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https://www.readbyqxmd.com/read/28628283/-case-report-pulmonary-embolism-complicated-by-angioneurotic-edema
#1
R Lopez, B Cuppens, S Robinet, A Ancion, V d'Orio, A Ghuysen, P Lancellotti
Although angioneurotic oedema (AE) is a rare entity, it sometimes leads to devastating consequences. We report the case of an oro-pharyngeal angioneurotic attack following the initiation of a fibrinolysis therapy by alteplase and relay by heparin in a patient with severe acute pulmonary embolism. In view of this original case, we propose to highlight the most recent elements concerning the physiopathology of this disease.
June 2017: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28619989/low-versus-standard-dose-alteplase-in-patients-on-prior-antiplatelet-therapy-the-enchanted-trial-enhanced-control-of-hypertension-and-thrombolysis-stroke-study
#2
Thompson G Robinson, Xia Wang, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph P Broderick, Andrew M Demchuk, Geoffery A Donnan, Jong S Kim, Pablo M Lavados, Tsong-Hai Lee, Richard I Lindley, Sheila C O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Thang H Nguyen, Ji-Guang Wang, Mark Woodward, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Many patients receiving thrombolysis for acute ischemic stroke are on prior antiplatelet therapy (APT), which may increase symptomatic intracerebral hemorrhage risk. In a prespecified subgroup analysis, we report comparative effects of different doses of intravenous alteplase according to prior APT use among participants of the international multicenter ENCHANTED study (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS: Among 3285 alteplase-treated patients (mean age, 66...
June 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28616283/the-use-of-thrombolytics-in-the-management-of-complex-pleural-fluid-collections
#3
Jessica Heimes, Hannah Copeland, Aditya Lulla, Marjulin Duldulao, Khaled Bahjri, Salman Zaheer, Jason M Wallen
BACKGROUND: To determine the efficacy of thrombolytics for the management of complex pleural fluid collections. METHODS: We reviewed patients that received alteplase for persistent loculated pleural fluid collections after simple tube drainage between July 01, 2007 and November 01, 2012. Our alteplase protocol is 6 mg of alteplase in 50 mL of normal saline injected into the pleural chest tube. The chest tube is clamped for four hours and then opened. Normally this is repeated daily for 2 to 3 days (d)...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28607341/thrombolysis-for-non-traumatic-intra-ventricular-hemorrhage-in-adults-a-critical-reappraisal
#4
Daniele Starnoni, Mauro Oddo, Rodolfo Maduri, Mahmoud Messerer, Roy T Daniel
Intra-ventricular hemorrhage (IVH) is a critical condition with high rate of morbidity and mortality due to acute hydrocephalus and secondary brain injury. Mechanisms underlining the clinical deterioration are not only related to the appearance of an acute hydrocephalus but also to blood- clot mass effect and the inflammatory effects of blood break-down products which impede local blood flow and exert a direct toxic effect on the peri-ventricular structures leading to chronic hydrocephalus. An effective treatment strategy should aim at IVH fast removal and reduction of blood-clot mass effect...
June 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28585904/egyptian-experience-in-increasing-utilization-of-reperfusion-therapies-in-acute-ischemic-stroke
#5
Magd Fouad Zakaria, Hany Aref, Azza Abd ElNasser, Nagia Fahmy, Mohamed Amir Tork, Mohamed Mahmoud Fouad, Ahmed ElBokl, Tamer Roushdy, Sara ElFaramawy, Mohammad Abdullah El-Shiekh, Ramez Reda Moustafa
Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28576782/tenecteplase-in-ischemic-stroke-offers-improved-recanalization-analysis-of-2-trials
#6
Andrew Bivard, Xuya Huang, Christopher R Levi, Neil Spratt, Bruce C V Campbell, Bharath Kumar Cheripelli, Dheeraj Kalladka, Fiona Catherine Moreton, Ian Ford, Christopher F Bladin, Stephen M Davis, Geoffrey A Donnan, Keith W Muir, Mark W Parsons
OBJECTIVE: To test whether patients with complete vessel occlusion show greater recanalization at 24 hours and have improved clinical outcomes at 24 hours and 90 days when treated with tenecteplase compared to alteplase. METHODS: Pooled clinical and imaging data from 2 phase 2 randomized trials comparing tenecteplase with alteplase allowed CT angiography (CTA) scans to be assessed centrally for occlusion status at baseline and at 24 hours post thrombolysis using the modified thrombolysis in cerebral infarction (TICI) scale...
June 2, 2017: Neurology
https://www.readbyqxmd.com/read/28569122/rationale-and-design-of-combination-of-an-immune-modulator-fingolimod-with-alteplase-bridging-with-mechanical-thrombectomy-in-acute-ischemic-stroke-famtais-trial
#7
Sheng Zhang, Ying Zhou, Ruiting Zhang, Meixia Zhang, Bruce Campbell, Longting Lin, Fu-Dong Shi, Min Lou
Rationale In acute ischemic stroke patients with large vessel occlusion, although reperfusion within 6 h after stroke onset using combined intravenous alteplase and mechanical thrombectomy (bridging therapy) can improve functional outcome, still approximately 50% patients suffer disability which may result from reperfusion injury. Proof-of-concept clinical trials have indicated that the sphingosine-1-phosphate receptor modulator fingolimod may be efficacious in attenuating brain inflammation and improving clinical outcomes in acute ischemic stroke patients as a single therapy beyond 4...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28550481/antiplatelet-pretreatment-and-outcomes-in-intravenous-thrombolysis-for-stroke-a-systematic-review-and-meta-analysis
#8
Georgios Tsivgoulis, Aristeidis H Katsanos, Ramin Zand, Vijay K Sharma, Martin Köhrmann, Sotirios Giannopoulos, Efthymios Dardiotis, Anne W Alexandrov, Panayiotis D Mitsias, Peter D Schellinger, Andrei V Alexandrov
Since there are contradictory data regarding the association of antiplatelet pretreatment (AP) with safety and efficacy outcomes of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), we conducted a systematic review and meta-analysis of available randomized-controlled clinical trials (RCTs) to investigate the association of AP with outcomes of AIS patients treated with intravenous alteplase. The outcome events of interest included symptomatic intracranial hemorrhage (sICH), fatal ICH, complete recanalization (CR), 3-month favorable functional outcome (FFO, mRS score 0-1), 3-month functional independence (FI, mRS score 0-2), and mortality...
June 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28536176/cost-of-alteplase-has-more-than-doubled-over-the-past-decade
#9
Dawn Kleindorfer, Joseph Broderick, Bart Demaerschalk, Jeffrey Saver
BACKGROUND AND PURPOSE: Intravenous alteplase (tissue-type plasminogen activator) has been shown to be cost-effective because of savings in long-term disability. In October of 2005, an increased DRG payment to hospitals for alteplase-treated stroke patients was introduced. We sought to describe the trends in the cost of alteplase over time, in comparison to trends in hospital reimbursement in the United States. METHODS: Using publicly available information on the Centers for Medicare and Medicaid Services (CMS) website (www...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28480034/co-administration-of-tissue-plasminogen-activator-and-hyperbaric-oxygen-in-ischemic-stroke-a-continued-promise-for-neuroprotection
#10
REVIEW
Ze-Song Yang, Jun Mu
Intravenous recombinant tissue-type plasminogen activator (r-tPA, alteplase) remains the recommended therapy for acute ischemic stroke. However, several factors are limiting its practical use. It makes it urgent for us to search more efficient strategies that can save the ischemic neurons, and safely extend the time window, while in the mean time reducing the detrimental effects for stroke thrombolysis. Hyperbaric oxygen therapy (HBOT) is considered to be potentially neuroprotective. Co-administration of r-tPA and HBOT has already been proved to be effective, safe and feasible in myocardial infarction...
January 2017: Medical Gas Research
https://www.readbyqxmd.com/read/28479799/advanced-age-and-higher-national-institutes-of-health-stroke-scale-score-as-predictors-of-poor-outcome-in-ischemic-stroke-patients-treated-with-alteplase-a-study-from-a-tertiary-care-centre-in-rural-north-west-india
#11
Amit Bhardwaj, Girish Sharma, Sunil Kumar Raina, Ashish Sharma, Monica Angra
INTRODUCTION: Thrombolytic therapy in acute ischemic stroke has been approved for treatment of acute stroke for past two decades. However, identification of predictors of poor outcome after the intravenous (IV) alteplase therapy in acute stroke patients is a matter of research. The present study was conducted with the aim of identifying poor prognostic factors in patients of acute ischemic stroke patients. METHODS: The data of 31 acute stroke patients treated with alteplase were gathered to identify the factors that were independent predictors of the poor outcome...
April 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28474654/pulmonary-artery-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism
#12
Abhijeet Singh, Ayush Gupta, Jagdish Chander Suri
A case of 60-year-old male with acute pulmonary embolism without hypotension but signs of right ventricular dysfunction and elevated cardiac biomarkers is reported in this study. The patient comes under intermediate high-risk category and was successfully thrombolysed with alteplase infused through pulmonary artery catheter. Catheter-directed thrombolysis (CDT) can be considered as much safer and effective alternative to systemic thrombolysis in such patients with lower risk of bleeding. This novel bedside method of pulmonary artery CDT with the advantage of no radiation exposure and real time monitoring of pulmonary artery pressures as an end-point of thrombolysis can be utilized in the near future...
May 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/28471898/early-neurological-deterioration-during-alteplase-infusion-for-acute-ischemic-stroke-an-uncommon-complication-of-intravenous-thrombolysis
#13
Apostolos Safouris, Odysseas Kargiotis, Georgios Magoufis, Aristeidis H Katsanos, Eleftherios Stamboulis, Georgios Tsivgoulis
INTRODUCTION: Recognizing new-territory ischemic stroke as an uncommon complication of intravenous thrombolysis is very important as it can lead to neurological deterioration during tissue-plasminogen-activator infusion. CASE REPORT: We report a case of an 80-year-old patient that has been treated with intravenous thrombolysis for right middle cerebral artery acute ischemic stroke. During infusion he had an abrupt neurological deterioration that proved to be a distal embolization of an asymptomatic non-occluding tip-of-the-basilar thrombus to the territory of left posterior cerebral artery that has been missed by the treating neurologist and radiologist in the pretreatment computed tomography angiography...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28463832/outcomes-of-endovascular-thrombectomy-with-and-without-thrombolysis-for-acute-large-artery-ischaemic-stroke-at-a-tertiary-stroke-centre
#14
Chee-Keong Wee, William McAuliffe, Constantine C Phatouros, Timothy J Phillips, David Blacker, Tejinder P Singh, Ellen Baker, Graeme J Hankey
BACKGROUND AND PURPOSE: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks...
May 2, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/28457860/assessment-of-healthcare-personnel-knowledge-of-stroke-care-at-a-large-referral-hospital-in-sub-saharan-africa-a-survey-based-approach
#15
Chen Lin, Ravi Vakani, Peter Kussin, Mary Guhwe, Alfredo E Farjat, Kingshuk Choudhury, David Renner, Chrispine Oduor, Carmelo Graffagnino
There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administered to health-care providers working in one large Kenyan acute referral hospital. Due to the prevalence of medical students (61...
April 27, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28446625/use-of-noncontrast-computed-tomography-and-computed-tomographic-perfusion-in-predicting-intracerebral-hemorrhage-after-intravenous-alteplase-therapy
#16
Connor Batchelor, Pooneh Pordeli, Christopher D d'Esterre, Mohamed Najm, Fahad S Al-Ajlan, Mari E Boesen, Connor McDougall, Lisa Hur, Enrico Fainardi, Jai Jai Shiva Shankar, Marta Rubiera, Alexander V Khaw, Michael D Hill, Andrew M Demchuk, Tolulope T Sajobi, Mayank Goyal, Ting-Yim Lee, Richard I Aviv, Bijoy K Menon
BACKGROUND AND PURPOSE: Intracerebral hemorrhage is a feared complication of intravenous alteplase therapy in patients with acute ischemic stroke. We explore the use of multimodal computed tomography in predicting this complication. METHODS: All patients were administered intravenous alteplase with/without intra-arterial therapy. An age- and sex-matched case-control design with classic and conditional logistic regression techniques was chosen for analyses. Outcome was parenchymal hemorrhage on 24- to 48-hour imaging...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28434774/myocardial-infarction-following-intravenous-thrombolysis-for-acute-ischemic-stroke-case-report-and-literature-review
#17
Marina Mannino, Salvatore Asciutto, Valeria Terruso, Matilde Gammino, Melchiorre Gilberto Cellura, Serena Monaco
Embolic complications of intravenous thrombolysis for acute ischemic stroke are increasingly recognized, and to date several cases of myocardial infarction soon after the administration of alteplase have been reported. We describe a case of early anterior myocardial infarction during intravenous thrombolysis for stroke and review the current literature.
April 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28431874/regional-disparities-in-the-quality-of-stroke-care
#18
Seth Seabury, Katalin Bognar, Yaping Xu, Caroline Huber, S Renee Commerford, Darren Tayama
BACKGROUND AND PURPOSE: There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. METHODS: This was a retrospective study using quality performance data from the 2015 Hospital Compare database linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File...
March 19, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28418189/epileptic-manifestations-in-stroke-patients-treated-with-intravenous-alteplase
#19
C Bentes, H Martins, A R Peralta, C Morgado, C Casimiro, A C Franco, A C Fonseca, R Geraldes, P Canhão, T Pinho E Melo, T Paiva, J M Ferro
BACKGROUND AND PURPOSE: Intravenous alteplase (rtPA) may be associated with seizures and epileptic activity in the electroencephalogram (EEG). The aim of this work was to compare the frequency of seizures and EEG abnormalities between stroke patients treated and not treated with rtPA. METHODS: This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, with 1-year follow-up. Patients were previously independent, had an admission National Institute of Health Stroke Scale score ≥4, an acute ischaemic lesion and no previous seizures...
June 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28414895/the-impact-of-ct-perfusion-threshold-on-predicted-viable-and-nonviable-tissue-volumes-in-acute-ischemic-stroke
#20
Xuya Huang, Dheeraj Kalladka, Bharath Kumar Cheripelli, Fiona Catherine Moreton, Keith W Muir
BACKGROUND AND PURPOSE: Perfusion imaging is used for patient selection in clinical practice and trials. Postprocessing and definitions of tissue viability are nevertheless not standardized. We compared the lesion volumes generated with two well-recognized perfusion tissue definitions in a single-center phase 2 thrombolysis study. METHODS: We analyzed perfusion imaging data from the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study using two popular tissue viability thresholds (ischemic core definition: (1) cerebral blood volume < 2...
April 17, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
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