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management of thrombolysis associated symptomatic intracerebral hemorrhage

Guofang Chen, Xia Wang, Thompson G Robinson, Miriam Pikkemaat, Richard I Lindley, Shengkui Zhou, Lei Ping, Weiwei Liu, Leijing Liu, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: History of prior stroke (PS) and diabetes mellitus (DM) are considered relative contraindications to the use of intravenous alteplase in patients with acute ischemic stroke (AIS). We aimed to assess whether a history of PS and DM modified the comparative effects of low- versus standard-dose alteplase in patients who participated in the alteplase-dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). METHODS: Data from an international, multi-center, prospective, randomized, open-label, blinded-endpoint trial were used to assess the benefits and risks of low (0...
April 15, 2018: Journal of the Neurological Sciences
Lars Kellert, Christian Hametner, Niaz Ahmed, Geraldine Rauch, Mary J MacLeod, Francesco Perini, Kennedy R Lees, Peter A Ringleb
BACKGROUND AND PURPOSE: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS: From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed...
July 2017: Stroke; a Journal of Cerebral Circulation
Steven L Gogela, Yair M Gozal, Bin Zhang, Thomas A Tomsick, Andrew J Ringer, Joseph P Broderick, Pooja Khatri, Todd A Abruzzo
OBJECTIVE The impact of extracranial carotid stenosis on interventional revascularization of acute anterior circulation stroke is unknown. The authors examined the effects of high-grade carotid stenosis on the results of endovascular treatment of patients in the Interventional Management of Stroke (IMS)-III trial. METHODS The 278 patients in the endovascular arm of the IMS-III trial were categorized according to the degree of carotid stenosis as determined by angiography. In comparing patients with severe stenosis or occlusion (≥ 70%) to those without severe stenosis (< 70%), the authors evaluated the time to endovascular reperfusion, modified Thrombolysis in Cerebrovascular Infarction (mTICI) scores, 24-hour mean infarct volumes, symptomatic intracerebral hemorrhage rates, and modified Rankin Scale (mRS) scores at 90 days...
January 2018: Journal of Neurosurgery
Renata Dal-Prá Ducci, Marcos Christiano Lange, Viviane de Hiroki Flumignan Zétola
Early risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and dependence at discharge...
June 2017: Internal and Emergency Medicine
Thomas V Kodankandath, Jane Shaji, Nina Kohn, Rohan Arora, Elliott Salamon, Richard B Libman, Jeffrey M Katz
BACKGROUND: The "drip-and-ship" paradigm is an important treatment modality for acute ischemic stroke (AIS) patients who do not have immediate access to a comprehensive stroke center (CSC). Intravenous thrombolysis is initiated at a primary stroke center followed by expeditious transfer to a CSC. We sought to determine factors associated with poor outcomes in drip-and-ship AIS patients transferred to a CSC. METHODS: This study is a retrospective analysis of 130 consecutive drip-and-ship patients transferred by ambulance to a single CSC between July 2012 and June 2014...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Wei Wu, Xiaochuan Huo, Xingquan Zhao, Xiaoling Liao, Chunjuan Wang, Yuesong Pan, Yilong Wang, Yongjun Wang
OBJECTIVE: Increased blood pressure (BP) management following acute ischemic stroke (AIS) remains controversial. This study aimed to identify the association between BP and clinical outcomes in AIS patients administered lytic medication in the TIMS-China (thrombolysis implementation and monitor of acute ischemic stroke in China) database. METHODS: The sample comprised 1128 patients hospitalized within 4.5 hours (h) of AIS for intravenous recombinant tissue plasminogen activator (i...
2016: PloS One
Calvin Hoi-Kwan Mak, Joanna Wing-Kiu Ho, Kwong-Yau Chan, Wai-Sang Poon, George Kwok-Chu Wong
Acute basilar artery occlusion has been managed aggressively with various modalities due to its potentially debilitating outcome. While intra-arterial mechanical thrombectomy with stentriever has established clear evidence for anterior circulation stroke with large vessel occlusion as an adjunct to intravenous thrombolysis or the sole modality in intravenous thrombolysis ineligible patients, similar high-level evidence was not available for intra-arterial mechanical thrombectomy of posterior circulation stroke with acute basilar artery occlusion...
October 2016: Neurosurgical Review
Maher Saqqur, Ashfaq Shuaib, Andrei V Alexandrov, Joseph Sebastian, Khurshid Khan, Ken Uchino
BACKGROUND: The relationship between hyperglycemia and arterial recanalization following intravenous recombinant tissue-plasminogen activator treatment in acute ischemic stroke is not well understood. AIM: We aimed to evaluate the effects of hyperglycemia in thrombolysed ischemic stroke patients on recanalization rate and clinical outcome. METHODS: We studied 348 (231 subjects from the CLOTBUST databank and 117 subjects from the CLOTBUST trial phase II) with documented intracranial artery occlusion treated with intravenous recombinant tissue-plasminogen activator...
October 2015: International Journal of Stroke: Official Journal of the International Stroke Society
Joyce S Balami, Brad A Sutherland, Laurel D Edmunds, Iris Q Grunwald, Ain A Neuhaus, Gina Hadley, Hasneen Karbalai, Kneale A Metcalf, Gabriele C DeLuca, Alastair M Buchan
BACKGROUND: Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed...
December 2015: International Journal of Stroke: Official Journal of the International Stroke Society
Badih Daou, Nohra Chalouhi, Robert M Starke, Richard Dalyai, Kate Hentschel, Pascal Jabbour, Robert Rosenwasser, Stavropoula I Tjoumakaris
BACKGROUND: The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. OBJECTIVE: To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. METHODS: Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed...
September 2015: Neurosurgery
Vincent Mok, Jong S Kim
Lacunar infarcts/lacunes, white matter hyperintensities (WMH), and cerebral microbleeds (CMBs) are considered various manifestations of cerebral small vessel disease (SVD). Since the exact mechanisms of these manifestations differ, their associated risk factors differ. High blood pressure is the most consistent risk factor for all of these manifestations. However, a "J curve" phenomenon in terms of blood pressure probably exists for WMH. The association between cholesterol levels and lacunar infarcts/lacunes or WMH was less consistent and sometimes conflicting; a low cholesterol level probably increases the risk of CMBs...
May 2015: Journal of Stroke
Farhan Siddiq, Malik M Adil, Kiersten E Norby, Haseeb A Rahman, Adnan I Qureshi
OBJECTIVE: Postthrombolytic intracerebral hemorrhage (ICH) is an infrequent occurrence in patients with acute ischemic stroke. There is controversy surrounding the value of neurosurgical treatment of symptomatic hematomas in these patients and whether availability of neurosurgical treatment is a necessary prerequisite for administration of thrombolytic agents. We report the frequency and outcomes of patients who undergo craniotomy for postthrombolytic ICH. METHODS: Patients with acute ischemic stroke who experienced postthrombolytic ICH were identified using the Nationwide Inpatient Sample from 2002-2010 and International Classification of Diseases, 9th Revision, Clinical Modification codes...
November 2014: World Neurosurgery
Timolaos Rizos, Solveig Horstmann, Ekkehart Jenetzky, Marcia Spindler, Christoph Gumbinger, Markus Möhlenbruch, Peter Ringleb, Werner Hacke, Roland Veltkamp
BACKGROUND: The emergency management of patients with acute ischemic stroke (IS) using oral anticoagulants (OAC) represents a great challenge. Effective anticoagulation predisposes to bleeding and represents a contraindication for systemic thrombolysis. However, patients on OAC can receive intravenous thrombolysis with recombinant tissue-type plasminogen activator if the international normalized ratio (INR) does not exceed 1.7, but data regarding the risk of hemorrhagic complications are highly controversial...
2012: Cerebrovascular Diseases
Daniel Strbian, Katja Piironen, Atte Meretoja, Tiina Sairanen, Jukka Putaala, Marjaana Tiainen, Ville Artto, Kirsi Rantanen, Olli Häppölä, Markku Kaste, Perttu J Lindsberg
BACKGROUND: Thrombolysis of ischemic stroke patients presenting with mild symptoms is controversial. AIM: We aimed to describe the clinical outcome and frequency of infarcts and symptomatic intracerebral hemorrhages on follow-up imaging of such thrombolysis-treated patients. METHODS: Our cohort included 1398 consecutive ischemic stroke patients treated with intravenous thrombolysis at the Helsinki University Central Hospital, years 1995-2010...
July 2013: International Journal of Stroke: Official Journal of the International Stroke Society
Maxim Mokin, Tareq Kass-Hout, Omar Kass-Hout, Robert Zivadinov, Bijal Mehta
BACKGROUND: There is limited knowledge on the radiographic features of thrombolysis-induced hemorrhage. The factors that influence early hematoma expansion have not been elucidated. METHODS: Patients presenting with a symptomatic intracerebral hemorrhage (ICH) as a result of intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) for acute ischemic stroke and had noncontrast computed tomographic (CT) scans of the head were included in this retrospective study...
November 2012: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Joshua N Goldstein, Marisela Marrero, Shihab Masrur, Muhammad Pervez, Alex M Barrocas, Abdul Abdullah, Alexandra Oleinik, Jonathan Rosand, Eric E Smith, Walter H Dzik, Lee H Schwamm
BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) is the most devastating complication of thrombolytic therapy for acute stroke. It is not clear whether patients with sICH continue to bleed after diagnosis, nor has the most appropriate treatment been determined. METHODS: We performed a retrospective analysis of our prospectively collected Get With the Guidelines-Stroke database between April 1, 2003, and December 31, 2007. Radiologic images and all procoagulant agents used were reviewed...
August 2010: Archives of Neurology
J S Bang, C W Oh, C Jung, S Q Park, K J Hwang, H-S Kang, M H Han, S H Lee, Y S Chung, O-K Kwon
BACKGROUND AND PURPOSE: Stents have been reported as an option for improvement of the recanalization rate in AIS. The authors have also used intracranial stents in failed cases of IAT with pharmacologic and mechanical methods since 2004. We retrospectively reviewed our cases of intracranial stent use for IAT of AIS for recanalization and as a rescue procedure for iatrogenic intracranial vascular dissection during IAT. MATERIALS AND METHODS: Thirty-two patients, who were diagnosed with AIS, were treated with intracranial stents (28 balloon-mounted and 7 self-expandable stents) at our neurovascular center between April 2004 and December 2008...
August 2010: AJNR. American Journal of Neuroradiology
Niaz Ahmed, Nils Wahlgren, Michael Brainin, José Castillo, Gary A Ford, Markku Kaste, Kennedy R Lees, Danilo Toni
BACKGROUND AND PURPOSE: The optimal management of blood pressure (BP) in acute stroke remains unclear. For ischemic stroke treated with intravenous thrombolysis, current guidelines suggest pharmacological intervention if systolic BP exceeds 180 mm Hg. We determined retrospectively the association of BP and antihypertensive therapy with clinical outcomes after stroke thrombolysis. METHODS: The SITS thrombolysis register prospectively recorded 11 080 treatments from 2002 to 2006...
July 2009: Stroke; a Journal of Cerebral Circulation
G J Hankey, C P Warlow
The last decade has seen several major technological advances in vascular neuroradiology, the most clinically significant of which have been the facility to image the brain and the extracranial carotid bifurcation noninvasively with accuracy and safety. Another major advance has been unequivocal evidence from formal statistical overviews that antiplatelet therapy, particularly aspirin, reduces the risk of serious vascular events by about 25%. These advances have changed clinical practice such that most patients presenting with symptoms suggestive of cerebral ischaemia should now have cranial CT to exclude intracerebral hemorrhage, not only because the causes and prognosis of cerebral ischaemia differ from those of intracerebral hemorrhage, but because many patients with cerebral ischaemia should be considered for antiplatelet therapy...
1991: Neuroradiology
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