The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke

IST 3 Collaborative Grp, Peter Sandercock, Richard Lindley, Joanna Wardlaw, Martin Dennis, Steff Lewis, Graham Venables, Adam Kobayashi, Anna Czlonkowska, Eivind Berge, Karsten Bruins Slot, Veronica Murray, Andre Peeters, Graeme Hankey, Karl Matz, Michael Brainin, Stefano Ricci, Maria Grazia Celani, Enrico Righetti, Teresa CantisaniGord Gubitz, Steve Phillips, Antonio Arauz, Kameshwar Prasad, Manuel Correia, Phillippe Lyrer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit.

Design: International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE) trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours), it can detect a 3% benefit.

Trial procedures: Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24-48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent ( Modified Rankin 0-2) at six months ( assessed via a postal questionnaire mailed directly to the patient). Secondary outcomes include: events within 7 days ( death, recurrent stroke, symptomatic intracranial haemorrhage), outcome at six months ( death, functional status, EuroQol).

Original languageEnglish
Article number37
Pages (from-to)-
Number of pages17
JournalTrials
Volume9
DOIs
Publication statusPublished - 17 Jun 2008

Keywords

  • TISSUE-PLASMINOGEN ACTIVATOR
  • RANDOMIZED CONTROLLED-TRIAL
  • SIMPLE QUESTIONS
  • BLOOD-PRESSURE
  • THERAPY
  • ALTEPLASE
  • MANAGEMENT
  • ATLANTIS
  • ECASS
  • HYPERTENSION

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