Who Benefits from tPA 3-6 hours after Stroke

描述(申请人提供)：目前，FDA批准的治疗急性中风的唯一方法是在症状出现后三小时内静脉注射组织型纤溶酶原激活剂(Iv TPA)。在美国，只有3%的中风患者接受静脉注射tPA，因为大多数患者到医院接受静脉注射tPA的时间超过了三个小时的限制。尽管临床试验还没有显示静脉注射tPA超过3小时的益处，但受益的中风患者亚群很可能存在。需要确定这一亚组，以增加可能接受tPA治疗的中风患者的比例。候选人提出了三个具体目标，以调查1)临床、2)计算机断层扫描(CT)和3)磁共振成像(MRI)特征是否有助于识别在3至6小时的时间窗口内最有可能对静脉注射tPA有良好反应的患者。基于这些项目的结果，候选人打算开发一种实用的临床预测工具，使医生能够对急性中风患者进行分层，并确定哪些人最有可能对tPA有良好的反应。兰斯伯格博士即将完成他在斯坦福大学医学中心的脑血管奖学金，他将于2004年7月1日加入斯坦福大学神经病学和神经科学系的工作人员。他的职业目标是通过临床研究和直接患者护理来改善中风患者的健康。他的职业发展计划将高度相关的临床研究方案与补充的教学培训结合在一起。他将完成临床流行病学和生物统计学的理学硕士课程，并将接受核磁共振技术方面的培训。这位候选人拥有一支导师团队，他们是以下四个领域的世界知名研究人员：急性中风的临床研究、神经放射学、核磁共振物理学和生物统计学。他们将在整个授奖期间提供指导，并促进他转变为一名成功的独立调查员。

DESCRIPTION (provided by applicant): Currently, the only FDA approved treatment for acute stroke is intravenous tissue plasminogen activator (iv tPA) administered within three hours after symptom onset. Only three percent of stroke patients in the United States receive iv tPA, because most patients present to the hospital beyond the three hour time-limit for iv tPA. Although clinical trials have not demonstrated benefit from iv tPA beyond three hours, a subgroup of stroke patients who benefit is likely to exist. This subgroup needs to be identified in order to increase the proportion of stroke patients who may be treated with tPA. The candidate proposes, in three Specific Aims, to investigate whether 1) clinical, 2) computed tomography (CT) and 3) magnetic resonance imaging (MRI) characteristics help identify patients who are most likely to have a favorable response to iv tPA in the three to six hour time-window. Based on the results of these projects, the candidate intents to develop a practical clinical prediction tool, which will enable physicians to stratify acute stroke patients and identify those who are most likely to have a favorable response to tPA. Dr. Lansberg is completing his Cerebrovascular Fellowship at Stanford University Medical Center and he will join the staff of the Department of Neurology and Neurological Sciences at Stanford University on July 1, 2004. His career goal is to improve the health of stroke patients through clinical research and direct patient care. His career development plan combines a highly relevant clinical research proposal with complementary didactic training. He will complete a Master of Science Program in Clinical Epidemiology and Biostatistics and he will get training in MRI technology. The candidate has a team of mentors who are world-renowned researchers in the following four fields: Clinical studies of acute stroke, neuroradiology, MRI physics and biostatistics. They will provide guidance throughout the award period and facilitate his transition into a successful independent investigator.