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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/28097310/combined-intravenous-thrombolysis-and-thrombectomy-vs-thrombectomy-alone-for-acute-ischemic-stroke-a-pooled-analysis-of-the-swift-and-star-studies
#1
Jonathan M Coutinho, David S Liebeskind, Lee-Anne Slater, Raul G Nogueira, Wayne Clark, Antoni Dávalos, Alain Bonafé, Reza Jahan, Urs Fischer, Jan Gralla, Jeffrey L Saver, Vitor M Pereira
Importance: Mechanical thrombectomy (MT) improves clinical outcomes in patients with acute ischemic stroke (AIS) caused by a large vessel occlusion. However, it is not known whether intravenous thrombolysis (IVT) is of added benefit in patients undergoing MT. Objective: To examine whether treatment with IVT before MT with a stent retriever is beneficial in patients undergoing MT. Design, Setting, and Participants: This post hoc analysis used data from 291 patients treated with MT included in 2 large, multicenter, prospective clinical trials that evaluated MT for AIS (Solitaire With the Intention for Thrombectomy performed from January 1, 2010, through December 31, 2011, and Solitaire Flow Restoration Thrombectomy for Acute Revascularization from January 1, 2010, through December 31, 2012)...
January 9, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28096032/creation-of-an-intensive-care-unit-and-organizational-changes-in-an-adult-emergency-department-impact-on-acute-stroke-management
#2
Laurent Puy, Chantal Lamy, Sandrine Canaple, Audrey Arnoux, Nicolas Laine, Ella Iacob, Jean-Marc Constans, Olivier Godefroy
BACKGROUND AND PURPOSE: Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3months. METHODS: Between October 2013 and September 2015, we performed a retrospective, observational, single-center, comparative study of patients admitted for ischemic stroke and treated with IV rtPA during two 321-day periods (before and after the creation of the ED ICU)...
January 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28095449/does-antiplatelet-therapy-during-bridging-thrombolysis-increase-rates-of-intracerebral-hemorrhage-in-stroke-patients
#3
Anne Broeg-Morvay, Pasquale Mordasini, Agnieszka Slezak, Kai Liesirova, Julia Meisterernst, Gerhard Schroth, Marcel Arnold, Simon Jung, Heinrich P Mattle, Jan Gralla, Urs Fischer
BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) after bridging thrombolysis for acute ischemic stroke is a devastating complication. We aimed to assess whether the additional administration of aspirin during endovascular intervention increases bleeding rates. METHODS: We retrospectively compared bleeding complications and outcome in stroke patients who received bridging thrombolysis with (tPA+ASA) and without (tPA-ASA) aspirin during endovascular intervention between November 2008 and March 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28087804/clinical-selection-strategies-to-identify-ischemic-stroke-patients-with-large-anterior-vessel-occlusion-results-from-sits-istr-safe-implementation-of-thrombolysis-in-stroke-international-stroke-thrombolysis-registry
#4
Jan F Scheitz, Azmil H Abdul-Rahim, Rachael L MacIsaac, Charith Cooray, Heidi Sucharew, Dawn Kleindorfer, Pooja Khatri, Joseph P Broderick, Heinrich J Audebert, Niaz Ahmed, Nils Wahlgren, Matthias Endres, Christian H Nolte, Kennedy R Lees
BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. METHODS: Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012-May 2014) were analyzed retrospectively...
January 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28079139/blood-occludin-level-as-a-potential-biomarker-for-early-blood-brain-barrier-damage-following-ischemic-stroke
#5
Rong Pan, Kewei Yu, Theodore Weatherwax, Handong Zheng, Wenlan Liu, Ke Jian Liu
Concern about intracerebral hemorrhage (ICH) is the primary reason for withholding tPA therapy from patients with ischemic stroke. Early blood brain barrier (BBB) damage is the major risk factor for fatal post-thrombolysis ICH, but rapidly assessing BBB damage before tPA administration is highly challenging. We recently reported that ischemia induced rapid degradation of tight junction protein occludin in cerebromicrovessels. The present study investigates whether the cleaved occludin is released into the blood stream and how blood occludin levels correlate to the extent of BBB damage using a rat model of ischemic stroke...
January 12, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28074981/-thrombolysis-in-stroke-mimics-experience-in-10-cases
#6
Alejandro M Brunser, Arnold Hoppe, Paula Muñoz, Pablo M Lavados, Sergio Illanes, Violeta Díaz, Verónica V Olavarría
BACKGROUND: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM. AIM: To describe the frequency and prognosis of SM treated with IVT. MATERIAL AND METHODS: Prospective analysis of all patients evaluated in a Chilean private clinic between December 2004 and July 2015 with a suspected acute ischemic stroke (AIS)...
October 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/28065616/experience-on-mechanical-thrombectomy-for-acute-stroke-treatment-in-a-brazilian-university-hospital
#7
Guilherme S Nakiri, Luis H Castro-Afonso, Lucas M Monsignore, Francisco A Dias, Frederico F Alessio-Alves, Soraia Ramos C Fabio, Millene R Camilo, Pedro T Cougo-Pinto, Octavio M Pontes-Neto, João Pereira Leite, Daniel G Abud
BACKGROUND: Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke. OBJECTIVE: Report the feasibility of mechanical thrombectomy as part of routine stroke care in a Brazilian public university hospital...
January 5, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28062625/high-sensitivity-troponin-i-in-stable-patients-with-atherosclerotic-disease-in-the-tra-2%C3%A2-p-timi-50-trial
#8
Alon Eisen, Marc P Bonaca, Petr Jarolim, Benjamin M Scirica, Harvey D White, Michal Tendera, Mikael Dellborg, Jose C Nicolau, Joao Morais, Keith A A Fox, Erin A Bohula, Sabina A Murphy, Eugene Braunwald, David A Morrow
BACKGROUND: Cardiac troponin I, measured with a high-sensitivity assay (hs-TnI), is well-established for risk prediction in acute coronary syndromes. However, its prognostic role in stable atherosclerotic disease, particularly for future myocardial infarction (MI), is less well defined. METHODS: We measured hs-TnI (Abbott ARCHITECT) in 15833 patients with prior MI, ischemic stroke, or peripheral arterial disease from the placebo-controlled Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-Thrombolysis in Myocardial Infarction (TIMI) 50 trial of the platelet inhibitor vorapaxar, excluding patients with recent MI (<30 days)...
January 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28060307/lateral-chronic-cranial-window-preparation-enables-in-vivo-observation-following-distal-middle-cerebral-artery-occlusion-in-mice
#9
Simon H Bayerl, Melina Nieminen-Kelhä, Thomas Broggini, Peter Vajkoczy, Vincent Prinz
Focal cerebral ischemia (i.e., ischemic stroke) may cause major brain injury, leading to a severe loss of neuronal function and consequently to a host of motor and cognitive disabilities. Its high prevalence poses a serious health burden, as stroke is among the principal causes of long-term disability and death worldwide(1). Recovery of neuronal function is, in most cases, only partial. So far, treatment options are very limited, in particular due to the narrow time window for thrombolysis(2,3). Determining methods to accelerate recovery from stroke remains a prime medical goal; however, this has been hampered by insufficient mechanistic insights into the recovery process...
December 29, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28059705/emergent-endovascular-management-of-long-segment-and-flow-limiting-carotid-artery-dissections-in-acute-ischemic-stroke-intervention-with-multiple-tandem-stents
#10
S A Ansari, A L Kühn, A R Honarmand, M Khan, M C Hurley, M B Potts, B S Jahromi, A Shaibani, M J Gounis, A K Wakhloo, A S Puri
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4)...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28038899/mechanical-thrombectomy-in-acute-ischemic-stroke-initial-single-center-experience-and-comparison-with-randomized-controlled-trials
#11
Andreia Carvalho, André Cunha, Marta Rodrigues, Sofia Figueiredo, Ludovina Paredes, Tiago Gregório, Hugo Morais, Joaquim Pinheiro, Vítor Tedim Cruz, José Mário Roriz, João Pinho, Carla Ferreira, Edgar Torre, Joana Nunes, Sérgio Castro, Manuel Ribeiro, Miguel Veloso, Pedro Barros
BACKGROUND: Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting? METHODS: We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative...
December 27, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28028726/predictors-of-in-hospital-mortality-and-dependence-at-discharge-in-patients-with-mca-stroke-with-intravenous-thrombolysis
#12
Renata Dal-Prá Ducci, Marcos Christiano Lange, Viviane de Hiroki Flumignan Zétola
Early risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and dependence at discharge...
December 27, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28028565/severe-cerebral-hypovolemia-on-perfusion-ct-and-lower-body-weight-are-associated-with-parenchymal-haemorrhage-after-thrombolysis
#13
S Tsetsou, M Amiguet, A Eskandari, R Meuli, P Maeder, B Jiang, M Wintermark, P Michel
INTRODUCTION: Haemorrhagic transformation of acute ischemic stroke (AIS) and particularly parenchymal haemorrhage (PH) remains a feared complication of intravenous thrombolysis (IVT). We aimed to identify clinical and perfusion CT (PCT) variables which are independently associated with PHs. METHODS: In this observational cohort study, based on the Acute Stroke Registry Analysis of Lausanne (ASTRAL) from 2003 to December 2013, we selected patients with AIS involving the middle cerebral artery (MCA) territory who were thrombolysed within 4...
December 27, 2016: Neuroradiology
https://www.readbyqxmd.com/read/28025467/mechanical-thrombectomy-using-the-trevo-provue-in-50-consecutive-patients-with-anterior-circulation-stroke-a-single-center-experience-after-approval-of-the-stent-retriever-in-japan
#14
Taichiro Imahori, Kazuhiro Tanaka, Junji Koyama, Atsushi Arai, Ryoji Shiomi, Hirofumi Iwahashi, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1-M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups...
December 27, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28017749/general-anesthesia-during-endovascular-stroke-therapy-does-not-negatively-impact-outcome
#15
Arthur Wang, Madison Stellfox, Fred Moy, Apolonia E Abramowicz, Rachel Lehrer, Rivkah Epstein, Nicole Eiden, Amy Aquilina, Noorie Pednekar, Glenn Brady, Matthew Wecksell, John Cooley, Justin Santarelli, Michael F Stiefel
OBJECTIVE: Recent randomized trials, have demonstrated that endovascular therapy improves outcomes in patients with an acute ischemic stroke from a large vessel occlusion (LVO). Sub-group analysis of the MR CLEAN study found that patients undergoing general anesthesia (GA) for the procedure did worse than those with non-general anesthesia (non-GA). Current guidelines now suggest that we consider non-GA over GA, without large, randomized trials specifically designed to address this issue...
December 22, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/28017746/outcome-evaluation-of-acute-ischemic-stroke-patients-treated-with-endovascular-thrombectomy-a-single-institution-experience-in-the-era-of-randomized-controlled-trials
#16
Francesca Sarzetto, Shaurya Gupta, Naif M Alotaibi, Peter Howard, Leodante da Costa, Chris Heyn, Pejman Jabehdar Maralani, Daipayan Guha, Rick Swartz, Karl Boyle, Victor X D Yang
BACKGROUND: Endovascular thrombectomy is an effective procedure to treat selected ischemic strokes as shown in recent randomized controlled trials (RCTs). However, the generalizability of these trial data to real-world setting is unknown. The aim of this study was to examine our single center experience with endovascular thrombectomy for acute ischemic strokes and perform a comparative outcome analysis to the most recent RCTs. METHODS: We performed a 5-year retrospective analysis, from April 2011 to March 2016, on 66 consecutive patients with acute ischemic stroke who received endovascular thrombectomy at our institution...
December 22, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/28002053/in-vitro-thrombolytic-efficacy-of-echogenic-liposomes-loaded-with-tissue-plasminogen-activator-and-octafluoropropane-gas
#17
Himanshu Shekhar, Kenneth B Bader, Shenwen Huang, Tao Peng, Shaoling Huang, David D McPherson, Christy K Holland
Echogenic liposomes loaded with the thrombolytic recombinant tissue-type plasminogen activator (rt-PA) are under development for the treatment of ischemic stroke. These agents are designed to co-encapsulate cavitation nuclei to promote bubble activity in response to ultrasound exposure, and to enable localized delivery of thrombolytic. Stable cavitation improves the efficacy of the thrombolytic through enhanced fluid mixing. Echogenic liposomes that encapsulate air-filled microbubbles nucleate scant stable cavitation activity in response to 120 kHz intermittent ultrasound exposure, and have demonstrated thrombolytic efficacy equivalent to rt-PA alone...
December 21, 2016: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28001316/computed-tomography-based-quantification-of-lesion-water-uptake-identifies-patients-within-4-5-hours-of-stroke-onset-a-multicenter-observational-study
#18
Jens Minnerup, Gabriel Broocks, Judith Kalkoffen, Soenke Langner, Michael Knauth, Marios Nikos Psychogios, Heike Wersching, Anja Teuber, Walter Heindel, Bernd Eckert, Heinz Wiendl, Peter Schramm, Jens Fiehler, André Kemmling
OBJECTIVE: Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours, the time window of thrombolysis. METHODS: Perfusion CT was used to identify ischemic brain tissue, and its density was measured in native CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake...
December 2016: Annals of Neurology
https://www.readbyqxmd.com/read/28000971/safety-and-tolerability-of-sonovue%C3%A2-in-patients-with-large-artery-anterior-circulation-acute-stroke
#19
Claudio Baracchini, Federica Viaro, Silvia Favaretto, Anna Palmieri, Caterina Kulyk, Francesco Causin, Filippo Farina, Enzo Ballotta
BACKGROUND AND PURPOSE: Ultrasound contrast agents (UCAs) are routinely used to improve the visualization of intracranial arteries. Since a higher rate of intracranial hemorrhage (ICH) has been observed in patients undergoing sonothrombolysis in combination with UCAs, we conducted this study with the aim of assessing safety and tolerability of SonoVue® in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) and eligible to intravenous thrombolysis and/or mechanical thrombectomy...
December 21, 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/27999507/the-penumbra-5max-ace-catheter-is-safe-efficient-and-cost-saving-as-a-primary-mechanical-thrombectomy-device-for-large-vessel-occlusions-in-acute-ischemic-stroke
#20
Gabriel A Vidal, James M Milburn
BACKGROUND: Reperfusion of large vessel occlusions in acute stroke can improve patient outcomes. The purposes of this study were to assess the safety and efficacy of the Penumbra 5MAX ACE catheter for revascularization of large vessels and to compare its cost to the cost of stent retrievers. METHODS: In this retrospective, single-center case review study, data were captured on consecutive patients treated with the Penumbra 5MAX ACE as first-line therapy during an 11-month period...
2016: Ochsner Journal
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