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<meta name="DC.Title" content="Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2427" />
<meta name="DC.Date" content="2011-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: ET is considered in selected patients with AIS with persistent arterial occlusion after receiving IVT. Limited data exist on the safety of IA high doses of UK and RT for ET. We investigated any correlation between IA doses of UK or RT and safety outcomes in patients who underwent ET.

MATERIALS AND METHODS: We identified all patients from our stroke registry who received UK or RT for ET from 1998 to 2008. Demographics, baseline National Institutes of Health Stroke Scale scores, recanalization rates, rates of attempted MT, mortality, SICH, and discharge modified Rankin Scale scores were collected.

RESULTS: Of 197 patients; 72 received UK and 125 received RT. More than 90% of patients in both groups had received prior IVT. The median IA dose of UK was 200,000 U (range, 25,000–1,500,000 U) and of RT was 2 mg (range, 1–8 mg). Concurrent MT was attempted in 59.7% of UK-treated patients and 72.0% of RT-treated patients, with SICH rates of 4.2% and 8.0%, respectively. Logistic regression adjusting for prior IVT and MT revealed no correlation between SICH and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .94) or RT (OR, 0.803; 95% CI, 0.48–1.33; P = .39). There was no correlation between mortality and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .51) or RT (OR, 1.048; 95% CI, 0.77–1.42; P = .75).

CONCLUSIONS: High IA doses of UK and RT may be safe when given with or without MT in patients with AIS despite receiving a full dose of intravenous recombinant tissue plasminogen activator. These results need prospective validation.

AHA/ASA
:   American Heart Association/American Stroke Association
AIS
:   acute ischemic stroke
CI
:   confidence interval
ET
:   endovascular therapy
FDA
:   US Food and Drug Administration
IA
:   intra-arterial
ICA
:   internal carotid artery
IVT
:   intravenous tissue plasminogen activator infusion
MCA
:   middle cerebral artery
MCD
:   mechanical clot disruption
mRS
:   modified Rankin Scale
MT
:   mechanical thrombolysis
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
PROACT II
:   Prolyse in Acute Cerebral Thromboembolism trial
SICH
:   symptomatic intracranial hemorrhage
RT
:   reteplase
rtP
:   recombinant tissue plasminogen activator
TICI
:   Thrombolysis in Cerebral Ischemia
UK
:   urokinase" />
<meta name="DC.Contributor" content="V. Misra" />
<meta name="DC.Contributor" content="R. El Khoury" />
<meta name="DC.Contributor" content="R. Arora" />
<meta name="DC.Contributor" content="P.R. Chen" />
<meta name="DC.Contributor" content="S. Suzuki" />
<meta name="DC.Contributor" content="N. Harun" />
<meta name="DC.Contributor" content="N.R. Gonzales" />
<meta name="DC.Contributor" content="A.D. Barreto" />
<meta name="DC.Contributor" content="J.C. Grotta" />
<meta name="DC.Contributor" content="S.I. Savitz" />
<meta name="article:published_time" content="2011-06-01" />
<meta name="article:section" content="Patient Safety" />
<meta name="citation_title" content="Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;ET is considered in selected patients with AIS with persistent arterial occlusion after receiving IVT. Limited data exist on the safety of IA high doses of UK and RT for ET. We investigated any correlation between IA doses of UK or RT and safety outcomes in patients who underwent ET.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We identified all patients from our stroke registry who received UK or RT for ET from 1998 to 2008. Demographics, baseline National Institutes of Health Stroke Scale scores, recanalization rates, rates of attempted MT, mortality, SICH, and discharge modified Rankin Scale scores were collected.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of 197 patients; 72 received UK and 125 received RT. More than 90% of patients in both groups had received prior IVT. The median IA dose of UK was 200,000 U (range, 25,000–1,500,000 U) and of RT was 2 mg (range, 1–8 mg). Concurrent MT was attempted in 59.7% of UK-treated patients and 72.0% of RT-treated patients, with SICH rates of 4.2% and 8.0%, respectively. Logistic regression adjusting for prior IVT and MT revealed no correlation between SICH and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; &lt;i&gt;P&lt;/i&gt; = .94) or RT (OR, 0.803; 95% CI, 0.48–1.33; &lt;i&gt;P&lt;/i&gt; = .39). There was no correlation between mortality and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; &lt;i&gt;P&lt;/i&gt; = .51) or RT (OR, 1.048; 95% CI, 0.77–1.42; &lt;i&gt;P&lt;/i&gt; = .75).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;High IA doses of UK and RT may be safe when given with or without MT in patients with AIS despite receiving a full dose of intravenous recombinant tissue plasminogen activator. These results need prospective validation.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2011/06/01" />
<meta name="citation_mjid" content="ajnr;32/6/998" />
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<meta name="citation_doi" content="10.3174/ajnr.A2427" />
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<meta name="citation_author" content="V. Misra" />
<meta name="citation_author" content="R. El Khoury" />
<meta name="citation_author" content="R. Arora" />
<meta name="citation_author" content="P.R. Chen" />
<meta name="citation_author" content="S. Suzuki" />
<meta name="citation_author" content="N. Harun" />
<meta name="citation_author" content="N.R. Gonzales" />
<meta name="citation_author" content="A.D. Barreto" />
<meta name="citation_author" content="J.C. Grotta" />
<meta name="citation_author" content="S.I. Savitz" />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: ET is considered in selected patients with AIS with persistent arterial occlusion after receiving IVT. Limited data exist on the safety of IA high doses of UK and RT for ET. We investigated any correlation between IA doses of UK or RT and safety outcomes in patients who underwent ET.

MATERIALS AND METHODS: We identified all patients from our stroke registry who received UK or RT for ET from 1998 to 2008. Demographics, baseline National Institutes of Health Stroke Scale scores, recanalization rates, rates of attempted MT, mortality, SICH, and discharge modified Rankin Scale scores were collected.

RESULTS: Of 197 patients; 72 received UK and 125 received RT. More than 90% of patients in both groups had received prior IVT. The median IA dose of UK was 200,000 U (range, 25,000–1,500,000 U) and of RT was 2 mg (range, 1–8 mg). Concurrent MT was attempted in 59.7% of UK-treated patients and 72.0% of RT-treated patients, with SICH rates of 4.2% and 8.0%, respectively. Logistic regression adjusting for prior IVT and MT revealed no correlation between SICH and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .94) or RT (OR, 0.803; 95% CI, 0.48–1.33; P = .39). There was no correlation between mortality and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .51) or RT (OR, 1.048; 95% CI, 0.77–1.42; P = .75).

CONCLUSIONS: High IA doses of UK and RT may be safe when given with or without MT in patients with AIS despite receiving a full dose of intravenous recombinant tissue plasminogen activator. These results need prospective validation.

AHA/ASA
:   American Heart Association/American Stroke Association
AIS
:   acute ischemic stroke
CI
:   confidence interval
ET
:   endovascular therapy
FDA
:   US Food and Drug Administration
IA
:   intra-arterial
ICA
:   internal carotid artery
IVT
:   intravenous tissue plasminogen activator infusion
MCA
:   middle cerebral artery
MCD
:   mechanical clot disruption
mRS
:   modified Rankin Scale
MT
:   mechanical thrombolysis
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
PROACT II
:   Prolyse in Acute Cerebral Thromboembolism trial
SICH
:   symptomatic intracranial hemorrhage
RT
:   reteplase
rtP
:   recombinant tissue plasminogen activator
TICI
:   Thrombolysis in Cerebral Ischemia
UK
:   urokinase" />
<meta name="og-title" property="og:title" content="Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/6/998" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: ET is considered in selected patients with AIS with persistent arterial occlusion after receiving IVT. Limited data exist on the safety of IA high doses of UK and RT for ET. We investigated any correlation between IA doses of UK or RT and safety outcomes in patients who underwent ET.

MATERIALS AND METHODS: We identified all patients from our stroke registry who received UK or RT for ET from 1998 to 2008. Demographics, baseline National Institutes of Health Stroke Scale scores, recanalization rates, rates of attempted MT, mortality, SICH, and discharge modified Rankin Scale scores were collected.

RESULTS: Of 197 patients; 72 received UK and 125 received RT. More than 90% of patients in both groups had received prior IVT. The median IA dose of UK was 200,000 U (range, 25,000–1,500,000 U) and of RT was 2 mg (range, 1–8 mg). Concurrent MT was attempted in 59.7% of UK-treated patients and 72.0% of RT-treated patients, with SICH rates of 4.2% and 8.0%, respectively. Logistic regression adjusting for prior IVT and MT revealed no correlation between SICH and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .94) or RT (OR, 0.803; 95% CI, 0.48–1.33; P = .39). There was no correlation between mortality and doses of UK (OR, 1.00; 95% CI, 0.99–1.00; P = .51) or RT (OR, 1.048; 95% CI, 0.77–1.42; P = .75).

CONCLUSIONS: High IA doses of UK and RT may be safe when given with or without MT in patients with AIS despite receiving a full dose of intravenous recombinant tissue plasminogen activator. These results need prospective validation.

AHA/ASA
:   American Heart Association/American Stroke Association
AIS
:   acute ischemic stroke
CI
:   confidence interval
ET
:   endovascular therapy
FDA
:   US Food and Drug Administration
IA
:   intra-arterial
ICA
:   internal carotid artery
IVT
:   intravenous tissue plasminogen activator infusion
MCA
:   middle cerebral artery
MCD
:   mechanical clot disruption
mRS
:   modified Rankin Scale
MT
:   mechanical thrombolysis
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
PROACT II
:   Prolyse in Acute Cerebral Thromboembolism trial
SICH
:   symptomatic intracranial hemorrhage
RT
:   reteplase
rtP
:   recombinant tissue plasminogen activator
TICI
:   Thrombolysis in Cerebral Ischemia
UK
:   urokinase" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node9517--5" data-node-nid="9517" id="top-node-9517--61000092848" data-pisa="ajnr;32/6/998" data-pisa-master="ajnr;ajnr.A2427" data-apath="/ajnr/32/6/998.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Patient Safety</span></span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-series highwire-cite-metadata">F</span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V. Misra</span>, <span class="highwire-citation-author" data-delta="1">R. El Khoury</span>, <span class="highwire-citation-author" data-delta="2">R. Arora</span>, <span class="highwire-citation-author" data-delta="3">P.R. Chen</span>, <span class="highwire-citation-author" data-delta="4">S. Suzuki</span>, <span class="highwire-citation-author" data-delta="5">N. Harun</span>, <span class="highwire-citation-author" data-delta="6">N.R. Gonzales</span>, <span class="highwire-citation-author" data-delta="7">A.D. Barreto</span>, <span class="highwire-citation-author" data-delta="8">J.C. Grotta</span> and <span class="highwire-citation-author" data-delta="9">S.I. Savitz</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">998-1001; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2427 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9517--61000092848" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V. Misra </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BMisra%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Misra%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AV.%2BMisra%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R. El Khoury </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BEl%2BKhoury%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=El%20Khoury%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BEl%2BKhoury%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">R. Arora </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BArora%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Arora%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BArora%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">P.R. Chen </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.R.%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.R.%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">S. Suzuki </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BSuzuki%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Suzuki%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BSuzuki%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">N. Harun </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BHarun%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Harun%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.%2BHarun%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">N.R. Gonzales </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.R.%2BGonzales%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gonzales%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN.R.%2BGonzales%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">A.D. Barreto </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.D.%2BBarreto%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Barreto%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.D.%2BBarreto%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">J.C. Grotta </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.C.%2BGrotta%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Grotta%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.C.%2BGrotta%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">S.I. 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    <div class="elements-frag-data highwire-markup" id="fig-data"><div id="fig-data-tables" class="group frag-table"><div class="fig-data-title-jump clearfix"><h3 class="fig-data-group-title">Tables</h3><div class="fig-data-jump-links"></div></div><div class="item-list"><ul class="fig-data-list clearfix" id="fragments-table"><li class="first"><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion" id="T1"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/27986/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-177846223" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 1:</span> <p id="p-13">Patient demographics and clinical characteristics</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-1"><thead valign="bottom" id="thead-1" class="table-vbottom"><tr id="tr-1"><th rowspan="1" colspan="1" id="th-1"></th><th align="center" rowspan="1" colspan="1" id="th-2" class="table-center">UK (<em>n</em> = 72)</th><th align="center" rowspan="1" colspan="1" id="th-3" class="table-center">RT (<em>n</em> = 125)</th></tr></thead><tbody valign="top" id="tbody-1" class="table-vtop"><tr id="tr-2"><td align="left" rowspan="1" colspan="1" id="td-1" class="table-left">Age (mean ± SD), yr</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-2" class="table-char">58 ± 15</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-3" class="table-char">61 ± 13</td></tr><tr id="tr-3"><td align="left" rowspan="1" colspan="1" id="td-4" class="table-left">Male</td><td align="char" char="(" rowspan="1" colspan="1" id="td-5" class="table-char">36 (50.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-6" class="table-char">67 (53.6)</td></tr><tr id="tr-4"><td align="left" rowspan="1" colspan="1" id="td-7" class="table-left">Female</td><td align="char" char="(" rowspan="1" colspan="1" id="td-8" class="table-char">36 (50.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-9" class="table-char">58 (46.4)</td></tr><tr id="tr-5"><td align="left" rowspan="1" colspan="1" id="td-10" class="table-left">Hypertension</td><td align="char" char="(" rowspan="1" colspan="1" id="td-11" class="table-char">43 (59.7)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-12" class="table-char">78 (62.4)</td></tr><tr id="tr-6"><td align="left" rowspan="1" colspan="1" id="td-13" class="table-left">Diabetes mellitus</td><td align="char" char="(" rowspan="1" colspan="1" id="td-14" class="table-char">14 (19.4)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-15" class="table-char">20 (16.0)</td></tr><tr id="tr-7"><td align="left" rowspan="1" colspan="1" id="td-16" class="table-left">Coronary artery disease</td><td align="char" char="(" rowspan="1" colspan="1" id="td-17" class="table-char">13 (18.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-18" class="table-char">33 (26.4)</td></tr><tr id="tr-8"><td align="left" rowspan="1" colspan="1" id="td-19" class="table-left">Atrial fibrillation</td><td align="char" char="(" rowspan="1" colspan="1" id="td-20" class="table-char">14 (19.4)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-21" class="table-char">29 (23.2)</td></tr><tr id="tr-9"><td align="left" rowspan="1" colspan="1" id="td-22" class="table-left">Tobacco use</td><td align="char" char="(" rowspan="1" colspan="1" id="td-23" class="table-char">11 (15.3)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-24" class="table-char">26 (20.8)</td></tr><tr id="tr-10"><td align="left" rowspan="1" colspan="1" id="td-25" class="table-left">Blood glucose (mean ± SD), mg/dl</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-26" class="table-char">149.4 ± 55</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-27" class="table-char">134.0 ± 51</td></tr><tr id="tr-11"><td align="left" rowspan="1" colspan="1" id="td-28" class="table-left">Presentation NIHSS median (range)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-29" class="table-char">16 (3–27)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-30" class="table-char">18 (2–39)</td></tr><tr id="tr-12"><td align="left" rowspan="1" colspan="1" id="td-31" class="table-left">Prior IV rtPA treatment (<em>n</em> = 182)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-32" class="table-char">65 (90.3)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-33" class="table-char">117 (93.6)</td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-other" id="fn-3">
<p id="p-14"><strong>Note:</strong>—Values in parentheses are percentages, except for Presentation NIHSS median.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion" id="T2"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/28119/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-177846223" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 2:</span> <p id="p-16">Angiographic and procedural characteristics</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-2"><thead valign="bottom" id="thead-2" class="table-vbottom"><tr id="tr-13"><th rowspan="1" colspan="1" id="th-4"></th><th align="center" rowspan="1" colspan="1" id="th-5" class="table-center">UK (<em>n</em> = 72)</th><th align="center" rowspan="1" colspan="1" id="th-6" class="table-center">RT (<em>n</em> = 125)</th></tr></thead><tbody valign="top" id="tbody-2" class="table-vtop"><tr id="tr-14"><td align="left" rowspan="1" colspan="1" id="td-34" class="table-left">ICA occlusion</td><td align="char" char="(" rowspan="1" colspan="1" id="td-35" class="table-char">22 (30.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-36" class="table-char">50 (40.0)</td></tr><tr id="tr-15"><td align="left" rowspan="1" colspan="1" id="td-37" class="table-left">    Carotid-t occlusion</td><td align="char" char="(" rowspan="1" colspan="1" id="td-38" class="table-char">8 (11.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-39" class="table-char">23 (18.4)</td></tr><tr id="tr-16"><td align="left" rowspan="1" colspan="1" id="td-40" class="table-left">MCA occlusion</td><td align="char" char="(" rowspan="1" colspan="1" id="td-41" class="table-char">50 (69.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-42" class="table-char">75 (60.0)</td></tr><tr id="tr-17"><td align="left" rowspan="1" colspan="1" id="td-43" class="table-left">    M1 occlusion</td><td align="char" char="(" rowspan="1" colspan="1" id="td-44" class="table-char">32 (44.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-45" class="table-char">45 (36.0)</td></tr><tr id="tr-18"><td align="left" rowspan="1" colspan="1" id="td-46" class="table-left">    M2 occlusion</td><td align="char" char="(" rowspan="1" colspan="1" id="td-47" class="table-char">18 (25.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-48" class="table-char">30 (24.0)</td></tr><tr id="tr-19"><td align="left" rowspan="1" colspan="1" id="td-49" class="table-left">IA thrombolytic dose (median, range)</td><td align="center" rowspan="1" colspan="1" id="td-50" class="table-center">200,000 U (25,000–1,500,000 U)</td><td align="center" rowspan="1" colspan="1" id="td-51" class="table-center">2 mg (1–8 mg)</td></tr><tr id="tr-20"><td align="left" rowspan="1" colspan="1" id="td-52" class="table-left">Mechanical thrombolysis</td><td align="char" char="(" rowspan="1" colspan="1" id="td-53" class="table-char">43 (59.7)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-54" class="table-char">90 (72.0)</td></tr><tr id="tr-21"><td align="left" rowspan="1" colspan="1" id="td-55" class="table-left">    Clot disruption with microwire</td><td align="char" char="." rowspan="1" colspan="1" id="td-56" class="table-char">18</td><td align="char" char="." rowspan="1" colspan="1" id="td-57" class="table-char">37</td></tr><tr id="tr-22"><td align="left" rowspan="1" colspan="1" id="td-58" class="table-left">    Snare</td><td align="char" char="." rowspan="1" colspan="1" id="td-59" class="table-char">2</td><td align="char" char="." rowspan="1" colspan="1" id="td-60" class="table-char">3</td></tr><tr id="tr-23"><td align="left" rowspan="1" colspan="1" id="td-61" class="table-left">    Balloon</td><td align="char" char="." rowspan="1" colspan="1" id="td-62" class="table-char">3</td><td align="char" char="." rowspan="1" colspan="1" id="td-63" class="table-char">7</td></tr><tr id="tr-24"><td align="left" rowspan="1" colspan="1" id="td-64" class="table-left">    Balloon +stent</td><td align="char" char="." rowspan="1" colspan="1" id="td-65" class="table-char">5</td><td align="char" char="." rowspan="1" colspan="1" id="td-66" class="table-char">6</td></tr><tr id="tr-25"><td align="left" rowspan="1" colspan="1" id="td-67" class="table-left">    Merci</td><td align="char" char="." rowspan="1" colspan="1" id="td-68" class="table-char">13</td><td align="char" char="." rowspan="1" colspan="1" id="td-69" class="table-char">30</td></tr><tr id="tr-26"><td align="left" rowspan="1" colspan="1" id="td-70" class="table-left">    Penumbra</td><td align="char" char="." rowspan="1" colspan="1" id="td-71" class="table-char">0</td><td align="char" char="." rowspan="1" colspan="1" id="td-72" class="table-char">3</td></tr><tr id="tr-27"><td align="left" rowspan="1" colspan="1" id="td-73" class="table-left">    Merci + Penumbra</td><td align="char" char="." rowspan="1" colspan="1" id="td-74" class="table-char">0</td><td align="char" char="." rowspan="1" colspan="1" id="td-75" class="table-char">3</td></tr><tr id="tr-28"><td align="left" rowspan="1" colspan="1" id="td-76" class="table-left">    Merci + balloon + stent</td><td align="char" char="." rowspan="1" colspan="1" id="td-77" class="table-char">2</td><td align="char" char="." rowspan="1" colspan="1" id="td-78" class="table-char">1</td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-other" id="fn-4">
<p id="p-17"><strong>Note:</strong>—Values in parentheses are percentages, except for IA thrombolytic dose.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion" id="T3"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/27991/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-177846223" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 3:</span> <p id="p-19">Angiographic and clinical outcome</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-3"><thead valign="bottom" id="thead-3" class="table-vbottom"><tr id="tr-29"><th rowspan="1" colspan="1" id="th-7"></th><th align="center" rowspan="1" colspan="1" id="th-8" class="table-center">UK (<em>n</em> = 72)</th><th align="center" rowspan="1" colspan="1" id="th-9" class="table-center">RT (<em>n</em> = 125)</th><th align="center" rowspan="1" colspan="1" id="th-10" class="table-center"><em>P</em> Value</th></tr></thead><tbody valign="top" id="tbody-3" class="table-vtop"><tr id="tr-30"><td align="left" rowspan="1" colspan="1" id="td-79" class="table-left">Δ NIHSS in 24 hr (mean ± SD)</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-80" class="table-char">3.2 ± 7.8</td><td align="char" char="&#xB1;" rowspan="1" colspan="1" id="td-81" class="table-char">2.0 ± 6.8</td><td align="char" char="." rowspan="1" colspan="1" id="td-82" class="table-char">.32</td></tr><tr id="tr-31"><td align="left" rowspan="1" colspan="1" id="td-83" class="table-left">Final TICI ≥2b</td><td align="char" char="(" rowspan="1" colspan="1" id="td-84" class="table-char">40 (55.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-85" class="table-char">77 (61.6)</td><td align="char" char="." rowspan="1" colspan="1" id="td-86" class="table-char">.45</td></tr><tr id="tr-32"><td align="left" rowspan="1" colspan="1" id="td-87" class="table-left">Discharge mRS, 0–3</td><td align="char" char="(" rowspan="1" colspan="1" id="td-88" class="table-char">27 (37.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-89" class="table-char">49 (39.2)</td><td align="char" char="." rowspan="1" colspan="1" id="td-90" class="table-char">.87</td></tr><tr id="tr-33"><td align="left" rowspan="1" colspan="1" id="td-91" class="table-left">SICH</td><td align="char" char="(" rowspan="1" colspan="1" id="td-92" class="table-char">3 (4.2)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-93" class="table-char">10 (8.0)</td><td align="char" char="." rowspan="1" colspan="1" id="td-94" class="table-char">.29</td></tr><tr id="tr-34"><td align="left" rowspan="1" colspan="1" id="td-95" class="table-left">Death</td><td align="char" char="(" rowspan="1" colspan="1" id="td-96" class="table-char">11 (15.3)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-97" class="table-char">20 (16.0)</td><td align="char" char="." rowspan="1" colspan="1" id="td-98" class="table-char">.89</td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-other" id="fn-5">
<p id="p-20"><strong>Note:</strong>—Values in parentheses are percentages.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li><li class="last"><div class="element-fig-data clearfix table-caption"><div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="table-expansion" id="T4"><span class="highwire-journal-article-marker-start"></span><div class="table-caption"><ul class="inline table-expansion-links"><li class="view-popup first last"><a href="/highwire/markup/28021/expansion?width=1000&amp;height=500&amp;iframe=true&amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed" class="colorbox colorbox-load table-expand-popup" rel="gallery-fragment-tables-177846223" data-icon-position="" data-hide-link-title="0">View popup</a></li></ul><span class="table-label">Table 4:</span> <p id="p-21">Angiographic and clinical outcome by site of vascular occlusion</p><div class="sb-div caption-clear"></div></div><table frame="hsides" id="table-4"><thead valign="bottom" id="thead-4" class="table-vbottom"><tr id="tr-35"><th rowspan="1" colspan="1" id="th-11"></th><th align="center" rowspan="1" colspan="1" id="th-12" class="table-center">UK (<em>n</em> = 72)</th><th align="center" rowspan="1" colspan="1" id="th-13" class="table-center">RT (<em>n</em> = 125)</th><th align="center" rowspan="1" colspan="1" id="th-14" class="table-center"><em>P</em> Value</th></tr></thead><tbody valign="top" id="tbody-4" class="table-vtop"><tr id="tr-36"><td align="left" rowspan="1" colspan="1" id="td-99" class="table-left">ICA occlusions</td><td rowspan="1" colspan="1" id="td-100"></td><td rowspan="1" colspan="1" id="td-101"></td><td rowspan="1" colspan="1" id="td-102"></td></tr><tr id="tr-37"><td align="left" rowspan="1" colspan="1" id="td-103" class="table-left">    Final TICI ≥2b</td><td align="char" char="(" rowspan="1" colspan="1" id="td-104" class="table-char">13 (59.1)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-105" class="table-char">32 (64.0)</td><td align="char" char="." rowspan="1" colspan="1" id="td-106" class="table-char">.86</td></tr><tr id="tr-38"><td align="left" rowspan="1" colspan="1" id="td-107" class="table-left">    Discharge mRS, 0–3</td><td align="char" char="(" rowspan="1" colspan="1" id="td-108" class="table-char">5 (22.7)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-109" class="table-char">12 (24)</td><td align="char" char="." rowspan="1" colspan="1" id="td-110" class="table-char">.98</td></tr><tr id="tr-39"><td align="left" rowspan="1" colspan="1" id="td-111" class="table-left">M1 occlusions</td><td rowspan="1" colspan="1" id="td-112"></td><td rowspan="1" colspan="1" id="td-113"></td><td rowspan="1" colspan="1" id="td-114"></td></tr><tr id="tr-40"><td align="left" rowspan="1" colspan="1" id="td-115" class="table-left">    Final TICI ≥2b</td><td align="char" char="(" rowspan="1" colspan="1" id="td-116" class="table-char">16 (50.0)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-117" class="table-char">28 (62.2)</td><td align="char" char="." rowspan="1" colspan="1" id="td-118" class="table-char">.23</td></tr><tr id="tr-41"><td align="left" rowspan="1" colspan="1" id="td-119" class="table-left">    Discharge mRS, 0–3</td><td align="char" char="(" rowspan="1" colspan="1" id="td-120" class="table-char">12 (37.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-121" class="table-char">21 (46.6)</td><td align="char" char="." rowspan="1" colspan="1" id="td-122" class="table-char">.37</td></tr><tr id="tr-42"><td align="left" rowspan="1" colspan="1" id="td-123" class="table-left">M2 occlusions</td><td rowspan="1" colspan="1" id="td-124"></td><td rowspan="1" colspan="1" id="td-125"></td><td rowspan="1" colspan="1" id="td-126"></td></tr><tr id="tr-43"><td align="left" rowspan="1" colspan="1" id="td-127" class="table-left">    Final TICI ≥2b</td><td align="char" char="(" rowspan="1" colspan="1" id="td-128" class="table-char">10 (55.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-129" class="table-char">16 (53.3)</td><td align="char" char="." rowspan="1" colspan="1" id="td-130" class="table-char">.85</td></tr><tr id="tr-44"><td align="left" rowspan="1" colspan="1" id="td-131" class="table-left">    Discharge mRS, 0–3</td><td align="char" char="(" rowspan="1" colspan="1" id="td-132" class="table-char">10 (55.5)</td><td align="char" char="(" rowspan="1" colspan="1" id="td-133" class="table-char">13 (43.3)</td><td align="char" char="." rowspan="1" colspan="1" id="td-134" class="table-char">.46</td></tr></tbody></table><div class="table-foot"><ul class="table-footnotes"><li class="fn-other" id="fn-6">
<p id="p-22"><strong>Note:</strong>—Values in parentheses are percentages.</p></li></ul></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div></div></li></ul></div></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 32</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2011 </div></div>
      
      
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      <div class="highwire-cite-title">Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Misra</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">El Khoury</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Arora</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.R.</span> <span class="nlm-surname">Chen</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Suzuki</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Harun</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">N.R.</span> <span class="nlm-surname">Gonzales</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.D.</span> <span class="nlm-surname">Barreto</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Grotta</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.I.</span> <span class="nlm-surname">Savitz</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">998-1001; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2427 </span></div>
  
  
  
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      <div class="highwire-cite-title">Safety of High Doses of Urokinase and Reteplase for Acute Ischemic Stroke</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Misra</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">El Khoury</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Arora</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">P.R.</span> <span class="nlm-surname">Chen</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Suzuki</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Harun</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">N.R.</span> <span class="nlm-surname">Gonzales</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.D.</span> <span class="nlm-surname">Barreto</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Grotta</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">S.I.</span> <span class="nlm-surname">Savitz</span></span></span></div>
  
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