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Stroke thrombolysis

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https://www.readbyqxmd.com/read/28944694/tissue-plasminogen-activator-based-nanothrombolysis-for-ischemic-stroke
#1
Shan Liu, Xiaozhou Feng, Rong Jin, Guohong Li
Thrombolysis with intravenous tissue plasminogen activator (tPA) is the only FDA approved treatment for patients with acute ischemic stroke, but its use is limited by narrow therapeutic window, selective efficacy, and hemorrhagic complication. In the past two decades, extensive efforts have been undertaken to extend its therapeutic time window and explore alternative thrombolytic agents, but both show little progress. Nanotechnology has emerged as a promising strategy to improve the efficacy and safety of tPA...
September 23, 2017: Expert Opinion on Drug Delivery
https://www.readbyqxmd.com/read/28942971/survival-and-recurrence-after-acute-pulmonary-embolism-treated-with-pulmonary-embolectomy-in-thrombolysis-in-new-york-state-1999-to-2013
#2
Timothy Lee, Shinobu Itagaki, Yuting P Chiang, Natalia N Egorova, David H Adams, Joanna Chikwe
BACKGROUND: Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy...
August 31, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28939674/thrombolysis-in-postoperative-stroke
#3
Nicolas Voelkel, Nikolai Dominik Hubert, Roland Backhaus, Roman Ludwig Haberl, Gordian Jan Hubert
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. METHODS: Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery...
September 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28939567/association-between-gender-and-short-term-outcome-in-patients-with-st-elevation-myocardial-infraction-participating-in-the-international-prospective-randomised-administration-of-ticagrelor-in-the-catheterisation-laboratory-or-in-the-ambulance-for-new-st-elevation
#4
Dimitrios Venetsanos, Sofia Sederholm Lawesson, Joakim Alfredsson, Magnus Janzon, Angel Cequier, Mohamed Chettibi, Shaun G Goodman, Arnoud W Van't Hof, Gilles Montalescot, Eva Swahn
OBJECTIVES: To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). SETTINGS: A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. PARTICIPANTS: Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included...
September 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28939303/early-partial-recanalization-after-intravenous-thrombolysis-leads-to-prediction-of-favorable-outcome-in-cases-of-acute-ischemic-stroke-with-major-vessel-occlusion
#5
Jun Young Chang, Hyun Park, Se Young Jang, Seunguk Jung, Hee-Joon Bae, O-Ki Kwon, Moon-Ku Han
We investigated the association between early recanalization degree after intravenous thrombolysis (IVT), occurrence of hemorrhagic transformation, and functional outcome. We also evaluated whether recombinant tissue plasminogen activator (rTPA) dosing error could influence the outcome. Patients with ischemic stroke with major vessel occlusion (n=256) who underwent IVT were included. Recanalization status (no recanalization, partial recanalization, and complete recanalization) was confirmed by subsequent magnetic resonance or conventional angiography...
September 19, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28936196/anti-inflammatory-targets-for-the-treatment-of-reperfusion-injury-in-stroke
#6
REVIEW
Atsushi Mizuma, Midori A Yenari
While the mainstay of acute stroke treatment includes revascularization via recombinant tissue plasminogen activator or mechanical thrombectomy, only a minority of stroke patients are eligible for treatment, as delayed treatment can lead to worsened outcome. This worsened outcome at the experimental level has been attributed to an entity known as reperfusion injury (R/I). R/I is occurred when revascularization is delayed after critical brain and vascular injury has occurred, so that when oxygenated blood is restored, ischemic damage is increased, rather than decreased...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28935502/outcomes-of-nonagenarians-with-acute-ischemic-stroke-treated-with-intravenous-thrombolytics
#7
Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, Catharina J M Klijn, Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli
BACKGROUND: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established. MATERIALS AND METHODS: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28931617/normobaric-hyperoxia-reduces-blood-occludin-fragments-in-rats-and-patients-with-acute-ischemic-stroke
#8
Shuhai Shi, Zhifeng Qi, Qingfeng Ma, Rong Pan, Graham S Timmins, Yongmei Zhao, Wenjuan Shi, Yunzhou Zhang, Xunming Ji, Ke Jian Liu
BACKGROUND AND PURPOSE: Damage of the blood-brain barrier (BBB) increases the incidence of neurovascular complications, especially for cerebral hemorrhage after tPA (tissue-type plasminogen activator) therapy. Currently, there is no effective method to evaluate the extent of BBB damage to guide tPA use. Herein, we investigated whether blood levels of tight junction proteins could serve as biomarker of BBB damages in acute ischemic stroke (AIS) in both rats and patients. We examined whether this biomarker could reflect the extent of BBB permeability during cerebral ischemia/reperfusion and the effects of normobaric hyperoxia (NBO) on BBB damage...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28928186/recombinant-human-tnk-tissue-type-plasminogen-activator-rhtnk-tpa-versus-alteplase-rt-pa-as-fibrinolytic-therapy-for-acute-st-segment-elevation-myocardial-infarction-china-tnk-stemi-protocol-for-a-randomised-controlled-non-inferiority-trial
#9
Hai-Bo Wang, Ping Ji, Xing-Shan Zhao, Haiyan Xu, Xiao-Yan Yan, Qin Yang, Chen Yao, Run-Lin Gao, Yang-Feng Wu, Shu-Bin Qiao
AIM: To evaluate the efficacy and safety of recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) in lowering major adverse cardiovascular and cerebrovascular events (MACCEs) in Chinese acute ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND ANALYSIS: The study is designed as a multicentre, randomised, controlled non-inferiority phase IV trial with balanced randomisation (1:1) in patients with STEMI. The planned sample size is 6200 participants (or 3100 per arm)...
September 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28927686/temporal-trends-in-the-levels-of-peripherally-circulating-leukocyte-subtypes-in-the-hours-after-ischemic-stroke
#10
Dipender Gill, Prasanthi Sivakumaran, Adarsh Aravind, Atisha Tank, Roshni Dosh, Roland Veltkamp
BACKGROUND: Leukocyte-mediated neuroinflammation may affect outcomes after ischemic stroke. AIMS: To explore temporal changes in levels of peripherally circulating leukocyte subtypes in the early hours after ischemic stroke in humans. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for acute ischemic stroke (AIS). Multivariable regression analysis was used to explore temporal changes in the levels of peripherally circulating leukocyte subtypes in the hours immediately after ischemic stroke...
September 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28923278/can-adjunctive-therapies-augment-the-efficacy-of-endovascular-thrombolysis-a-potential-role-for-activated-protein-c
#11
REVIEW
Arun Paul Amar, Abhay P Sagare, Zhen Zhao, Yaoming Wang, Amy R Nelson, John H Griffin, Berislav V Zlokovic
In the management of acute ischemic stroke, vessel recanalization correlates with functional status, mortality, cost, and other outcome measures. Thrombolysis with intravenous tissue plasminogen activator has many limitations that restrict its applicability, but recent advances in the development of mechanical thrombectomy devices as well as improved systems of stroke care have resulted in greater likelihood of vessel revascularization. Nonetheless, there remains substantial discrepancy between rates of recanalization and rates of favorable outcome...
September 15, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28923277/animal-models-of-ischaemic-stroke-and-characterisation-of-the-ischaemic-penumbra
#12
REVIEW
Christopher McCabe, Mariana M Arroja, Emma Reid, I Mhairi Macrae
Over the past forty years, animal models of focal cerebral ischaemia have allowed us to identify the critical cerebral blood flow thresholds responsible for irreversible cell death, electrical failure, inhibition of protein synthesis, energy depletion and thereby the lifespan of the potentially salvageable penumbra. They have allowed us to understand the intricate biochemical and molecular mechanisms within the 'ischaemic cascade' that initiate cell death in the first minutes, hours and days following stroke...
September 16, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28922363/predictors-of-post-thrombolysis-symptomatic-intracranial-hemorrhage-in-chinese-patients-with-acute-ischemic-stroke
#13
Mingyong Liu, Yuesong Pan, Lichun Zhou, Yongjun Wang
BACKGROUND AND PURPOSE: Predictors of symptomatic intracranial hemorrhage (sICH) in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator remain unclear. METHODS: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study were assessed to explore risk factors for symptomatic intracranial hemorrhage after intravenous thrombolysis. Three candidate sICH definitions were analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/28916667/cost-effectiveness-of-thrombectomy-in-patients-with-acute-ischemic-stroke-the-thrace-randomized-controlled-trial
#14
Hamza Achit, Marc Soudant, Kossar Hosseini, Aurélie Bannay, Jonathan Epstein, Serge Bracard, Francis Guillemin
BACKGROUND AND PURPOSE: The benefit of mechanical thrombectomy added to intravenous thrombolysis (IVT) in patients with acute ischemic stroke has been largely demonstrated. However, evidence of the economic incentive of this strategy is still limited, especially in the context of a randomized controlled trial. We aimed to analyze whether mechanical thrombectomy combined with IVT (IVMT) is cost-effective when compared with IVT alone. METHODS: Individual-level cost and outcome data were collected in the THRACE randomized controlled trial (Thrombectomie des Artères Cerébrales) including patients with acute ischemic stroke...
September 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28913720/emergency-neurological-life-support-acute-ischemic-stroke
#15
Hartmut Gross, Noah Grose
Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including both intravenous thrombolysis and endovascular approaches to thrombus removal. Extensive study has demonstrated that rapid, protocolized, assessment and treatment is essential to improving neurological outcome. For this reason, acute ischemic stroke was chosen as an emergency neurological life support protocol. The protocol focuses on the first hour of medical care following the acute onset of a neurological deficit...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913684/-telemedicine-in-stroke-care
#16
REVIEW
L Breuer, S Schwab
Telemedicine is already widely used in many telestroke networks and ensures stroke treatment close to the patient's home in rural and medically underserved areas. This is particularly effective when telemedicine is integrated into a stroke unit concept. While telemedically based thrombolysis therapy has become routine practice for many years, practical implementation of comprehensive mechanical thrombectomy and the related processes remains challenging. The main tasks for the future further include development of a structured stroke aftercare system in neurologically underserved areas and permanent assurance of high-quality stroke care in telemedically connected sites...
September 14, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28906581/is-there-a-benefit-of-mechanical-thrombectomy-in-patients-with-large-stroke-dwi-aspects%C3%A2-5
#17
Pierre-François Manceau, Sébastien Soize, Matthias Gawlitza, Guillaume Fabre, Serge Bakchine, Carole Durot, Isabelle Serre, Georgios-Emmanouil Metaxas, Laurent Pierot
BACKGROUND: Whether to withhold mechanical thrombectomy when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is undetermined. We aimed to identify markers that will help to select patients with large DWI lesions (DWI-Alberta Stroke Program Early CT Score, DWI-ASPECTS≤5) that may benefit from thrombectomy. METHODS: From May 2010 to November 2016, we studied 82 acute ischemic stroke patients with DWI-ASPECTS≤5 (43 men, 64.6±14.4 years, NIHSS 18...
September 14, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28905995/leptomeningeal-collateral-status-predicts-outcome-after-middle-cerebral-artery-occlusion
#18
C F Madelung, C Ovesen, C Trampedach, A Christensen, I Havsteen, C K Hansen, H Christensen
OBJECTIVES: Perfusion through leptomeningeal collateral vessels is a likely pivotal factor in the outcome of stroke patients. We aimed to investigate the effect of collateral status on outcome in a cohort of unselected, consecutive stroke patients with middle cerebral artery occlusion undergoing reperfusion therapy. MATERIALS AND METHODS: This retrospectively planned analysis was passed on prospectively collected data from 187 consecutive patients with middle cerebral artery occlusion admitted within 4...
September 14, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28905212/hub-and-spoke-stroke-network-in-the-veneto-region-a-retrospective-study-investigating-the-effectiveness-of-the-stroke-pathway-and-trends-over-time
#19
L Nardetto, B Giometto, G Moretto, D Mantoan, M Saia
After recognizing the pivotal role played by stroke unit (SU) admission in reducing mortality and dependency in stroke patients, the need to organize and monitor stroke networks has become an increasingly essential aspect of stroke care. We conducted a retrospective study of stroke patients admitted to hospitals in the Veneto region from 2007 to 2015 in order to evaluate the effectiveness of the stroke pathway and trends over time. Between 2007 and 2015, 61,062 stroke patients were discharged from Veneto hospitals: they were more frequently female, females were older than males, and had higher intrahospital mortality and a lower probability of undergoing systemic thrombolysis...
September 13, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28905077/-stroke-due-to-acute-occlusion-of-the-basilar-artery-diagnosis-and-treatment
#20
REVIEW
S Nagel
Acute occlusion of the basilar artery is a rare and, if left untreated, severe neurovascular condition with a high mortality. The clinical presentation is often atypical and hence diagnosis may be delayed. Because of the devastating natural course, recanalization strategies were often more aggressive than in patients with occlusions in the anterior circulation. To date, there is no evidence-based therapy, and recent larger registry studies and meta-analyses do not show a clear superiority of endovascular approaches over systemic thrombolysis alone...
September 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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