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ECASS III
About the Trial
The third European Cooperative Acute Stroke Study randomized 821 patients with acute ischemic stroke to intravenous alteplase or placebo between 3 and 4.5 hours after symptom onset. A favorable outcome at 90 days occurred in 52.4 percent of the alteplase group versus 45.2 percent with placebo, despite more symptomatic intracranial hemorrhage. Published in the New England Journal of Medicine in 2008, the trial extended the window established by the NINDS trial, and guidelines soon endorsed treatment up to 4.5 hours in eligible patients. ECASS III also reinforced that benefit declines with every minute of delay, sharpening the time is brain message.
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