  PubMed  Google Scholar 

  12. Koch GG, Tangen CM, Jung JW, Amara IA. Issues for covariance analysis of dichotomous and ordered categorical data from randomized clinical trials and non-parametric strategies for addressing them. Stat Med. 1998;17(15–16):1863–92. Epub 1998/09/28.

    Article  CAS  PubMed  Google Scholar 

  13. Lees KR, Zivin JA, Ashwood T, Davalos A, Davis SM, Diener HC, et al. NXY-059 for acute ischemic stroke. N Engl J Med. 2006;354(6):588–600. Epub 2006/02/10.

    Article  CAS  PubMed  Google Scholar 

  14. Shuaib A, Lees KR, Lyden P, Grotta J, Davalos A, Davis SM, et al. NXY-059 for the treatment of acute ischemic stroke. N Engl J Med. 2007;357(6):562–71. Epub 2007/08/10.

    Article  CAS  PubMed  Google Scholar 

  15. Davalos A, Alvarez-Sabin J, Castillo J, Diez-Tejedor E, Ferro J, Martinez-Vila E, et al. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet. 2012;380(9839):349–57. Epub 2012/06/14.

    Article  CAS  PubMed  Google Scholar 

  16. Mandava P, Kent TA. Intra-arterial therapies for acute ischemic stroke. Neurology. 2007;68(24):2132–9. Epub 2007/06/15.

    Article  PubMed  Google Scholar 

  17. Mandava P, Suarez JI, Kent TA. Intravenous rt-PA versus endovascular therapy for acute ischemic stroke. Curr Atheroscler Rep. 2008;10(4):332–8. Epub 2008/07/09.

    Article  PubMed  Google Scholar 

  18. Dolan KD, Yang L, Trampel CP. Nonlinear regression technique to estimate kinetic parameters and confidence intervals in unsteady-state conduction-heated foods. J Food Eng. 2007;80:581–93.

    Article  Google Scholar 

  19. Mandava P, Krumpelman CS, Shah JN, White DL, Kent TA. Quantification of errors in ordinal outcome scales using Shannon entropy: effect on sample size calculations. PLoS One. 2013;8(7):e67754. Epub 2013/07/19.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. Epub 1995/12/14.

    Article  Google Scholar 

  21. Using the F-test to compare two models. Non-linear regression. Stat Topic Files. 2013; Available from: https://sakai.duke.edu/access/content/group/25e08a3d-9fc4-41b0-a7e9-815732c1c4ba/New%20folder/Stat%20Topic%20Files/Non-Linear%20Regression/FTestTutorial.pdf.

  22. Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, et al. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 2004;351(21):2170–8. Epub 2004/11/19.

    Article  CAS  PubMed  Google Scholar 

  23. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368(10):893–903. Epub 2013/02/09.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Ciccone A, Valvassori L, Ponzio M, Ballabio E, Gasparotti R, Sessa M, et al. Intra-arterial or intravenous thrombolysis for acute ischemic stroke? The SYNTHESIS pilot trial. J Neurointervent Surg. 2010;2(1):74–9. Epub 2010/03/01.

    Article  CAS  Google Scholar 

  25. Haley Jr EC, Thompson JL, Grotta JC, Lyden PD, Hemmen TG, Brown DL, et al. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke. 2010;41(4):707–11. Epub 2010/02/27.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Hill MD, Martin RH, Palesch YY, Tamariz D, Waldman BD, Ryckborst KJ, et al. The Albumin in Acute Stroke Part 1 Trial: an exploratory efficacy analysis. Stroke. 2011;42(6):1621–5. Epub 2011/05/07.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Lang W, Stadler CH, Poljakovic Z, Fleet D. A prospective, randomized, placebo-controlled, double-blind trial about safety and efficacy of combined treatment with alteplase (rt-PA) and Cerebrolysin in acute ischaemic hemispheric stroke. Int J Stroke. 2013;8(2):95–104. Epub 2012/09/27.

    Article  PubMed  Google Scholar 

  28. Lyden P, Jacoby M, Schim J, Albers G, Mazzeo P, Ashwood T, et al. The Clomethiazole Acute Stroke Study in tissue-type plasminogen activator-treated stroke (CLASS-T): final results. Neurology. 2001;57(7):1199–205. Epub 2001/10/10.

    Article  CAS  PubMed  Google Scholar 

  29. Molina CA, Barreto AD, Tsivgoulis G, Sierzenski P, Malkoff MD, Rubiera M, et al. Transcranial ultrasound in clinical sonothrombolysis (TUCSON) trial. Ann Neurol. 2009;66(1):28–38. Epub 2009/08/12.

    Article  CAS  PubMed  Google Scholar 

  30. Pancioli AM, Adeoye O, Schmit PA, Khoury J, Levine SR, Tomsick TA, et al. Combined approach to lysis utilizing eptifibatide and recombinant tissue plasminogen activator in acute ischemic stroke-enhanced regimen stroke trial. Stroke. 2013;44(9):2381–7. Epub 2013/07/28.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Pancioli AM, Broderick J, Brott T, Tomsick T, Khoury J, Bean J, et al. The combined approach to lysis utilizing eptifibatide and rt-PA in acute ischemic stroke: the CLEAR stroke trial. Stroke. 2008;39(12):3268–76. Epub 2008/09/06.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Piironen K, Tiainen M, Mustanoja S, Kaukonen KM, Meretoja A, Tatlisumak T, et al. Mild hypothermia after intravenous thrombolysis in patients with acute stroke: a randomized controlled trial. Stroke. 2014;45(2):486–91. Epub 2014/01/18.

    Article  CAS  PubMed  Google Scholar 

  33. Zinkstok SM, Roos YB. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet. 2012;380(9843):731–7. Epub 2012/07/04.

    Article  CAS  PubMed  Google Scholar 

  34. Chamorro A, Amaro S, Castellanos M, Segura T, Arenillas J, Marti-Fabregas J, et al. Safety and efficacy of uric acid in patients with acute stroke (URICO-ICTUS): a randomised, double-blind phase 2b/3 trial. Lancet Neurol. 2014;13(5):453–60. Epub 2014/04/08.

    Article  CAS  PubMed  Google Scholar 

  35. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368(10):904–13. Epub 2013/02/08.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Huang X, Cheripelli BK, Lloyd SM, Kalladka D, Moreton FC, Siddiqui A, et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. Lancet Neurol. 2015;14(4):368–76. Epub 2015/03/03.

    Article  CAS  PubMed  Google Scholar 

  37. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29. Epub 2008/09/26.

    Article  CAS  PubMed  Google Scholar 

  38. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282(21):2019–26. Epub 1999/12/11.

    Article  CAS  PubMed  Google Scholar 

  39. Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol. 2008;7(4):299–309. Epub 2008/02/26.

    Article  PubMed  Google Scholar 

  40. Clark WM, Albers GW, Madden KP, Hamilton S. The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g): results of a double-blind, placebo-controlled, multicenter study. Thrombolytic therapy in acute ischemic stroke study investigators. Stroke. 2000;31(4):811–6. Epub 2001/02/07.

    Article  CAS  PubMed  Google Scholar 

  41. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51. Epub 1998/10/27.

    Article  CAS  PubMed  Google Scholar 

  42. Parsons M, Spratt N, Bivard A, Campbell B, Chung K, Miteff F, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012;366(12):1099–107. Epub 2012/03/23.

    Article  CAS  PubMed  Google Scholar 

  43. The RANTTAS Investigators. A randomized trial of tirilazad mesylate in patients with acute stroke (RANTTAS). Stroke. 1996;27(9):1453–8. Epub 1996/09/01.

    Article  Google Scholar 

  44. Enlimomab Acute Stroke Trial Investigators. Use of anti-ICAM-1 therapy in ischemic stroke: results of the Enlimomab Acute Stroke Trial. Neurology. 2001;57(8):1428–34. Epub 2001/10/24.

    Article  Google Scholar 

  45. Abciximab Emergent Stroke Treatment Trial (AbESTT) Investigators. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of a randomized phase 2 trial. Stroke. 2005;36(4):880–90. Epub 2005/02/26.

    Article  Google Scholar 

  46. Adams Jr HP, Effron MB, Torner J, Davalos A, Frayne J, Teal P, et al. Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II). Stroke. 2008;39(1):87–99. Epub 2007/11/23.

    Article  CAS  PubMed  Google Scholar 

  47. Bogousslavsky J, Victor SJ, Salinas EO, Pallay A, Donnan GA, Fieschi C, et al. Fiblast (trafermin) in acute stroke: results of the European-Australian phase II/III safety and efficacy trial. Cerebrovasc Dis. 2002;14(3–4):239–51. Epub 2002/10/31.

    Article  CAS  PubMed  Google Scholar 

  48. Camerlingo M, Salvi P, Belloni G, Gamba T, Cesana BM, Mamoli A. Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions. Stroke. 2005;36(11):2415–20. Epub 2005/10/15.

    Article  CAS  PubMed  Google Scholar 

  49. Clark W, Ertag W, Orecchio E, Raps E. Cervene in acute ischemic stroke: results of a double-blind, placebo-controlled, dose-comparison study. J Stroke Cerebrovasc Dis. 1999;8(4):224–30. Epub 2007/09/27.

    Article  CAS  PubMed  Google Scholar 

  50. Clark WM, Coull BM, Karukin M, Hendin B, Kelley R, Rosing H, et al. Randomized trial of Cervene, a kappa receptor-selective opioid antagonist, in acute ischemic stroke. J Stroke Cerebrovasc Dis. 1996;6(1):35–40. Epub 1996/09/01.

    Article  CAS  PubMed  Google Scholar 

  51. Clark WM, Raps EC, Tong DC, Kelly RE. Cervene (Nalmefene) in acute ischemic stroke: final results of a phase III efficacy study. The Cervene Stroke Study Investigators. Stroke. 2000;31(6):1234–9. Epub 2000/06/03.

    Article  CAS  PubMed  Google Scholar 

  52. Davis SM, Lees KR, Albers GW, Diener HC, Markabi S, Karlsson G, et al. Selfotel in acute ischemic stroke: possible neurotoxic effects of an NMDA antagonist. Stroke. 2000;31(2):347–54. Epub 2000/02/05.

    Article  CAS  PubMed  Google Scholar 

  53. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke. 1998;29(1):4–11. Epub 1998/01/28.

    Article  PubMed  Google Scholar 

  54. Ehrenreich H, Weissenborn K, Prange H, Schneider D, Weimar C, Wartenberg K, et al. Recombinant human erythropoietin in the treatment of acute ischemic stroke. Stroke. 2009;40(12):e647–56. Epub 2009/10/17.

    Article  CAS  PubMed  Google Scholar 

  55. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999;282(21):2003–11. Epub 1999/12/11.

    Article  CAS  PubMed  Google Scholar 

  56. Ginsberg MD, Palesch YY, Martin RH, Hill MD, Moy CS, Waldman BD, et al. The Albumin in Acute Stroke (ALIAS) Multicenter Clinical Trial Safety Analysis of Part 1 and Rationale and Design of Part 2. Stroke. 2011;42(1):119–27.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Grotta J. Lubeluzole treatment of acute ischemic stroke. The US and Canadian Lubeluzole Ischemic Stroke Study Group. Stroke. 1997;28(12):2338–46. Epub 1997/12/31.

    Article  CAS  PubMed  Google Scholar 

  58. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274(13):1017–25. Epub 1995/10/04.

    Article  CAS  PubMed  Google Scholar 

  59. Levy DE, del Zoppo GJ, Demaerschalk BM, Demchuk AM, Diener H-C, Howard G, et al. Ancrod in acute ischemic stroke results of 500 subjects beginning treatment within 6 hours of stroke onset in the ancrod stroke program. Stroke. 2009;40(12):3796–803.

    Article  PubMed  Google Scholar 

  60. Ogawa A, Mori E, Minematsu K, Taki W, Takahashi A, Nemoto S, et al. Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke. 2007;38(10):2633–9. Epub 2007/08/19.

    Article  CAS  PubMed  Google Scholar 

  61. Rosso C, Corvol JC, Pires C, Crozier S, Attal Y, Jacqueminet S, et al. Intensive versus subcutaneous insulin in patients with hyperacute stroke: results from the randomized INSULINFARCT trial. Stroke. 2012;43(9):2343–9. Epub 2012/06/16.

    Article  PubMed  Google Scholar 

  62. Rudolf J. Hydroxyethyl starch for hypervolemic hemodilution in patients with acute ischemic stroke: a randomized, placebo-controlled phase II safety study. Cerebrovasc Dis. 2002;14(1):33–41. Epub 2002/07/05.

    Article  CAS  PubMed  Google Scholar 

  63. Sacco RL, DeRosa JT, Haley Jr EC, Levin B, Ordronneau P, Phillips SJ, et al. Glycine antagonist in neuroprotection for patients with acute stroke: GAIN Americas: a randomized controlled trial. JAMA. 2001;285(13):1719–28. Epub 2001/04/13.

    Article  CAS  PubMed  Google Scholar 

  64. Teal P, Davis S, Hacke W, Kaste M, Lyden PD, Fierus M, et al. A randomized, double-blind, placebo-controlled trial to evaluate the efficacy, safety, tolerability, and pharmacokinetic/pharmacodynamic effects of a targeted exposure of intravenous repinotan in patients with acute ischemic stroke modified randomized exposure controlled trial (mRECT). Stroke. 2009;40(11):3518–25.

    Article  CAS  PubMed  Google Scholar 

  65. Torgano G, Zecca B, Monzani V, Maestroni A, Rossi P, Cazzaniga M, et al. Effect of intravenous Tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial. Cerebrovasc Dis. 2010;29(3):275–81.

    Article  CAS  PubMed  Google Scholar 

  66. Piggot TD. Missing data in meta-analysis: strategies and approaches. Advances in Meta-analysis. New York: Springer; 2012. p. 80–1.

    Google Scholar 

  67. Mandava P, Dalmeida W, Anderson JA, Thiagarajan P, Fabian RH, Weir RU, et al. A pilot trial of Low-dose intravenous Abciximab and unfractionated heparin for acute ischemic stroke: translating GP IIb/IIIa receptor inhibition to clinical practice. Transl Stroke Res. 2010;1(3):170–7. Epub 2010/09/01.

    Article  CAS  PubMed  Google Scholar 

  68. Mandava P, Martini SR, Munoz M, Dalmeida W, Sarma AK, Anderson JA, et al. Hyperglycemia worsens outcome after rt-PA primarily in the large-vessel occlusive stroke subtype. Transl Stroke Res. 2014;5(4):519–25. Epub 2014/04/05.

    Article  PubMed  Google Scholar 

  69. Mandava P, Shah SD, Sarma AK, Dalmeida D, Kent TA. A pooled analysis indicates the promise and pitfalls of improving upon intravenous rt-PA for ischemic stroke. International Stroke Conference; 2014. San Diego: American Heart Association; 2014.

    Google Scholar 

Download references

Compliance with Ethical Standards:

Funding

Computing resources of the Computational and Integrative Biomedical Research Center at Baylor College of Medicine were utilized for this study (P.M.).

Conflict of Interest

Drs. Mandava P and Kent TA are copyright holders of pPREDICTS. Drs. Shah SD and Sarma AK have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Author information

Authors and Affiliations

  1. Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd (127), Houston, TX, 77030, USA

    Pitchaiah Mandava & Thomas A. Kent

  2. Center for Translational Research in Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Thomas A. Kent

  3. Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Pitchaiah Mandava, Shreyansh D. Shah, Anand K. Sarma & Thomas A. Kent

Authors
  1. Pitchaiah Mandava
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shreyansh D. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anand K. Sarma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas A. Kent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pitchaiah Mandava.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

 (DOC 34 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mandava, P., Shah, S.D., Sarma, A.K. et al. An Outcome Model for Intravenous rt-PA in Acute Ischemic Stroke. Transl. Stroke Res. 6, 451–457 (2015). https://doi.org/10.1007/s12975-015-0427-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12975-015-0427-5

Keywords

Search

Navigation