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("Thrombolysis" OR "Thrombolytic") AND "Emergency"

Joonsang Yoo, Sung-Il Sohn, Jinkwon Kim, Seong Hwan Ahn, Kijeong Lee, Jang-Hyun Baek, Kyoungsub Kim, Jeong-Ho Hong, Jaseong Koo, Young Dae Kim, Jaehyuk Kwak, Hyo Suk Nam, Ji Hoe Heo
BACKGROUND: The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient's stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). METHODS: We included consecutive patients who received IV tPA during a 1...
August 9, 2018: Cerebrovascular Diseases
Gianni Dall'Ara, Simone Grotti, Elisa Conficoni, Armando Zammarchi, Ottorino Catapano, Filippo Ottani, Fabio Tarantino, Marcello Galvani
The recommended treatment for ST-segment elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI). However, in a non-negligible proportion of patients, pPCI is ineffective and the cardiologist must face the decision of how to achieve optimal myocardial reperfusion. Although the possibility of a rescue fibrinolytic strategy has not been evaluated yet in this clinical setting, it is a viable alternative to emergency cardiac surgery. We here report the case of a 60-year-old STEMI patient presenting with a coronary anatomy unsuitable for percutaneous mechanical revascularization, characterized by marked dilation and tortuosity of the proximal and middle epicardial segments...
September 2018: Giornale Italiano di Cardiologia
Corey J Warf, Martin R Huecker, Daniel J O'Brien, Don A Bertolotti
A 56-year-old female presented to the emergency department with evolving cardiac tamponade after receiving alteplase for acute ischemic stroke. This is the first case report of cardiac tamponade from thrombolytics in the setting of recent pacemaker placement. Point-of-care ultrasound was used to make the diagnosis quickly and expedite the patient to the operating room where a pericardial window was performed.
August 2018: Clinical practice and cases in emergency medicine
Silke Walter, Henry Zhao, Damien Easton, Cees Bil, Jonas Sauer, Yang Liu, Martin Lesmeister, Iris Q Grunwald, Geoffrey A Donnan, Stephen M Davis, Klaus Fassbender
Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites...
August 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Nika Guberina, U Dietrich, A Radbruch, J Goebel, C Deuschl, A Ringelstein, M Köhrmann, C Kleinschnitz, M Forsting, C Mönninghoff
PURPOSE: New software solutions emerged to support radiologists in image interpretation in acute ischemic stroke. This study aimed to validate the performance of computer-aided assessment of the Alberta Stroke Program Early CT score (ASPECTS) for detecting signs of early infarction. METHODS: ASPECT scores were assessed in 119 CT scans of patients with acute middle cerebral artery ischemia. Patient collective was differentiated according to (I) normal brain, (II) leukoencephalopathic changes, (III) infarcts, and (IV) atypical parenchymal defects (multiple sclerosis, etc...
September 2018: Neuroradiology
Kaustubh Limaye, Michael Wall, Sami Uwaydat, Sheharayar Ali, Amir Shaban, Sami Al Kasab, Harold Adams
Central retinal artery occlusion (CRAO) is a medical emergency that, if not treated, may result in irreversible loss of vision. It continues to be an important cause for acute painless loss of vision. Amaurosis fugax or "transient CRAO" has long been considered an equivalent of transient cerebral ischemic event. Animal models, in addition to data from retrospective and randomized clinical studies, provide valuable insights into the time interval for irreversible retinal ischemia. Subset analyses from 2 large studies of patients with CRAO show benefit from treatment with thrombolysis within 6 hours from symptoms onset...
July 27, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Sina Mashayekhi, Mojtaba Ziaee, Alireza Garjani, Parvin Sarbakhsh, Samad Ghaffari
BACKGROUND: Biomarkers possess important diagnostic and prognostic value in acute coronary syndromes (ACSs). Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) is one of the markers involved in atherosclerotic plaque vulnerability and rupture. OBJECTIVE: This study aimed to evaluate the prognostic value of sLOX-1 through its correlation with Thrombolysis in Myocardial Infarction (TIMI) risk score and its possible association with clinical outcomes in 2 major spectrums of ACS...
July 23, 2018: Journal of Emergency Medicine
Qiang Su, Huafeng Yang, Lang Li
Objective: Recent studies have demonstrated that miRNA-155 is involved in the occurrence and development of atherosclerosis. Furthermore, miRNA-155 has emerged as a new indirect marker for inflammation associated with adverse outcomes in oncology and cardiovascular diseases. This study investigated the correlation between the levels of miRNA-155 and coronary slow flow (CSF). Methods: A total of 66 patients with CSF and 66 patients with normal coronary flow were enrolled in this study...
2018: Disease Markers
Yaohui Wang, Chongyang Zhang, Wei Sun, Xiaodong Hu, Zhe Lyu, Weibin Liu
OBJECTIVE: To investigate the prehospital intervention based on emergency medical services (EMS) in patients with acute ischemic stroke (AIS) for door-to-needle time (DNT) with intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) impact. METHODS: 112 emergency patients receiving rt-PA intravenous thrombolysis admitted to the First Hospital of Qinhuangdao City based on EMS from June 2016 to December 2017 were enrolled. According to whether or not to receive prehospital interventions, patients were divided into prehospital intervention group (n = 42) and routine treatment group (n = 70)...
July 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Karsten Wolter, Georges Decker, Daniel Kuetting, Jonel Trebicka, Steffen Manekeller, Carsten Meyer, Hans Schild, Daniel Thomas
BACKGROUND: Acute portal vein thrombosis is a potentially fatal condition. In symptomatic patients not responding to systemic anticoagulation, interventional procedures have emerged as an alternative to surgery. This study sought to retrospectively evaluate initial results of interventional treatment of acute portal vein thrombosis (aPVT) using a transjugular interventional approach. MATERIALS AND METHODS: Between 2014 and 2016, 11 patients were treated because of aPVT (male: 7; female: 4; mean age: 41...
August 2018: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Caroline Haig, David Carrick, Jaclyn Carberry, Kenneth Mangion, Annette Maznyczka, Kirsty Wetherall, Margaret McEntegart, Mark C Petrie, Hany Eteiba, Mitchell Lindsay, Stuart Hood, Stuart Watkins, Andrew Davie, Ahmed Mahrous, Ify Mordi, Nadeem Ahmed, Vannesa Teng Yue May, Ian Ford, Aleksandra Radjenovic, Paul Welsh, Naveed Sattar, Keith G Oldroyd, Colin Berry
OBJECTIVES: The aim of this study was to mechanistically investigate associations among cigarette smoking, microvascular pathology, and longer term health outcomes in patients with acute ST-segment elevation myocardial infarction (MI). BACKGROUND: The pathophysiology of myocardial reperfusion injury and prognosis in smokers with acute ST-segment elevation MI is incompletely understood. METHODS: Patients were prospectively enrolled during emergency percutaneous coronary intervention...
July 13, 2018: JACC. Cardiovascular Imaging
Shizhong Zhang, Yanyan Hu, Zhen Li, Dezhang Huang, Mingran Zhang, Chenglong Wang, Zhigang Wang
AIM: We experienced a series of patients with hemorrhagic CVST, who were successfully treated with endovascular treatment (EVT). The aim was to explore the best scheme for the future through our treatment data of hemorrhagic CVST. MATERIAL AND METHODS: A retrospective analysis was conducted, selecting nine hemorrhagic CVST patients, who were mainly treated with EVT. Characteristics of hemorrhagic CVST were recorded, including risk factors, thrombus location, presenting symptoms, and treatment details included type of EVT...
2018: American Journal of Translational Research
Mingsu Liu, Yang Zheng, Guangqin Li
BACKGROUND: Intravenous thrombolysis treatment (IVT) and endovascular therapy (EVT) have been proved as fist-line beneficial option for eligible patients who have acute ischemic stroke (AIS) with major safety concern of symptomatic intracranial hemorrhage (sICH). Unfortunately, the emergency management of patients with AIS taking vitamin K antagonists and with international normalized ratio higher than 1.7 or taking new oral anticoagulants (NOACs) represents a great challenge. We aim to comprehensively determine the safety of EVT in patients under prior-stroke anticoagulants and IVT in patients under NOAC use...
July 12, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Batur Gonenc Kanar, Kursat Tigen, Halil Atas, Altug Cincin, Beste Ozben
A prosthetic valve thrombosis (PVT), which is a potentially fatal complication, refers to the presence of non-infective thrombotic material on a prosthetic valve apparatus, interfering with its function. Possible complications of a PVT include transient neurologic embolic events, cardiac arrest due to a stuck valve prosthesis, and cardio-embolic myocardial infarction (MI). The choice of treatments, including a redo surgery, a percutaneous coronary intervention (PCI), and a fibrinolysis with PVT or MI dosages, depends on the patient's clinical and hemodynamic status and thrombotic burden involving the prosthetic valve and surrounding tissues...
June 19, 2018: American Journal of Emergency Medicine
Rupeng Mong, Ling Tiah, Michelle Wong, Camlyn Tan
INTRODUCTION: Telestroke allows for remote determination of suitability for treatment with thrombolysis in patients with acute ischaemic stroke. However, this approach is time-dependent and most centres have yet to achieve the recommended treatment times. We describe a quality improvement initiative aimed at improving the telestroke workflow and treatment times at our centre. METHODS: A multidisciplinary workgroup comprising clinicians, stroke case managers and radiology staff was formed to oversee the initiative...
July 16, 2018: Singapore Medical Journal
Wenbo Zhao, Ruiwen Che, Sijie Li, Changhong Ren, Chuanhui Li, Chuanjie Wu, Hui Lu, Jian Chen, Jiangang Duan, Ran Meng, Xunming Ji
Objective: Remote ischemic conditioning (RIC) has been demonstrated to be safe and feasible for patients with acute ischemic stroke (AIS), as well as for those receiving intravenous thrombolysis. We assessed the safety and feasibility of RIC for AIS patients undergoing endovascular treatment (ET). Methods: We conducted a pilot study with patients with AIS who were suspected of having an emergent large-vessel occlusion in the anterior circulation and who were scheduled for ET within 6 hours of ictus...
July 2018: Annals of Clinical and Translational Neurology
Saana Pihlasviita, Olli S Mattila, Juhani Ritvonen, Gerli Sibolt, Sami Curtze, Daniel Strbian, Heini Harve, Mikko Pystynen, Markku Kuisma, Turgut Tatlisumak, Perttu J Lindsberg
OBJECTIVES: To clarify diagnostic accuracy and consequences of misdiagnosis in the admission evaluation of stroke-code patients in a neurologic emergency department with less than 20-minute door-to-thrombolysis times. METHODS: Accuracy of admission diagnostics was studied in an observational cohort of 1,015 stroke-code patients arriving by ambulance as candidates for recanalization therapy between May 2013 and November 2015. Immediate admission evaluation was performed by a stroke neurologist or a neurology resident with dedicated stroke training, primarily utilizing CT-based imaging...
August 7, 2018: Neurology
Takehiko Oami, Taku Oshima, Reiko Oku, Kazuya Nakanishi
Background: Thrombolysis for pulmonary embolism and targeted temperature management for cardiac arrest are controversial treatments in pregnancy. Case: A 37-year-old woman at 23 weeks gestation presented with persistent dyspnea. She experienced cardiac arrest soon after arrival at the emergency room. Massive right ventricular dilatation on echocardiography during the transient return of spontaneous circulation suggested pulmonary embolism. We administered recombinant tissue plasminogen activator for suspected pulmonary embolism to successfully resuscitate the patient experiencing refractory cardiac arrest despite heparin infusion...
July 2018: Acute Medicine & Surgery
Michaela V Bonfert, Katharina Badura, Julia Gerstl, Ingo Borggraefe, Florian Heinen, Sebastian Schroeder, Martin Olivieri, Raphael Weinberger, Mirjam N Landgraf, Katharina Vill, Moritz Tacke, Steffen Berweck, Karl Reiter, Florian Hoffmann, Thomas Nicolai, Lucia Gerstl
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke...
2018: Frontiers in Pediatrics
Georgios Tsivgoulis, Frederik Geisler, Aristeidis H Katsanos, Janika Kõrv, Alexander Kunz, Robert Mikulik, Michal Rozanski, Matthias Wendt, Heinrich J Audebert
BACKGROUND AND PURPOSE: Mobile stroke units (MSUs) are known to increase the proportion of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) in the first golden hour (GH) after onset compared with hospital settings (HS). However, because of the low number of AIS patients treated with intravenous thrombolysis within this ultraearly time window in conventional care, characteristics, and outcome of this subgroup of AIS patients have not been compared between MSU and HS...
July 9, 2018: Stroke; a Journal of Cerebral Circulation
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