Post-marketing Clinical Study of Alteplase for Acute Ischemic Stroke （Japan Alteplase Clinical Trial Ⅱ：J-ACT Ⅱ）
Condition: Stroke
MeSH terms: Stroke; Ischemic Stroke
Intervention: Alteplase
Intervention description: 0.6 mg/kg of Alteplase is intravenously administered
Intervention MeSH terms: Tissue Plasminogen Activator; Plasminogen
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 58.0
Sex: All
Minimum age: 20 Years
Healthy volunteers: No
Keywords: Cerebral Infarction; acute ischemic stroke; Brain ischemia

Summary:

      The purpose of this study is to confirm the efficacy and safety of intravenously administered
      alteplase in patients with acute ischemic stroke based on the rate of recanalization assessed
      by magnetic resonance angiography (MRA), the rate of patients with a modified Rankin Scale
      (mRS) score of 0-1, and the incidence of symptomatic intracranial hemorrhage (sICH), in
      comparison with the data reported in the current literature.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients with acute ischemic stroke within 3 hours of onset, with a clearly defined
             time of onset.

          -  Patients who have been revealed to have occlusion on one side of the middle cerebral
             artery (M1 or M2 portion) on MRA before the start of treatment.

          -  Patients for whom consent has been obtained from either themselves or from their
             legally acceptable representatives in written form.

        Exclusion Criteria:

          -  Patients with very light neurological symptoms (an NIHSS score of <= 4) or with
             rapidly improving symptoms before the start of treatment.

          -  Patients with serious neurological disorders (an NIHSS score of >= 23), or serious
             consciousness disorders (a Japan Coma Scale score of >= 100) before the start of
             treatment.

          -  Patients with functional disorders (a mRS score of >= 2) before stroke onset.

          -  Patients who have been administered drugs that are not allowed to be administered
             concomitantly with alteplase (other thrombolytic agents) after the stroke onset.

          -  Patients who have been revealed to have extensive early ischemic change (an Alberta
             Stroke Program Early CT score of <= 6) on computed tomography (CT) before treatment.

          -  Patients who have been revealed to have obvious occlusion in the blood vessel except
             for the middle cerebral artery on MRA before treatment.

          -  Patients who are forbidden to undergo magnetic resonance imaging (MRI).

          -  Patients who are defined as having cerebral hemorrhage or subarachnoid hemorrhage
             (SAH) on CT before treatment.

          -  Patients whose symptoms suggest SAH.

          -  Patients with hemorrhage (gastrointestinal hemorrhage, urinary hemorrhage,
             retroperitoneal hemorrhage, or hemoptysis).

          -  Patients with a platelet count below 100,000/mm3.

          -  Patients with fasting blood glucose levels of < 50 mg/dL or > 400 mg/dL.

          -  Patients whose activated partial thromboplastin time (APTT) is prolonged due to
             heparin administration within 48 hours before stroke onset.

          -  Patients who have been administered oral anticoagulants with values of the
             international normalized ratio of prothrombin time (PT-INR) of > 1.7.

          -  Patients who have a systolic blood pressure of > 185 mmHg or a diastolic blood
             pressure of > 110 mmHg.

          -  Patients who need antihypertensive therapy (e.g. continuous infusion of
             antihypertensive drug etc.) to lower blood pressure below those limits under the
             preceding article.

          -  Patients who have a history of intracranial hemorrhage, or who have a disease
             considered to increase the risk of intracranial hemorrhage such as an intracranial
             tumor, cerebral aneurysm, or intracranial arteriovenous malformation, etc.

          -  Patients who have a history of stroke within 3 months before onset.

          -  Patients who were operated on or injured their head or spinal cord within 3 months
             before onset.

          -  Patients who have a history of gastrointestinal or urinary tract hemorrhage within 21
             days before onset.

          -  Patients who had a major surgery or serious trauma (except for head or spinal cord
             trauma) within 14 days before onset.

          -  Patients who have a history of organ biopsy, arterial puncture, or lumbar puncture
             within 10 days before onset.

          -  Patients with severe hepatic dysfunction or severe renal dysfunction.

          -  Patients with acute pancreatitis.

          -  Patients who had a seizure at the onset of stroke.

          -  Patients who have a history of hypersensitivity to protein preparations.

          -  Patients who are lactating, pregnant, probably pregnant, or menstruating.

          -  Patients with malignant tumors.

          -  Patients with acute myocardial infarction (AMI) or pericarditis after AMI.

          -  Patients with concurrent infectious endocarditis, moyamoya disease (Willis circle
             occlusion syndrome), aortic dissection, or neck trauma, etc.

          -  Patients with strong suspicion of ischemic cerebrovascular disorder caused by
             non-thrombotic occlusion or any other hemodynamic condition.

          -  Patients judged to be difficult in monitoring for 3 months by their physician.

          -  Patients who have participated in other clinical trials during the last 3 months.

          -  In addition to the above exclusion criteria, patients judged to be inadequate to
             participate in this study by their physician.