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How do pre-thrombolysis CT scan appearances in acute stroke aid prognosis? Insights from the ENCHANTED trial
In acute stroke, CT scanning was the predominant imaging modality in clinical trials of thrombolysis and thrombectomy. While CT reliably excludes intracranial haemorrhage and some structural stroke mimics, the inherently slow decrease in X-ray attenuation over the hours after stroke onset limits the sensitivity of CT to acute ischaemia. Interpretation of subtle early ischaemic changes is confounded by common background abnormalities including atrophy, old infarcts or haemorrhage, and rarefaction of cerebral white matter due to chronic ischaemia (leukoaraiosis). In this issue, the ENCHANTED investigators report associations of both acute ischaemia and background ‘brain frailty’ on pre-thrombolysis CT with clinical outcomes in a large clinical trial.1
ENCHANTED compared standard dose alteplase with a lower dose regime that is widely used in south-east …
Contributors I am the sole author.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests I have received fees for participation in advisory boards for Boehringer Ingelheim, Biogen, ReNeuron, Bayer and Daiichi Sankyo. I am the chief investigator for the ATTEST-2 trial, which receives support from Boehringer Ingelheim for tenecteplase supply. I hold grants with Profs Wardlaw and Robinson and Dr Mair and serve on trial steering committees with these investigators. Prof Lindley chairs the independent Data Monitoring Committee for the ATTEST-2 trial.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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