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Stroke thrombolysis

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https://www.readbyqxmd.com/read/29341345/increase-in-neutrophil-after-r-tpa-thrombolysis-predicts-poor-functional-outcome-of-ischemic-stroke-a-longitudinal-study
#1
Jijun Shi, Hao Peng, Shoujiang You, Yuanyuan Liu, Jiaping Xu, Yingying Xu, Huihui Liu, Rongfang Shi, Yongjun Cao, Chun-Feng Liu
BACKGROUND: Neutrophil, a pivotal immune responder to ischemic brain insult, has been involved in neuroplasticity and increases after stroke. r-tPA, a promising treatment improving neuroplasticity, promotes neutrophil degranulation. However, the dynamic profile of neutrophil after r-tPA treatment and its effect on neurological recovery after stroke is not well studied. METHODS: We measured cell counts of neutrophil, lymphocyte, and their ratio (NLR) on admission and 24 hours after r-tPA infusion in 372 consecutively recruited acute ischemic stroke patients (mean age 64 years)...
January 17, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29339370/nature-s-wastebasket-the-role-of-the-external-carotid-artery-in-acute-stroke
#2
Jesse Jones, Conrad William Liang, Nima Ramezan-Arab, Gary Duckwiler, Satoshi Tateshima
We describe a novel technical approach to acute stroke illustrated by the case of a 41 year old male who presented with tandem right common carotid artery (CCA) and M1 occlusions. His NIHSS was 17 and Alberta stroke programe early CT score (ASPECTs) was 8. Thrombectomy initially proved challenging due to large volume CCA thrombus that repeatedly occluded the aspiration catheters. However, by inflating a balloon distally and pulling clot into the adjacent ECA, we were able to quickly restore distal contrast flow to the intracranial circulation and achieve Thrombolysis In Cerebral Infarction/Arterial Occlusive Lesion (TICI2C/AOL3) revascularization...
January 15, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29338750/reperfusion-therapy-in-acute-ischemic-stroke-dawn-of-a-new-era
#3
REVIEW
Sonu Bhaskar, Peter Stanwell, Dennis Cordato, John Attia, Christopher Levi
Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed...
January 16, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29333567/predictors-for-intracranial-hemorrhage-following-intravenous-thrombolysis-in-posterior-circulation-stroke
#4
Dorňák Tomáš, Král Michal, Sedláčková Zuzana, Šaňák Daniel, Čecháková Eva, Divišová Petra, Zapletalová Jana, Kaňovský Petr
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90...
January 15, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29331961/combining-intravenous-thrombolysis-and-antithrombotic-agents-in-stroke-an-update
#5
REVIEW
Laurent Derex, Chloé Paris, Norbert Nighoghossian
No abstract text is available yet for this article.
January 13, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29329535/measurement-of-the-potential-geographic-accessibility-from-call-to-definitive-care-for-patient-with-acute-stroke
#6
J Freyssenge, F Renard, A M Schott, L Derex, N Nighoghossian, K Tazarourte, C El Khoury
BACKGROUND: The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility. METHODS: The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car...
January 12, 2018: International Journal of Health Geographics
https://www.readbyqxmd.com/read/29327997/mechanical-thrombectomy-in-basilar-artery-occlusion-influence-of-reperfusion-on-clinical-outcome-and-impact-of-the-first-line-strategy-adapt-vs-stent-retriever
#7
Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, Bertrand Lapergue
OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29322481/influence-of-thrombolysis-on-the-safety-and-efficacy-of-blocking-platelet-adhesion-or-secretory-activity-in-acute-ischemic-stroke-in-mice
#8
Michael K Schuhmann, Peter Kraft, Michael Bieber, Axel Haarmann, György A Homola, Mirko Pham, Bernhard Nieswandt, Guido Stoll
In acute ischemic stroke (AIS), there is an alarming discrepancy between recanalization rates of up to 70% by combined recombinant tissue-type plasminogen activator (rt-PA) therapy and mechanical thrombectomy, and no clinical benefit in at least every second stroke patient. This is partly due to ischemia/reperfusion (I/R) injury. In a translational approach, we used mice lacking dense- (Unc13d -/- ) or α-granules (Nbeal2 -/- ) and mice after blocking of platelet glycoprotein receptor (GP) Ib conferring protection from I/R injury...
January 10, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29322232/mechanical-thrombectomy-using-the-new-solitaire%C3%A2-platinum-stent-retriever-reperfusion-results-complication-rates-and-early-neurological-outcome
#9
Johannes Pfaff, Stefan Rohde, Tobias Engelhorn, Arnd Doerfler, Martin Bendszus, Markus Alfred Möhlenbruch
BACKGROUND AND PURPOSE: The application of radiopaque markers to the Solitaire™ stent-retriever for better visibility during mechanical thrombectomy (MT) has the potential to alter the well-known characteristics of the device; however, it is uncertain whether this adjustment influences efficacy or safety of the enhanced stent-retriever. METHODS: Retrospective analysis of stroke databases of three comprehensive stroke centers. Our investigation was focused on technical and angiographic parameters, including procedure times, reperfusion results (thrombolysis in cerebral infarction, TICI), periprocedural complications and favorable early neurological recovery at discharge (modified Rankin scale ≤2 or National Institutes of Health Stroke Scale, NIHSS = 0 or ∆NIHSS ≥ 10), from consecutive patients with acute anterior circulation ischemic stroke treated with a Solitaire™ Platinum stent-retriever between October 2016 and March 2017...
January 10, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29321338/improving-access-to-thrombolysis-and-inhospital-management-times-in-ischemic-stroke-a-stepped-wedge-randomized-trial
#10
Julie Haesebaert, Norbert Nighoghossian, Catherine Mercier, Anne Termoz, Sylvie Porthault, Laurent Derex, Pierre-Yves Gueugniaud, Estelle Bravant, Muriel Rabilloud, Anne-Marie Schott
BACKGROUND AND PURPOSE: A suboptimal number of ischemic stroke patients eligible for thrombolysis actually receive it, partly because of extended inhospital delays. We developed a comprehensive program designed for emergency unit staff and evaluated its effectiveness for reducing intrahospital times and improving access to thrombolysis. METHODS: We conducted a randomized stepped-wedge controlled trial in 18 emergency unit. The sequentially implemented training intervention, targeting emergency physicians and nurses, was based on specifically designed videos and interactive simulation workshops on intrahospital management optimization...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29320558/thrombolysis-in-stroke-patients-comparability-of-point-of-care-versus-central-laboratory-international-normalized-ratio
#11
Ramona C Dolscheid-Pommerich, Sarah Dolscheid, Lars Eichhorn, Birgit Stoffel-Wagner, Ingo Graeff
BACKGROUND: In acute stroke patients, thrombolysis is one gold standard therapy option within the first four hours after the ischemic event. A contraindication for thrombolysis is an International Normalized Ratio (INR) value >1.7. Since time is brain, rapid and reliable INR results are fundamental. Aim was to compare INR values determined by central laboratory (CL) analyzer and Point-of-Care Testing(POCT)-device and to evaluate the quality of POCT performance in cases of potential therapeutic thrombolysis at a certified stroke unit...
2018: PloS One
https://www.readbyqxmd.com/read/29319407/malpractice-litigation-in-acute-stroke-care-where-are-we-now
#12
Gilberto Kk Leung, Gerard Porter
Acute stroke care has undergone momentous changes in recent years with the introduction of intravenous thrombolysis, mechanical thrombectomy and integrated stroke services. While these are welcome developments, they also carry unique medico-legal challenges. In 2015, a patient from Greater Manchester was awarded over £1 million in compensation after ambulance paramedics failed to admit her to a specialist unit. This paper explores the medico-legal implications of this first but over looked thrombolysis-related claim in the United Kingdom...
January 1, 2018: Medico-legal Journal
https://www.readbyqxmd.com/read/29317364/early-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-in-asian-patients-a-single-centre-study
#13
Prakash Paliwal, Farasat Kazmi, Hock Luen Teoh, Leonard Ll Yeo, Raymond Cs Seet, Tseng Tsai Yeo, Lwin Sein, Ning Chou, Thomas Tch, Bernard Pl Chan, Vijay K Sharma
INTRODUCTION: Early Decompression craniectomy(within 48-hours of stroke-onset) in acute and malignant middle cerebral artery(MCA) ischemic stroke(IS) reduces mortality and increases the proportion of patients with favourable functional outcome. Various cultural and social issues anong Asians lead to some differences in clinical practice specially when surgical interventions are involved. Accordingly decompressive craniectomy in Asian stroke patients is often delayed. MATERIALS & METHODS: Data for all acute IS patients hospitalized to our center were entered into a prospectively maintained registry...
January 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29316375/selection-criteria-for-endovascular-therapy-for-acute-ischaemic-stroke-are-patients-missing-out
#14
Julian Maingard, Leonid Churilov, Peter Mitchell, Richard Dowling, Bernard Yan
INTRODUCTION: Endovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. METHODS: We included patients with anterior circulation stroke treated with ECR from a single centre...
January 9, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29314208/pretreatment-lesional-volume-impacts-clinical-outcome-and-thrombectomy-efficacy
#15
Yu Xie, Catherine Oppenheim, Francis Guillemin, Vincent Gautheron, Benjamin Gory, Hélène Raoult, Sébastien Soize, Jacques Felblinger, Gabriela Hossu, Serge Bracard
OBJECTIVE: We aimed to characterize the association between pretreatment lesional volume measured on diffusion-weighted images and functional outcome, and estimate the impact on thrombectomy efficacy for ischemic stroke with anterior proximal intracranial arterial occlusion. METHODS: Anterior circulation ischemic stroke patients who had pretreatment diffusion-weighted imaging in the THRACE study were included. Lesional volume was semi-automatically segmented. Logistic regression was applied to model clinical outcome as a function of lesional volume...
January 3, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29313576/pharmacological-reperfusion-therapy-with-tenecteplase-in-7-668-indian-patients-with-st-elevation-myocardial-infarction-a-real-world-indian-experience
#16
S S Iyengar, Tiny Nair, Jagdish Hiremath, Anjan Lal Dutta, Uday Jadhav, V K Katyal, Dayanand Kumbla, Immaneni Sathyamurthy, R K Jain, M Srinivasan, Prasant Kr Sahoo
Objective: This real-world, observational, prescription event monitoring study was conducted to evaluate safety and efficacy of indigenous tenecteplase (TNK-tPA) in Indian patients presenting with ST elevation myocardial infarction (STEMI). Methods: This is a multi-centric, observational, prescription event monitoring study. Data was collected for 7,668 patients from 1,307 investigator sites across India from January 2011 to February 2016. Results: Overall, 76...
September 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29313057/regional-differences-in-thrombectomy-rates-secondary-use-of-billing-codes-in-the-miracum-medical-informatics-for-research-and-care-in-university-medicine-consortium
#17
Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach
BACKGROUND AND PURPOSE: Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS: Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines...
January 8, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29311264/starting-sich-nomogram-to-predict-symptomatic-intracerebral-hemorrhage-after-intravenous-thrombolysis-for-stroke
#18
Manuel Cappellari, Gianni Turcato, Stefano Forlivesi, Cecilia Zivelonghi, Paolo Bovi, Bruno Bonetti, Danilo Toni
BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (sICH) is a rare but the most feared complication of intravenous thrombolysis for ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of sICH in intravenous thrombolysis-treated stroke patients included in the multicenter SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register). METHODS: All patients registered in the SITS-ISTR by 179 Italian centers between May 2001 and March 2016 were originally included...
January 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29308832/comparison-of-risk-pci-grace-timi-risk-scores-for-prediction-of-major-adverse-cardiac-events-in-patients-with-acute-coronary-syndrome
#19
Tamara Jakimov, Igor Mrdović, Branka Filipović, Marija Zdravković, Aleksandra Djoković, Saša Hinić, Nataša Milić, Branislav Filipović
AIM: To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). METHODS: This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014...
December 31, 2017: Croatian Medical Journal
https://www.readbyqxmd.com/read/29304524/amino-fucoidan-as-a-vector-for-rtpa-induced-fibrinolysis-in-experimental-thrombotic-events
#20
Radouane Ghebouli, Stephane Loyau, Murielle Maire, Pierre Saboural, Jean-Philippe Collet, Martine Jandrot-Perrus, Didier Letourneur, Frédéric Chaubet, Jean-Baptiste Michel
Acute ischaemic stroke, myocardial infarction and pulmonary embolism are the main causes of mortality and morbidity worldwide. Thrombolysis by intravenous injection of recombinant tissue plasminogen activator (rtPA) remains the most common non-interventional treatment to recanalize occluded vessels. However, this procedure is limited by significant drawbacks, including high doses and bleeding complications. Recent studies showed that fucoidan targets the intraluminal thrombus in vivo. We have developed a chimaera covalently linking fucoidan, able to target platelets within the thrombus, to dilysine, able to non-covalently bind rtPA...
January 2018: Thrombosis and Haemostasis
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