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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/28536425/intravenous-thrombolysis-in-chinese-patients-with-different-subtype-of-mild-stroke-thrombolysis-in-patients-with-mild-stroke
#1
Weiqi Chen, Yuesong Pan, Xingquan Zhao, Liping Liu, Hao Li, Xiaoling Liao, Chunjuan Wang, Yilong Wang, Yongjun Wang
Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate whether patients with mild stroke or its specific etiologic subtype might benefit from rt-PA therapy. Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) and (2) the China National Stroke Registry (CNSR) database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale ≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype...
May 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28536167/intravenous-thrombolysis-in-acute-ischemic-stroke-patients-pretreated-with-non-vitamin-k-antagonist-oral-anticoagulants-an-editorial-review
#2
REVIEW
Georgios Tsivgoulis, Apostolos Safouris
No abstract text is available yet for this article.
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#3
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28533683/new-standardized-nursing-cooperation-workflow-to-reduce-stroke-thrombolysis-delays-in-patients-with-acute-ischemic-stroke
#4
Yan Zhou, Zhuojun Xu, Jiali Liao, Fangming Feng, Lai Men, Li Xu, Yanan He, Gang Li
OBJECTIVE: We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. PATIENTS AND METHODS: AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28532498/the-golden-hour-of-acute-ischemic-stroke
#5
Rajiv Advani, Halvor Naess, Martin W Kurz
BACKGROUND: Acute Ischemic Stroke (AIS) treatment has been revolutionised in the last two decades with the increasing use of Intravenous Thrombolysis (IVT) and with the advent of Endovascular therapy (EVT). AIS treatment and outcome are time dependant and time saving measures are being implemented at every step of the treatment chain. These changes have resulted in lower treatment times in-hospital, but it is unclear if this translates into more patients being treated within 60 min of symptom onset - the Golden Hour...
May 22, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28527588/mechanical-thrombectomy-for-acute-ischemic-stroke-in-a-patient-with-concomitant-spontaneous-intracerebral-hemorrhage
#6
Stefano Forlivesi, Paolo Bovi, Manuel Cappellari
Data from randomized clinical trials and current guidelines suggest that patients with anterior circulation occlusion with contraindications to intravenous thrombolysis may benefit from direct mechanical thrombectomy. Nevertheless, no data are available on the efficacy and safety of direct mechanical thrombectomy in patients with concomitant spontaneous intracerebral hemorrhage. We report the case of a 51-year-old woman with a spontaneous intracerebral hemorrhage in the right parietal and occipital lobes, who experienced, 7 days later, an occlusion of the proximal left middle cerebral artery...
May 17, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28522637/general-anesthesia-versus-conscious-sedation-for-endovascular-treatment-of-acute-ischemic-stroke-the-anstroke-trial-anesthesia-during-stroke
#7
Pia Löwhagen Hendén, Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, Sven-Erik Ricksten
BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28522232/efficacy-of-new-measures-saving-time-in-acute-stroke-management-a-quantified-analysis
#8
Ana María Iglesias Mohedano, Andrés García Pastor, Fernando Díaz Otero, Pilar Vázquez Alen, Marta Vales Montero, Elisa Luque Buzo, Nuria Redondo Ráfales, Beatriz Chavarria Cano, Yolanda Fernández Bullido, Jose Antonio Villanueva Osorio, Antonio Gil Núñez
BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014...
May 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28513116/worse-outcome-in-patients-with-acute-stroke-and-atrial-fibrillation-following-thrombolysis
#9
Michael Findler, Jeremy Molad, Natan M Bornstein, Eitan Auriel
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and a common cause of ischemic stroke. Stroke patients with AF have been shown to have a poorer neurological outcome than stroke patients without AF. OBJECTIVES: To determine the impact of pre-existing AF on residual degree of disability in patients treated with IV thrombolysis. METHODS: In this case-control study, data of 214 stroke patients (63 with AF and 151 without AF) were collected from the National Acute Stroke Israeli Registry, a nationwide quadrennial stroke database...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28506796/from-head-to-toe-sex-and-gender-differences-in-the-treatment-of-ischemic-cerebral-disease
#10
REVIEW
Lorenzo Falsetti, Giovanna Viticchi, Laura Buratti, Clotilde Balucani, Alberto M Marra, Mauro Silvestrini
Stroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men...
May 12, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28500226/mr-perfusion-lesions-after-tia-or-minor-stroke-are-associated-with-new-infarction-at-7-days
#11
Jun Lee, Manabu Inoue, Michael Mlynash, Sharanpal K Mann, Carlo W Cereda, Michael Ke, Gregory W Albers, Jean M Olivot
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled...
May 12, 2017: Neurology
https://www.readbyqxmd.com/read/28494694/antagonizing-dabigatran-by-idarucizumab-in-cases-of-ischemic-stroke-or-intracranial-hemorrhage-in-germany-a-national-case-collection
#12
Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Katharina Althaus, Jörg Berrouschot, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Klaus Gröschel, Claus G Haase, Andreas Harloff, Valentin Held, Andreas Kauert, Peter Kraft, Arne Lenz, Wolfgang Müllges, Mark Obermann, Someieh Partowi, Jan Purrucker, Peter A Ringleb, Joachim Röther, Raluca Rossi, Niklas Schäfer, Andreas Schneider, Ramona Schuppner, Rüdiger J Seitz, Kristina Szabo, Robert Wruck
Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28490161/endovascular-stroke-therapy-focused-on-stent-retriever-thrombectomy-and-direct-clot-aspiration-historical-review-and-modern-application
#13
REVIEW
Dong-Hun Kang, Jaechan Park
Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays...
May 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28487329/aspects-alberta-stroke-program-early-ct-score-measurement-using-hounsfield-unit-values-when-selecting-patients-for-stroke-thrombectomy
#14
Maxim Mokin, Christopher T Primiani, Adnan H Siddiqui, Aquilla S Turk
BACKGROUND AND PURPOSE: The ASPECTS (Alberta Stroke Program Early CT Score) is a quantitate score that measures the extent of early ischemic changes. Our aim was to investigate how measurement of ASPECTS using Hounsfield unit (HU) values on initial noncontrast head computerized tomography (CT) correlates with the extent of final infarct on follow-up imaging. METHODS: Cases of acute stroke from the middle cerebral artery M1 occlusion in which complete recanalization (TICI [Thrombolysis in Cerebral Infarction] 3) was achieved were included for analysis...
May 9, 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
#15
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
#16
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/28479465/safety-of-early-carotid-endarterectomy-after-intravenous-thrombolysis-in-acute-ischemic-stroke
#17
Igor Gunka, Dagmar Krajickova, Michal Lesko, Ondrej Renc, Jan Raupach, Stanislav Jiska, Miroslav Lojik, Vendelin Chovanec, Radovan Maly
BACKGROUND: The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. MATERIAL AND METHODS: A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28479184/systemic-thrombolysis-in-acute-ischemic-stroke-after-dabigatran-etexilate-reversal-with-idarucizumab-a-case-report
#18
Derya Tireli, Jun He, Mette Maria Nordling, Troels Wienecke
INTRODUCTION: Idarucizumab is a reversal agent for dabigatran etexilate. By reversing the anticoagulating effect of dabigatran etexilate with idarucizumab (Praxbind), patients presenting with an acute ischemic stroke can now be eligible for thrombolysis. PATIENT: We describe our experience with idarucizumab in a 71-year-old male patient pretreated with dabigatran etexilate. The patient arrived with a hemiparesis, central facial palsy, and dysarthria. METHOD: Dabigatran etexilate was antagonized with idarucizumab, approximately 2...
May 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28478980/use-of-geospatial-modeling-to-evaluate-the-impact-of-telestroke-on-access-to-stroke-thrombolysis-in-ontario
#19
Lauren Jewett, Ario Mirian, Ben Connolly, Frank L Silver, Demetrios J Sahlas
BACKGROUND: The treatment of acute ischemic stroke in Ontario is coordinated through a network of stroke centers, supplemented by emergency telemedicine consultations to nonstroke centers through the Ontario Telemedicine Network's province-wide Telestroke program. Using geoinformatics, we sought to evaluate the overall impact of Telestroke on access to stroke thrombolysis in Ontario. METHODS: Ontario population data (census) were used to overlay polygons created by Service Area Analysis using ArcGIS 10...
May 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28478979/risk-factors-and-stroke-characteristic-in-patients-with-postoperative-strokes
#20
Yi Dong, Wenjie Cao, Xin Cheng, Kun Fang, Xiaolong Zhang, Yuxiang Gu, Bing Leng, Qiang Dong
BACKGROUND: Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes...
May 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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