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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/29778315/the-risk-of-hemorrhagic-transformation-after-thrombolysis-for-acute-ischemic-stroke-in-chinese-versus-north-americans-a-comparative-study
#1
Xiaomeng Xu, Deren Wang, Fang Wang, Casey Norton, Xinfeng Liu, Magdy Selim
BACKGROUND: There is a widespread belief that Asians are more susceptible to hemorrhagic transformation (HT) after receiving recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke (AIS). However, this has not been examined in clinical practice. This study aims to compare the incidence of symptomatic hemorrhagic transformation (SHT) among thrombolysis-treated AIS patients in China and in the United States. METHODS: We compared 212 consecutive patients receiving thrombolysis within 4...
May 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29777016/clinical-utility-of-electronic-alberta-stroke-program-early-computed-tomography-score-software-in-the-enchanted-trial-database
#2
Simon Nagel, Xia Wang, Cheryl Carcel, Thompson Robinson, Richard I Lindley, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke. METHODS: All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemic stroke who participated in the alteplase dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded...
May 18, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29773715/embolus-retriever-with-interlinked-cages-versus-other-stent-retrievers-in-acute-ischemic-stroke-an-observational-comparative-study
#3
Philipp Gruber, Salome Zeller, Carlos Garcia-Esperon, Jatta Berberat, Javier Anon, Michael Diepers, Krassen Nedeltchev, Fabian Flottmann, Jens Fiehler, Luca Remonda, Timo Kahles
BACKGROUND AND PURPOSE: Given the promising performance of the new Embolus Retriever with Interlinked Cages (ERIC) in smaller case series, we sought to assess the efficacy and safety of mechanical thrombectomy (MT) with ERIC compared with other stent retrievers (SRs) in acute ischemic stroke due to large vessel occlusion (LVO). METHODS: We reviewed the databases of two comprehensive stroke centers in in Germany and Switzerland for MT due to LVO in the anterior circulation with either ERIC or another SR as a first device...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29770166/free-radical-damage-in-ischemia-reperfusion-injury-an-obstacle-in-acute-ischemic-stroke-after-revascularization-therapy
#4
REVIEW
Ming-Shuo Sun, Hang Jin, Xin Sun, Shuo Huang, Fu-Liang Zhang, Zhen-Ni Guo, Yi Yang
Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29769590/low-factor-xiii-levels-after-intravenous-thrombolysis-predict-short-term-mortality-in-ischemic-stroke-patients
#5
Edina Gabriella Székely, Katalin Réka Czuriga-Kovács, Zsuzsanna Bereczky, Éva Katona, Zoltán András Mezei, Attila Nagy, Noémi Klára Tóth, Ervin Berényi, László Muszbek, László Csiba, Zsuzsa Bagoly
In this observational study we investigated whether levels of factor XIII (FXIII) and its major polymorphisms affect the outcome of thrombolysis by recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke (AIS) patients. Study cohort included 132 consecutive AIS patients undergoing i.v. thrombolysis within 4.5 h of symptom onset. Blood samples taken on admission, immediately after and 24 h after therapy were analyzed for FXIII activity and antigen levels. FXIII-A p.Val34Leu, p.Tyr204Phe, FXIII-B p...
May 16, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29768352/effectiveness-of-trevo-stent-retriever-in-acute-ischemic-stroke-comparison-with-solitaire-stent
#6
Ho Jun Yi, Dong Hoon Lee, Sang Uk Kim
Recently, mechanical thrombectomy with stent retriever has achieved faster and higher rates of recanalization for intracranial major vessel occlusion. However, comparative studies of the most widely used Solitaire and Trevo stents have been rarely published.The authors retrospectively reviewed a total of 200 patients who performed mechanical thrombectomy at our center during 4 years and divided patients into 2 groups: mechanical thrombectomy with Solitaire stent (Group 1: Solitaire) and mechanical thrombectomy with Trevo stent (Group 2: Trevo)...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29766770/mri-guided-thrombolysis-for-stroke-with-unknown-time-of-onset
#7
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29765502/the-phenolic-components-of-gastrodia-elata-improve-prognosis-in-rats-after-cerebral-ischemia-reperfusion-by-enhancing-the-endogenous-antioxidant-mechanisms
#8
Anhuan Shi, Jianming Xiang, Fangyan He, Yanping Zhu, Gongbei Zhu, Yuhan Lin, Ningna Zhou
Pharmacological or spontaneous thrombolysis in ischemic stroke triggers an outbreak of reactive oxygen species and results in neuron death. Nrf2-mediated antioxidation in cells has been proved as a pivotal target for neuroprotection. This research reports that phenolic components of Gastrodia elata Blume (PCGE), a traditional Chinese medicine, can alleviate the pathological lesions in the penumbra and hippocampus by increasing the survival of neurons and astrocytes and improve neurofunction and cognition after reperfusion in a rat model of middle cerebral artery occlusion...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29762091/rapid-automated-quantification-of-cerebral-leukoaraiosis-on-ct-images-a-multicenter-validation-study
#9
Liang Chen, Anoma Lalani Carlton Jones, Grant Mair, Rajiv Patel, Anastasia Gontsarova, Jeban Ganesalingam, Nikhil Math, Angela Dawson, Basaam Aweid, David Cohen, Amrish Mehta, Joanna Wardlaw, Daniel Rueckert, Paul Bentley
Purpose To validate a random forest method for segmenting cerebral white matter lesions (WMLs) on computed tomographic (CT) images in a multicenter cohort of patients with acute ischemic stroke, by comparison with fluid-attenuated recovery (FLAIR) magnetic resonance (MR) images and expert consensus. Materials and Methods A retrospective sample of 1082 acute ischemic stroke cases was obtained that was composed of unselected patients who were treated with thrombolysis or who were undergoing contemporaneous MR imaging and CT, and a subset of International Stroke Thrombolysis-3 trial participants...
May 15, 2018: Radiology
https://www.readbyqxmd.com/read/29762085/association-between-comorbid-cancer-and-outcomes-among-admissions-for-acute-ischemic-stroke-receiving-systemic-thrombolysis
#10
Erin R Weeda, Nicole Bohm
Background The impact of cancer on outcomes was not assessed in major trials of systemic thrombolysis in acute ischemic stroke. Aims To evaluate the association between comorbid cancer and hospital outcomes among patients receiving systemic thrombolysis for the treatment of acute ischemic stroke. Methods The 2013 and 2014 United States National Inpatient Sample was used to identify adult patients hospitalized for acute ischemic stroke who received systemic thrombolysis. Identified admissions were stratified into two cohorts based on the presence or absence of comorbid cancer...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29754671/rationale-and-design-for-the-vascular-outcomes-study-of-asa-along-with-rivaroxaban-in-endovascular-or-surgical-limb-revascularization-for-peripheral-artery-disease-voyager-pad
#11
Warren H Capell, Marc P Bonaca, Mark R Nehler, Edmond Chen, John M Kittelson, Sonia S Anand, Scott D Berkowitz, Eike Sebastian Debus, Fabrizio Fanelli, Lloyd Haskell, Manesh R Patel, Rupert Bauersachs, William R Hiatt
BACKGROUND: Patients with peripheral artery disease (PAD) undergoing a lower-extremity revascularization are at heightened risk for ischemic cardiac and limb events. Although intensification of antithrombotic therapy after revascularization has demonstrated benefit in coronary disease populations, this approach has not been well studied or shown consistent benefit in PAD. Recent trial evidence demonstrated that a treatment strategy of rivaroxaban added to background antiplatelet therapy reduced ischemic risk in patients following recent acute coronary syndromes, as well as in patients with stable atherosclerotic vascular disease...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29749914/endovascular-thrombectomy-can-be-beneficial-to-acute-ischemic-stroke-patients-with-large-infarcts
#12
Shaowei Jiang, Ya Peng, Chao-Hui Jing, Ai-Hua Fei, Hai-Rong Wang, Cheng-Jin Gao, Miao Chen, Yi Li, Shuming Pan
OBJECTIVE This study aimed to assess whether patients with acute ischemic stroke (AIS) and large infarct lesions benefit from reperfusion management. To determine the efficacy of different recanalization managements on AIS patients with Alberta Stroke Program Early CT Score (ASPECTS) < 6, the authors retrospectively analyzed hospitalized patients with AIS. METHODS Eighty-nine patients with AIS and ASPECTS < 6 were screened from 13,285 hospitalized patients treated by thrombolysis, thrombectomy, or conventional care in two stroke medical centers...
May 11, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29748424/intravenous-recombinant-tissue-type-plasminogen-activator-influence-on-outcome-in-anterior-circulation-ischemic-stroke-treated-by-mechanical-thrombectomy
#13
Marc Ferrigno, Nicolas Bricout, Didier Leys, Laurent Estrade, Charlotte Cordonnier, Thomas Personnic, Maeva Kyheng, Hilde Henon
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) improves functional outcome in patients with ischemic stroke related to proximal-vessel occlusion in the anterior circulation. Whether MT alone is as effective as IVT/MT remains controversial. We aimed at evaluating the influence of IVT in patients with large anterior circulation artery occlusion treated with MT. METHODS: We did a prospective observational cohort study in patients with stroke related to large anterior circulation artery occlusion treated by MT who were admitted to Lille University Hospital, Lille, France...
May 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29744447/in-vivo-evaluation-of-urokinase-loaded-hollow-nanogels-for-sonothrombolysis-on-suture-embolization-induced-acute-ischemic-stroke-rat-model
#14
Yuming Teng, Haiqiang Jin, Ding Nan, Mengnan Li, Chenghe Fan, Yuanyuan Liu, Pu Lv, Wei Cui, Yongan Sun, Hongjun Hao, Xiaozhong Qu, Zhenzhong Yang, Yining Huang
The urokinase-type plasminogen activator (uPA) loaded hollow nanogels (nUK) were synthesized by a one-step reaction of glycol chitosan and aldehyde capped poly (ethylene oxide). The resultant formulation is sensitive to diagnostic ultrasound (US) of 2 MHz. Herein, we evaluated the in vivo sonothrombolysis performance of the nUK on acute ischemic stroke rat model which was established by suture embolization of middle cerebral artery (MCA). Via intravenous (i.v.) administration, the experimental data prove a controlled release of the therapeutic protein around the clots under ultrasound stimulation, leading to enhanced thrombolysis efficiency of the nUK, evidenced from smaller infarct volume and better clinical scores when compared to the i...
March 2018: Bioactive Materials
https://www.readbyqxmd.com/read/29743763/impact-of-stroke-code-rapid-response-team-an-attempt-to-improve-intravenous-thrombolysis-rate-and-to-shorten-door-to-needle-time-in-acute-ischemic-stroke
#15
Sushma K Gurav, Kapil G Zirpe, R S Wadia, Avinash Naniwadekar, Prajakta U Pote, Amit Tungenwar, Abhijeet M Deshmukh, Srikanta Mohopatra, Balakrishna Nimavat, Prasad Surywanshi
Objective: "Stroke code" (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. Materials and Methods: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of "SC" (post-SC era) were analyzed (2015-2016) and compared with the retrospective data of patients treated in the "pre-SC era." Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated...
April 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29736735/current-endovascular-approach-to-the-management-of-acute-ischemic-stroke
#16
REVIEW
Rakesh Khatri, Anantha R Vellipuram, Alberto Maud, Salvador Cruz-Flores, Gustavo J Rodriguez
PURPOSE OF REVIEW: The review provides an overview of current endovascular management of patients with acute ischemic stroke in the light of recent landmark trials proving unequivocal benefit of the intervention. RECENT FINDINGS: Several randomized trials looking at selective groups of patients presenting after an acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the endovascular treatment compared to intravenous thrombolysis, leading to expedited changes in the American Heart Association/American Stroke Association guidelines...
May 7, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29736159/consensus-statements-by-korean-society-of-interventional-neuroradiology-and-korean-stroke-society-hyperacute-endovascular-treatment-workflow-to-reduce-door-to-reperfusion-time
#17
Dae-Hyun Kim, Byungjun Kim, Cheolkyu Jung, Hyo Suk Nam, Jin Soo Lee, Jin Woo Kim, Woong Jae Lee, Woo-Keun Seo, Ji-Hoe Heo, Seung Kug Baik, Byung Moon Kim, Joung-Ho Rha
Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers...
May 7, 2018: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/29731013/hypertension-canada-s-2018-guidelines-for-diagnosis-risk-assessment-prevention-and-treatment-of-hypertension-in-adults-and-children
#18
Kara A Nerenberg, Kelly B Zarnke, Alexander A Leung, Kaberi Dasgupta, Sonia Butalia, Kerry McBrien, Kevin C Harris, Meranda Nakhla, Lyne Cloutier, Mark Gelfer, Maxime Lamarre-Cliche, Alain Milot, Peter Bolli, Guy Tremblay, Donna McLean, Raj S Padwal, Karen C Tran, Steven Grover, Simon W Rabkin, Gordon W Moe, Jonathan G Howlett, Patrice Lindsay, Michael D Hill, Mike Sharma, Thalia Field, Theodore H Wein, Ashkan Shoamanesh, George K Dresser, Pavel Hamet, Robert J Herman, Ellen Burgess, Steven E Gryn, Jean C Grégoire, Richard Lewanczuk, Luc Poirier, Tavis S Campbell, Ross D Feldman, Kim L Lavoie, Ross T Tsuyuki, George Honos, Ally P H Prebtani, Gregory Kline, Ernesto L Schiffrin, Andrew Don-Wauchope, Sheldon W Tobe, Richard E Gilbert, Lawrence A Leiter, Charlotte Jones, Vincent Woo, Robert A Hegele, Peter Selby, Andrew Pipe, Philip A McFarlane, Paul Oh, Milan Gupta, Simon L Bacon, Janusz Kaczorowski, Luc Trudeau, Norman R C Campbell, Swapnil Hiremath, Michael Roerecke, Joanne Arcand, Marcel Ruzicka, G V Ramesh Prasad, Michel Vallée, Cedric Edwards, Praveena Sivapalan, S Brian Penner, Anne Fournier, Geneviève Benoit, Janusz Feber, Janis Dionne, Laura A Magee, Alexander G Logan, Anne-Marie Côté, Evelyne Rey, Tabassum Firoz, Laura M Kuyper, Jonathan Y Gabor, Raymond R Townsend, Doreen M Rabi, Stella S Daskalopoulou
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included...
May 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29729542/safety-and-cost-effectiveness-thrombolysis-by-diffusion-weighted-imaging-and-fluid-attenuated-inversion-recovery-mismatch-for-wake-up-stroke
#19
REVIEW
Tong Sun, Zhuan Xu, Shan-Shan Diao, Lu-Lu Zhang, Qi Fang, Xiu-Ying Cai, Yan Kong
Wake-up stroke, defined as patients who wake up with stroke symptoms which were not present prior to falling asleep, accounted for 14%-25% of acute ischemic stroke. Due to the unknown time of symptom onset, wake-up stoke was not in including criteria of intravenous thrombolysis. Several large randomized stroke trials using diffusion-weighted imaging(DWI)and fluid attenuated inversion recovery(FLAIR)mismatch patient selection may identify a subset of patients with wake-up stroke that can safely and effectively benefit from intravenous thrombolysis...
April 23, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29728903/tenecteplase-versus-alteplase-in-acute-ischemic-stroke-systematic-review-and-meta-analysis
#20
A Thelengana, Divya M Radhakrishnan, Manya Prasad, Amit Kumar, Kameshwar Prasad
Tenecteplase is a product of genetic modification of recombinant tissue plasminogen activator with superior pharmacodynamic and pharmacokinetic properties. This meta-analysis was to determine whether intravenous thrombolysis with tenecteplase in patients with acute ischemic stroke has better efficacy and safety outcomes than with intravenous alteplase. PubMed, Cochrane Central Register of Controlled Trials, WHO International clinical trials registry platform (ICTRP), Australian New Zealand Clinical Trials Registry (ANZCTR), EU Clinical Trials Register (EU-CTR) and ClinicalTrials...
May 4, 2018: Acta Neurologica Belgica
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