lack of patients

The primary objective of the study is to assess the safety of N-Acetylcysteine as a thrombolytic agent in acute ischemic stroke, especially regarding the risk of hemorrhagic transformation.

Preclinical studies demonstrated that N-Acetylcysteine (NAC) is able to break von Willebrand Factor (VWF) multimers by bisulfide bond reduction. Since thrombi in stroke patients are rich in VWF, NAC could be used as a thrombolytic agent during the acute phase. This study aims at assessing the safety of NAC in combination with alteplase (rt-PA) at the acute phase of ischemic stroke.

Inclusion Criteria:

• Patient presenting with an acute ischemic stroke (non lacunar) as assessed by cerebral imaging (either CT or MRI), with or without visible vessel occlusion.
• Patient eligible to intravenous thrombolysis according to current criteria, including patients who will also benefit from endovascular treatment (if eligible).
• Personal or familial consent to participate in the study.

Exclusion Criteria:

• Known hypersensitivity to N-Acetylcysteine or to any excipient from the formulation.
• Coma and/or NIHSS <4 or ≥20.
• Daily treatment with Nitrovasodilator before the inclusion.
• Known asthma or chronic obstructive pulmonary disease requiring bronchodilatators or steroids.
• Participation to another interventional study if it requires administration of an experimental treatment in the first 3 days after NAC treatment.
• Women of childbearing age (age < or = to 50)
• Known history of prior treatment with vitamin-K antagonist or direct oral anticoagulant.
• Known history of severe hepatopathy including cirrhosis, portal hypertension (esophageal varices) and evolutive hepatopathy.