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March 24, 2020; 94 (12) Article

Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window

Georgios Tsivgoulis, Aristeidis H. Katsanos, Konark Malhotra, Amrou Sarraj, Andrew D. Barreto, Martin Köhrmann, Christos Krogias, Niaz Ahmed, Valeria Caso, Peter D. Schellinger, Andrei V. Alexandrov
First published December 31, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008904
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Article Information

vol. 94 no. 12 e1241-e1248
DOI: 
https://doi.org/10.1212/WNL.0000000000008904
PubMed: 
31892636
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
0028-3878
Online ISSN: 
1526-632X
History: 
  • Received June 3, 2019
  • Accepted in final form September 30, 2019
  • First Published December 31, 2019.

Article Versions

Copyright & Usage: 
© 2019 American Academy of Neurology

Author Disclosures

    1. Georgios Tsivgoulis, MD,
    2. Aristeidis H. Katsanos, MD,
    3. Konark Malhotra, MD,
    4. Amrou Sarraj, MD,
    5. Andrew D. Barreto, MD, MS,
    6. Martin Köhrmann, MD,
    7. Christos Krogias, MD,
    8. Niaz Ahmed, MD,
    9. Valeria Caso, MD,
    10. Peter D. Schellinger, MD and
    11. Andrei V. Alexandrov, MD
  1. Georgios Tsivgoulis, MD,
    2. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Journal of Neuroimaging, Associate Editor for Neurosonology, 2009- Stroke, Editorial Board Member, 2015-

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Aristeidis H. Katsanos, MD,
    3. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Journal of Neuroimaging, Editorial Board Member Stroke, Editorial Board Member PLOS One, Guest Academic Editor Frontiers in Neurology, Guest Editor

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Konark Malhotra, MD,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Amrou Sarraj, MD,
    5. Scientific Advisory Boards:

    1. Stryker Neurovascular - Commercial

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. Stryker Neurovascular - Commercial

    Editorial Boards:

    1. Frontiers in Neurology - Associate Editor

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Stryker Neurovascular - Commercial

    Speakers' Bureaus:

    1. Stryker Neurovascular - Commercial

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Stryker Neurovascular - Commercial

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. Andrew D. Barreto, MD, MS,
    6. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Martin Köhrmann, MD,
    7. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  7. Christos Krogias, MD,
    8. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. honoraria for oral presentations or travel grants for scientific meetings from Bayer Vital, Daiichi-Sankyo, none related to this manuscript.

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  8. Niaz Ahmed, MD,
    9. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. I am chairman of SITS International, which received grant from Boehringer-Ingelheim. SITS is currently conducting studies supported by Boehringer-Ingelheim as well as in collaboration with Karolinska Institutet, supported by Stryker, Covidien and Phenox.

    Research Support, Government Entities:

    1. I am coordinating a phase III clinical trial for which we have received grants provided by the Swedish Research Council

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. I am chairman of SITS International, which is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet, and private donors. I am also supported by grants provided by the Stockholm County Council.

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  9. Valeria Caso, MD,
    10. Scientific Advisory Boards:

    1. Respect ESUS Bayer SPI

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. Daichi-Sankyo BI Servier

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. speaker’s bureau of Boehringer Ingelheim, Bayer, daichi- Sankyo, Ever Pharma

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NONE

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  10. Peter D. Schellinger, MD and
    11. Scientific Advisory Boards:

    1. (1) Boehringer Ingelheim since 2003 (2) Daiichi Sankyo since 2014 (3) Cerevast until 2016 (4) Takeda 2017 (5) Portola 2019

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. (1) Boehringer Ingelheim since 2003 (2) Medtronic since 2015 (3) BMS/Pfizer since 2012 (4) Daiichi Sankyo since 2014 (5) Sun Pharma since 2016 (6) Cerevast until 2016 (7) Covidien until 2017

    Editorial Boards:

    1. (1) Stroke (2006-2009) (2) Journal of Stroke (2012-today)

    Patents:

    1. NONE

    Publishing Royalties:

    1. NeuroIntensiv eds 1-3, Springer, since 2008

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. (1) Boehringer Ingelheim since 2003 (2) Daiichi Sankyo since 2014 (3) Cerevast until 2016

    Speakers' Bureaus:

    1. (1) Boehringer Ingelheim since 2003 (2) Medtronic since 2015 (3) BMS/Pfizer since 2012 (4) Daiichi Sankyo since 2014 (5) Sun Pharma since 2016 (6) Cerevast until 2016 (7) Covidien until 2017

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NINDS, NIH 2003-2004

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  11. Andrei V. Alexandrov, MD
    12. Scientific Advisory Boards:

    1. Commercial entity: Cerevast Therapeutics, Inc

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Cerebrovascular Diseases, Editorial Board member, 2011- present Interventional Neurology, EB Member, 2016-present

    Patents:

    1. “Therapeutic Methods and Apparatus for Use of Sonication to Enhance Perfusion of Tissue” Inventors: Alexandrov AV, Aronowski J, Wojner AW US patent 6,733,450 (May 11, 2004) Assignee: Texas Systems, Board of Reagents

    Publishing Royalties:

    1. Alexandrov AV. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. New York: Futura / Blackwell Publishing. 2003. ISBN 1- 4051-0381-7 Alexandrov AV. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. Oxford: Blackwell Publishing (in Chinese) 2007. ISBN 7- 117-07389-6 Alexandrov AV. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. (2nd Edition) Oxford: Wiley-Blackwell Publishers. 2011. 9781405195768.

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Commercial entity: Cerevast Therapeutics, Inc.

    Speakers' Bureaus:

    1. Genentech, Inc

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. Commercial entity: Cerevast Therapeutics, Inc.

    Research Support, Government Entities:

    1. ZODIAC trial, NINR (R01 pending)

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. Commercial entity: Cerevast Therapeutics, Inc.

    License fee payments, Technology or Inventions:

    1. “Therapeutic Methods and Apparatus for Use of Sonication to Enhance Perfusion of Tissue” Inventors: Alexandrov AV, Aronowski J, Wojner AW US patent 6,733,450 (May 11, 2004) Assignee: Texas Systems, Board of Reagents Source of payment: Cerevast Therapeutics, Inc.

    Royalty Payments, Technology or Inventions:

    1. “Therapeutic Methods and Apparatus for Use of Sonication to Enhance Perfusion of Tissue” Inventors: Alexandrov AV, Aronowski J, Wojner AW US patent 6,733,450 (May 11, 2004) Assignee: Texas Systems, Board of Reagents Source of payment: Cerevast Therapeutics, Inc.

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  1. From the Second Department of Neurology (G.T., A.H.K.), “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.V.A.), University of Tennessee Health Science Center, Memphis; Department of Neurology (A.H.K., C.K.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Neurology (K.M.), Allegheny Health Network, Pittsburgh, Pennsylvania; Department of Neurology (A.S., A.D.B.), University of Texas Health Science Center, Houston; Department of Neurology (M.K.), Universitaetsklinikum Essen, Germany; Department of Neurology (N.A.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A.), Karolinska Institute, Stockholm, Sweden; Stroke Unit and Division of Cardiovascular Medicine (V.C.), University of Perugia, Italy; and Departments of Neurology and Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany.
  1. Correspondence
    Dr. Tsivgoulis tsivgoulisgiorg{at}yahoo.gr
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Article usage: December 2019 to April 2020

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