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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/28319471/early-secondary-prevention-after-initially-ineffective-revascularization-treatments-for-acute-ischemic-stroke-due-to-tandem-occlusion
#1
Stefano Forlivesi, Elia Pancheri, Giuseppe Moretto, Paolo Bovi, Manuel Cappellari
The most effective treatment of patients with stroke due to tandem occlusion is still unclear. We report the case of a man with stroke due to tandem internal carotid artery/middle cerebral artery occlusion, who underwent initially ineffective intravenous thrombolysis (IVT) and endovascular treatment. Early anticoagulation with apixaban was started after 48 h of IVT, given a newly diagnosed nonvalvular atrial fibrillation. Spontaneous partial recanalization of the cervical internal carotid artery was noted, and carotid endarterectomy was performed 72 h after IVT and 8 h after the last dose of apixaban...
March 17, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28319240/two-paradigms-for-endovascular-thrombectomy-after-intravenous-thrombolysis-for-acute-ischemic-stroke
#2
Gaspard Gerschenfeld, Ioan-Paul Muresan, Raphael Blanc, Michael Obadia, Marie Abrivard, Michel Piotin, Sonia Alamowitch
Importance: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome. Objective: To compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership)...
March 20, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28318954/computed-tomography-perfusion-based-decision-making-for-acute-ischemic-stroke-missing-the-mismatch
#3
J A Molad, M Findler, E Auriel
The emerging use of mechanical thrombectomy for acute ischemic stroke treatment focuses on the importance of patient selection. Computed tomography perfusion (CTP) is one of widely used techniques. However, the accuracy and reliability of this modality is in debate among vascular neurologists. We present a case of an 80-year-old man admitted because of acute ischemic stroke. CT angiography demonstrated left proximal M2 occlusion. As CTP demonstrated signs of large ischemic core with no significant penumbra, mechanical thrombectomy was not performed following tPA administration...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28315960/intravenous-thrombolysis-for-ischemic-stroke-in-the-golden-hour-propensity-matched-analysis-from-the-sits-east-registry
#4
Georgios Tsivgoulis, Aristeidis H Katsanos, Pavla Kadlecová, Anna Czlonkowska, Adam Kobayashi, Miroslav Brozman, Viktor Švigelj, Laszlo Csiba, Klara Fekete, Janika Kõrv, Vida Demarin, Aleksandras Vilionskis, Dalius Jatuzis, Yakup Krespi, Chrissoula Liantinioti, Sotirios Giannopoulos, Robert Mikulik
As there are scarce data regarding the outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) within 60 min from symptom onset ("golden hour"), we sought to compare outcomes between AIS patients treated within [GH(+)] and outside [GH(-)] the "golden hour" by analyzing propensity score matched data from the SITS-EAST registry. Clinical recovery (CR) at 2 and 24 h was defined as a reduction of ≥10 points on NIHSS-score or a total NIHSS-score of ≤3 at 2 and 24 h, respectively...
March 18, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28314516/impact-of-an-intrahospital-mobile-thrombolysis-team-on-3-month-clinical-outcomes-in-patients-benefiting-from-intravenous-thrombolysis-for-acute-ischemic-stroke
#5
B Hebant, A Triquenot-Bagan, E Guegan-Massardier, O Ozkul-Wermester, L Grangeon, D Maltête
INTRODUCTION/OBJECTIVE: The benefits of thrombolysis in patients presenting with acute ischemic stroke (IS) are highly time-dependent. The aim of our study was to evaluate the clinical benefit, after 3 months, of an intrahospital mobile thrombolysis team (MTT) for thrombolysis in IS. PATIENTS AND METHODS: A total of 95 consecutive patients treated with IV tPA for acute IS at the neurology department of Rouen University Hospital between 1 January and 31 December 2015 were retrospectively identified...
March 14, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28302608/ipsilateral-prominent-thalamostriate-vein-on-susceptibility-weighted-imaging-predicts-poor-outcome-after-intravenous-thrombolysis-in-acute-ischemic-stroke
#6
X Zhang, S Zhang, Q Chen, W Ding, B C V Campbell, M Lou
BACKGROUND AND PURPOSE: The impact of deep cerebral veins on neurologic outcome after intravenous thrombolysis in patients with acute ischemic stroke is unclear. We investigated the relationship between the appearance of deep cerebral veins on susceptibility-weighted imaging and neurologic outcome in patients who underwent thrombolysis. MATERIALS AND METHODS: We retrospectively analyzed 109 consecutive patients with acute ischemic stroke who had pretreatment SWI and received intravenous thrombolysis within 6 hours...
March 16, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28291782/obesity-paradox-in-stroke-myth-or-reality-a-systematic-review
#7
Lisa Oesch, Turgut Tatlisumak, Marcel Arnold, Hakan Sarikaya
BACKGROUND AND PURPOSE: Both stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest a better prognosis in obese patients after stroke ("obesity paradox"). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search. METHODS: The reviewers searched MEDLINE from inception to December 2015...
2017: PloS One
https://www.readbyqxmd.com/read/28289148/admission-hyperglycemia-and-outcomes-in-large-vessel-occlusion-strokes-treated-with-mechanical-thrombectomy
#8
Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Kira Dillard, Aristeidis H Katsanos, Georgios Magoufis, Jason J Chang, Ramin Zand, Daniel Hoit, Apostolos Safouris, Asim Choudhri, Anne W Alexandrov, Andrei V Alexandrov, Adam S Arthur, Lucas Elijovich
BACKGROUND AND PURPOSE: Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS: Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated...
March 13, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28283607/individual-and-system-contributions-to-race-and-sex-disparities-in-thrombolysis-use-for-stroke-patients-in-the-united-states
#9
Roland Faigle, Victor C Urrutia, Lisa A Cooper, Rebecca F Gottesman
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) is underutilized in ethnic minorities and women. To disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients. METHODS: Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke (<25% minority patients [white hospitals], 25% to 50% minority patients [mixed hospitals], or >50% minority patients [minority hospitals])...
March 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28277445/thrombolytic-therapy-in-wake-up-stroke-patients
#10
Gretchen M Stern, Nicholas Van Hise, Lindsay M Urben, Matthew J Korobey, Jamie M Pitlick, Andrew J Crannage
OBJECTIVE: The aim of the study is to review existing and ongoing trial data on wake-up stroke (WUS) patients for thrombolytic therapy. METHODS: A literature search was conducted in PubMed (conception-October 2016) using the terms wake-up stroke, acute ischemic stroke, wake-up thrombolysis, computed tomography imaging in wake-up stroke, and magnetic resonance imaging in wake-up stroke. Ongoing trials were found using the ClinicalTrials.gov website. RESULTS: The search yielded 61 articles in PubMed and 7 ongoing trials...
March 9, 2017: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/28277288/ct-imaging-selection-in-acute-stroke
#11
Laurie Bouchez, Roman Sztajzel, Maria Isabel Vargas, Paolo Machi, Zsolt Kulcsar, Pierre-Alexandre Poletti, Vitor Mendes Pereira, Karl-Olof Lövblad
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia...
October 26, 2016: European Journal of Radiology
https://www.readbyqxmd.com/read/28275651/platelet-microparticles-a-biomarker-for-recanalization-in-rtpa-treated-ischemic-stroke-patients
#12
Andrew Bivard, Lisa F Lincz, Jane Maquire, Mark Parsons, Christopher Levi
OBJECTIVES: Identification of a biomarker for acute recanalization could have significant clinical impact. METHODS: We prospectively collected baseline, 24-h, and 90-day clinical and imaging data from consecutive ischemic stroke patients who fulfilled standard clinical eligibility criteria for treatment with intravenous recombinant tissue plasminogen activator (rtPA). Computed tomography angiography was acquired at 24 h and assessed using the thrombolysis is myocardial infarction (TIMI) scale with a score of 2b/3 indicating recanalization...
March 2017: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/28269641/peripheral-sensory-stimulation-is-neuroprotective-in-a-rat-photothrombotic-ischemic-stroke-model
#13
Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor
Ischemic stroke is one of the leading causes of death and disability in the world. Thrombolytic therapy using recombinant tissue plasminogen activator (rtPA), the only FDA-approved drug for acute ischemia, is limited by a narrow therapeutic time window and risk of hemorrhage. There is a serious need for a neuroprotective therapy which is clinically viable. We earlier demonstrated that peripheral sensory stimulation (PSS) is a potential therapeutic intervention for hyperacute ischemia resulting in recovery of neurovascular functions when administered immediately following ischemia onset in a rat model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28267563/protective-effects-of-angiopoietin-like-4-on-the-blood-brain-barrier-in-acute-ischemic-stroke-treated-with-thrombolysis-in-mice
#14
Bin Zhang, Xiaofeng Xu, Xiuli Chu, Xiaoyang Yu, Yuwu Zhao
AIMS: Given the risk of blood-brain barrier damage (BBB) caused by ischemic and tissue plasminogen activator thrombolysis, the preservation of vascular integrity is important. Angiopoietin-like 4 (ANGPTL4), a protein secreted in hypoxia, is involved in the regulation of vascular permeability. We hypothesized that Angptl4 might exert a protective effect in thrombolysis through stabilizing blood-brain barrier and inhibit hyper-permeability. METHODS: We investigated the role of Angptl4 in stroke using a transient focal cerebral ischemia mouse model...
March 4, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28266894/aspects-based-reperfusion-status-on-arterial-spin-labeling-is-associated-with-clinical-outcome-in-acute-ischemic-stroke-patients
#15
Songlin Yu, Samantha J Ma, David S Liebeskind, Dandan Yu, Ning Li, Xin J Qiao, Xingfeng Shao, Lirong Yan, Bryan Yoo, Fabien Scalzo, Jason D Hinman, Latisha K Sharma, Neal Rao, Reza Jahan, Satoshi Tateshima, Gary R Duckwiler, Jeffrey L Saver, Noriko Salamon, Danny Jj Wang
The purpose of this study was to develop and evaluate a scoring system for assessing reperfusion status based on arterial spin labeled (ASL) perfusion MRI in acute ischemic stroke (AIS) patients receiving thrombolysis and/or endovascular treatment. Pseudo-continuous ASL with background suppressed 3D GRASE was acquired along with DWI in 90 patients within 24 h post-treatment. An automatic reperfusion scoring system (auto-RPS) was devised based on the Alberta Stroke Program Early CT Score (ASPECTS) template, and compared with manual RPS and DWI-ASPECTS...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28266892/inflammatory-and-metalloproteinases-profiles-predict-three-month-poor-outcomes-in-ischemic-stroke-treated-with-thrombolysis
#16
Anna Maria Gori, Betti Giusti, Benedetta Piccardi, Patrizia Nencini, Vanessa Palumbo, Mascia Nesi, Antonia Nucera, Giovanni Pracucci, Paolina Tonelli, Eleonora Innocenti, Alice Sereni, Elena Sticchi, Danilo Toni, Paolo Bovi, Mario Guidotti, Maria Rosaria Tola, Domenico Consoli, Giuseppe Micieli, Rossana Tassi, Giovanni Orlandi, Maria Sessa, Francesco Perini, Maria Luisa Delodovici, Maria Luisa Zedde, Francesca Massaro, Rosanna Abbate, Domenico Inzitari
Inflammatory mediators and metalloproteinases are altered in acute ischemic stroke (AIS) and play a detrimental effect on clinical severity and hemorrhagic transformation of the ischemic brain lesion. Using data from the Italian multicenter observational MAGIC (MArker bioloGici nell'Ictus Cerebrale) Study, we evaluated the effect of inflammatory and metalloproteinases profiles on three-month functional outcome, hemorrhagic transformation and mortality in 327 patients with AIS treated with intravenous thrombolys in according to SITS-MOST (Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy) criteria...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28265013/absent-filling-of-ipsilateral-superficial-middle-cerebral-vein-is-associated-with-poor-outcome-after-reperfusion-therapy
#17
Sheng Zhang, Yangxiao Lai, Xinfa Ding, Mark Parsons, John H Zhang, Min Lou
BACKGROUND AND PURPOSE: Our aim was to study the effect of drainage of cortical veins, including the superficial middle cerebral vein (SMCV), vein of Trolard, and vein of Labbé on neurological outcomes after reperfusion therapy. METHODS: Consecutive ischemic stroke patients who underwent pretreatment computed tomographic perfusion and 24-hour computed tomographic perfusion or magnetic resonance perfusion after intravenous thrombolysis were included. We defined "absent filling of ipsilateral cortical vein" (eg, SMCV-) as no contrast filling of the vein across the whole venous phase on 4-dimensional computed tomographic angiography in the ischemic hemisphere...
March 6, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28264235/efficacy-of-balloon-guiding-catheter-for-mechanical-thrombectomy-in-patients-with-anterior-circulation-ischemic-stroke
#18
Jae-Sang Oh, Seok-Mann Yoon, Jai-Joon Shim, Jae-Won Doh, Hack-Gun Bae, Kyeong-Seok Lee
OBJECTIVE: To evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke. METHODS: Sixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated...
March 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28261510/is-intravenous-heparin-a-contraindication-for-tpa-in-ischemic-stroke
#19
Zain Kulairi, Nisha Deol, Renee Tolly, Rohan Manocha, Maliha Naseer
There are approximately 2 million cardiac catheterizations that occur every year in the United States and with an aging population this number continues to rise. Adverse events due to this procedure occur at low rates and include stroke, arrhythmia, and myocardial infarctions. Due to the high volume of procedures there are a growing number of adverse events. Stroke after cardiac catheterization (SCC) has an incidence between 0.27 and 0.5% and is one of the most debilitating complications leading to high rates of mortality and morbidity...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28258802/endovascular-stroke-treatment-of-acute-tandem-occlusion-a-single-center-experience
#20
Fabrizio Sallustio, Caterina Motta, Giacomo Koch, Silvia Pizzuto, Bruce C V Campbell, Marina Diomedi, Barbara Rizzato, Alessandro Davoli, Giorgio Loreni, Daniel Konda, Matteo Stefanini, Sebastiano Fabiano, Enrico Pampana, Paolo Stanzione, Roberto Gandini
PURPOSE: To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment. MATERIALS AND METHODS: Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow...
February 28, 2017: Journal of Vascular and Interventional Radiology: JVIR
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