Who Benefits from tPA 3-6 hours after Stroke

描述（由申请人提供）：目前，FDA批准的唯一治疗急性卒中的方法是在症状发作后3小时内静脉注射组织纤溶酶原激活剂（iv tPA）。在美国，只有3%的中风患者接受静脉注射tPA，因为大多数患者在静脉注射tPA的3小时时限后到医院就诊。尽管临床试验尚未证明iv tPA超过3小时的获益，但可能存在获益的卒中患者亚组。需要确定该亚组，以增加可能接受tPA治疗的卒中患者比例。候选人提出，在三个特定目标中，研究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最有可能在3 - 6小时时间窗内对iv tPA产生良好反应的患者。根据这些项目的结果，候选人打算开发一种实用的临床预测工具，使医生能够对急性卒中患者进行分层，并确定那些最有可能对tPA产生良好反应的患者。Lansberg博士正在斯坦福大学医学中心完成他的脑血管奖学金，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。他的职业目标是通过临床研究和直接的病人护理来改善中风病人的健康。他的职业发展计划结合了高度相关的临床研究建议与补充教学培训。他将完成临床流行病学和生物统计学硕士课程，并将接受MRI技术培训。候选人拥有一个导师团队，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，MRI物理学和生物统计学。他们将在整个授予期间提供指导，并协助他过渡到一个成功的独立调查员。

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.