Proact 2 ia prourokinase
474 screening angiograms, 180 randomized, mean age 64, NIHSS 17, all MCA occlusions 2:1 ratio placebo controlled,all patients received low dose heparin. MRS<=2 at 90 days was 40 % in pro UK group v. 25 % placebo, 15 % absolute benefit, mortality (pro UK) 25 % v. (placebo) 27 %. NTT for 1 benefit =7. Not approved due to high rate of ICH.
IMS Study Bridging therapy eg. .6 mg/kg iv tpa (15 % bolus) followed by ia tpa up to 22 mg over 2 hours, ages 18-80, NIHSS>=10 within 3 hours. Primary outcome safety SICH, clinical outcome mRS 0-1 at 3 months. 28/77 (36%) had major occlusion or high grade ICA stenosis, but 56 % were TIMI 2 or 3 at end of 2 hours of infusion.
IMS 2 - 3 ongoing multicenter randomized trial with similar design except that coull use iv tPA.endovascular (IA, MERCI, or ultrasound lysis) v. iv tPA alone.
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