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Y-X Wang, Y-Q Li, Y Chen, C-H Zhang, Z Dong, Z Wang, S-N Zhao, C-H Li, P-L Zhang
OBJECTIVE: Orolingual angioedema (OA) is a rare clinical complication with a potentially fatal risk that occurs after the intravenous application of alteplase (rt-PA) in patients with acute ischemic stroke. The purpose of this work is to investigate the related factors of OA in patients with acute ischemic stroke after the administration of intravenous thrombolytic therapy, to improve the predictive ability of OA during intravenous thrombolytic therapy, and to reduce the prevalence of complications...
March 2018: European Review for Medical and Pharmacological Sciences
Tsuyoshi Ohta, Kenji Okada, Maki Fukuda, Noritaka Masahira, Toshiki Matsuoka, Takaya Tsuno, Mitsuhiro Takemura
OBJECT: The purpose of this study was to investigate the safety and efficacy of intravenous low-dose alteplase for acute ischemic stroke patients with relative contraindications. METHODS: The consecutive series of patients admitted within 4.5 hours of ischemic stroke onset between September 2012 and April 2017 were retrospectively evaluated. A good outcome at 90 days and symptomatic intracerebral hemorrhage were evaluated to determine the association with intravenous low-dose alteplase, especially in the presence of relative contraindications...
March 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Tianming Zhao, Jixiang Ni, Xuehua Hu, Yingnan Wang, Xinge Du
Thrombolysis and anticoagulation were the main treatment methods for acute pulmonary embolism. However, the use of thrombolysis drugs may lead to bleeding complications. We compared intermittent low-dose urokinase (UK) and alteplase (recombinant tissue plasminogen activator [rt-PA]) in normotensive patients with intermediate-high-risk pulmonary embolism. The UK group was treated with intravenous UK 10 000 U/kg once a day for 7 days. The rt-PA group was given alteplase 50 mg by intravenous injection within 2 hours of admission...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Francesc Miró-Mur, Carlos Laredo, Arturo Renú, Salvatore Rudilosso, Yashu Zhao, Sergio Amaro, Laura Llull, Xabier Urra, Anna M Planas, Ángel Chamorro
Ischemic stroke sets in motion a dialogue between the central nervous and the immune systems that includes the sympathetic/adrenal system. We investigated the course of immune cells and adrenocortical and adrenomedullary effectors in a cohort of 51 patients with acute stroke receiving reperfusion therapy (intravenous alteplase or mechanical thrombectomy) and its correlation with stroke outcomes and infarct growth. Cortisol increased rapidly and fleetingly after stroke, but 39% of patients who had larger infarctions on admission showed a positive delta cortisol at day 1...
March 13, 2018: Brain, Behavior, and Immunity
William J Meurer, Bradley Barth, Michael Abraham, Jerome Hoffman, Gary M Vilke, Gerard DeMers
BACKGROUND: Stroke treatment is a continuum that begins with the rapid identification of symptoms and treatment with transition to successful rehabilitation. Therapies for acute ischemic stroke (AIS) may vary based on anatomic location, interval from symptom onset, and coexisting health conditions. Successful therapy requires a seamless systematic approach with coordination from prehospital environment through acute management at medical facilities to disposition and long-term care of the patient...
March 12, 2018: Journal of Emergency Medicine
Dia Byrne, Linda Penwarden
The purpose of this article is to share the efforts of one institution in reducing risk of central line-associated bloodstream infections (CLABSIs). The aim is to review alteplase use as a marker for peripherally inserted central catheter (PICC) occlusions, which may increase risk of CLABSIs. The discovery that alteplase use increased with the number of PICC lumens allowed for exploration of ordering and placement practices. Following education, placement of double-lumen PICCs decreased.
March 2018: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
Adnan I Qureshi, Mikayel Grigoryan, Muhammad A Saleem, Emrah Aytac, Shawn S Wallery, Gustavo J Rodriguez, Muhammad F K Suri
BACKGROUND AND PURPOSE: To determine the effectiveness of prolonged microcatheter-based local thrombolytic infusion in treatment of patients with cerebral venous thrombosis who achieved no or suboptimal recanalization with transvenous endovascular treatment. METHODS: Data collection: Prospectively registries supplemented by retrospective review. SETTINGS: Three hospitals with tertiary referral base. PATIENTS: Patients who underwent transvenous endovascular treatment for cerebral venous thrombosis...
February 26, 2018: Neurocritical Care
Charlotte Zerna, Thomas Jeerakathil, Michael D Hill
Stroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experienced physicians under the guidance of stroke neurology experts...
December 27, 2017: Canadian Journal of Cardiology
Walter Muruet, Anthony Rudd, Charles D A Wolfe, Abdel Douiri
BACKGROUND AND PURPOSE: Intravenous thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery because clinical trials follow-up times are limited. METHODS: Patients registered between January 2005 and December 2015, to the population-based South London Stroke Register of first-ever strokes. Propensity score was used to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates...
February 12, 2018: Stroke; a Journal of Cerebral Circulation
Chongqing Huang, Guanfeng Yu, Jingyong Huang
OBJECTIVE: To investigate the clinical effect of endovascular interventional treatment for iliac vein compression syndrome (IVCS). MATERIAL AND METHODS: The data of 68 patients with IVCS, underwent interventional treatment in our hospital, were analyzed retrospectively. Among these patients, 46 were complicated with lower extremity varicose veins. 65 patients underwent stent implantation, while 3 patients underwent simple balloon angioplasty. 14 patients were complicated with post-thrombotic syndrome (PTS) and 11patients with acute deep venous thrombosis (DVT)...
February 8, 2018: Annals of Vascular Surgery
Elizabeth D Waring, Truman J Milling, Steven Warach
Acute thrombolysis has a proven benefit for adults presenting with acute ischemic stroke, but data within the pediatric population are extremely limited. We report the case of a 14-year-old girl who presented with right-sided weakness and ataxia, loss of sensation, and altered mental status. Magnetic resonance imaging with diffusion-weighted imaging showed an acute lesion in the distribution of the left posterior cerebral artery, and magnetic resonance angiogram demonstrated occlusion of the third branch of the left posterior cerebral artery...
February 5, 2018: Pediatric Emergency Care
Jong S Kim, Yeon-Jung Kim, Kyung Bok Lee, Jae Kwan Cha, Jong-Moo Park, Yangha Hwang, Eung-Gyu Kim, Joung-Ho Rha, Jaseong Koo, Jei Kim, Yong-Jae Kim, Woo-Keun Seo, Dong-Eog Kim, Thompson G Robinson, Richard I Lindley, Xia Wang, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown. METHODS: In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0...
January 2018: Journal of Stroke
Hyun-Wook Nah, Dae-Hyun Kim, Myongjin Kang, Jae-Hyung Choi, Hyun-Seok Park, Jae-Kwan Cha
BACKGROUND: We sought to investigate whether early thrombolytic treatment can result in favorable functional outcome even in patients with large diffusion-weighted imaging (DWI) lesions. MATERIALS AND METHODS: We analyzed 566 patients who received intravenous alteplase within 4.5 hours from onset, initially underwent DWI and magnetic resonance angiography, and had acute infarction confined to anterior circulation. DWI lesion volumes were measured semiautomatically...
February 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Nandakumar Nagaraja, Nudrat Tasneem, Amir Shaban, Sudeepta Dandapat, Uzair Ahmed, Bruno Policeni, Heena Olalde, Hyungsub Shim, Edgar A Samaniego, Connie Pieper, Santiago Ortega-Gutierrez, Enrique C Leira, Harold P Adams
BACKGROUND AND PURPOSE: Intravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation. METHODS: Consecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation...
February 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Vincent Gautheron, Yu Xie, Marie Tisserand, Hélène Raoult, Sébastien Soize, Olivier Naggara, Romain Bourcier, Sébastien Richard, Francis Guillemin, Serge Bracard, Catherine Oppenheim
BACKGROUND AND PURPOSE: Stroke patients with large diffusion-weighted imaging (DWI) volumes are often excluded from reperfusion because of reckoned futility. In those with DWIvolume >70 mL, included in the THRACE trial (Mechanical Thrombectomy After Intravenous Alteplase Versus Alteplase Alone After Stroke), we report the associations between baseline parameters and outcome. METHODS: We examined 304 patients with anterior circulation stroke and pretreatment magnetic resonance imaging...
March 2018: Stroke; a Journal of Cerebral Circulation
Norio Tanahashi, Takenori Yamaguchi, Hideto Awano, Hiroaki Matsuda
BACKGROUND: We investigated how diabetes mellitus (DM) affects the outcome of acute ischemic stroke (AIS), comparing with the outcomes in those who had hypertension (HT) and atrial fibrillation (AF). METHODS: This study was a sub-analysis of PROTECT4.5, which was previously performed as a large-scale, prospective observational study of edaravone with approximately 10,000 patients with AIS in Japan. The study patients treated with edaravone alone or edaravone + alteplase (recombinant tissue plasminogen activator [tPA]) were analyzed for their outcomes and explored for the risk factors of poor outcome, after being divided into 8 groups according to their affected complications of DM, HT, or AF in the groups treated with edaravone alone or edaravone + tPA...
January 17, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Mick Kumwenda, Lisa Dougherty, Helen Spooner, Victoria Jackson, Sandip Mitra, Nicholas Inston
Tunnelled central venous access devices (CVADs) are defined as any intravenous multipurpose catheters placed within the central veins for use in haemodialysis and administration of blood products or chemotherapy in oncology and haematological conditions. Frequent complications include thrombosis and catheter-related infection, which may lead to significant adverse patient outcomes. Once thrombosis is suspected correction should be attempted empirically with thrombolytic agents. Commonly available thrombolytic agents in the UK include urokinase (Syner-Kinase) and alteplase (Cathflo)...
January 25, 2018: British Journal of Nursing: BJN
Takehiro Kitagawa, Junkoh Yamamoto, Makoto Kureshima, Hitoshi Maeda, Shigeru Nishizawa
A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. The patient was treated with alteplase about 2.5 h after onset. Immediately after the intravenous alteplase administration, the hemiparesis improved. However, his respiratory condition unexpectedly worsened 10 h after onset. Chest radiography demonstrated an infiltrative shadow in both lung fields...
January 2018: No Shinkei Geka. Neurological Surgery
Harshal Shukla, Vicken Yaghdjian, Issam Koleilat
Hypothenar hammer syndrome is a cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery in the setting of a complete or incomplete palmar arch. Acute occlusive thrombus or embolus of the hand represents a complex problem that often may require immediate surgical intervention. We report a case of acute unilateral arterial hand ischemia requiring catheter-directed thrombolysis with Alteplase therapy in a patient with acute occlusive arterial thrombosis of the left ulnar artery...
2018: SAGE open medical case reports
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