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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/28808918/idarucizumab-in-dabigatran-treated-patients-with-acute-ischemic-stroke-receiving-alteplase-a-systematic-review-of-the-available-evidence
#1
REVIEW
Slaven Pikija, Laszlo K Sztriha, J Sebastian Mutzenbach, Stefan M Golaszewski, Johann Sellner
BACKGROUND AND PURPOSE: Current guidelines do not recommend the use of intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke who receive direct oral anticoagulants. While the humanized monoclonal antibody idarucizumab can quickly reverse the anticoagulant effects of the thrombin inhibitor dabigatran, safety data for subsequent tissue plasminogen activator treatment are sparse. Here, we review current knowledge about dabigatran reversal prior to systemic reperfusion treatment in acute ischemic stroke...
August 14, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28806993/successful-intravenous-thrombolysis-for-ischemic-stroke-after-reversal-of-dabigatran-anticoagulation-with-idarucizumab-a-case-report
#2
Sergio Agosti, Laura Casalino, Enrico Rocci, Gabriele Zaccone, Eugenia Rota
BACKGROUND: Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment for immediate reversal of dabigatran-induced anticoagulation, has been introduced into the market to be used in life-threatening bleeding or urgent surgery, allowing for rapid normalization of clotting parameters. The use of idarucizumab is not yet well established in patients presenting with acute ischemic stroke on dabigatran who are candidates for thrombolytic therapy...
August 15, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28804875/prehospital-pathways-of-occipital-stroke-patients-with-mainly-visual-symptoms
#3
S Räty, K Silvennoinen, T Tatlisumak
OBJECTIVES: Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition...
August 13, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28801174/the-cerebral-collateral-circulation-relevance-to-pathophysiology-and-treatment-of-stroke
#4
REVIEW
Myron D Ginsberg
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome...
August 8, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28798356/low-serum-albumin-level-as-a-predictor-of-hemorrhage-transformation-after-intravenous-thrombolysis-in-ischemic-stroke-patients
#5
Ruiwen Che, Xiaoqin Huang, Wenbo Zhao, Fang Jiang, Longfei Wu, Zhen Zhang, Tingting Bian, Qingfeng Ma, Zhipeng Yu, Qian Zhang, Kai Dong, Haiqing Song, Xunming Ji
Serum albumin levels has been shown to predict outcome in ischemic stroke patients. We aimed to investigate the relationship between serum albumin levels and hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute stroke. 428 patients receiving intravenous rt-PA therapy were included from 2013 to 2016 and were categorized into two groups: low level (<35 mmol/L) and normal level (35-55 mmol/L) group. Demographic, clinical and laboratory information, HT and functional outcomes were analyzed...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28798266/thrombectomy-of-calcified-emboli-in-stroke-does-histology-of-thrombi-influence-the-effectiveness-of-thrombectomy
#6
Tomas Dobrocky, Eike Piechowiak, Alessandro Cianfoni, Felix Zibold, Luca Roccatagliata, Pascal Mosimann, Simon Jung, Urs Fischer, Pasquale Mordasini, Jan Gralla
BACKGROUND AND PURPOSE: Thrombus composition has been postulated to affect the success of endovascular therapy. Calcified clots are composed of large amounts of calcium phosphate which influences their mechanical properties and may serve as a model for testing this hypothesis. The aim of this study was to evaluate the recanalization and complication rates of calcified thromboemboli in patients with acute ischemic stroke who underwent thrombectomy. MATERIAL AND METHODS: A retrospective analysis was performed of all calcified intracranial thromboemboli in patients suffering an acute ischemic stroke, referred for endovascular therapy at two centers between January 2013 and July 2016...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28796540/recent-advances-in-targeted-delivery-of-tissue-plasminogen-activator-for-enhanced-thrombolysis-in-ischemic-stroke
#7
Masumeh Zamanlu, Mehdi Farhoudi, Morteza Eskandani, Javad Mahmoudi, Jaleh Barar, Mohammad Rafi, Yadollah Omidi
Tissue plasminogen activator (tPA) is the only FDA approved medical treatment for the ischemic stroke. However, it associates with some inevitable limitations, including: short therapeutic window, extremely short half-life and low penetration in large clots. Systemic administration (i.v./i.a.) may lead to complications such as hemorrhagic conversion in the brain and relapse in the form of re-occlusion. Furthermore, ultrasound has been utilized in combination with contrast agents, echogenic liposome, microspheres or nanoparticles carrying tPA for improving thrombolysis - an approach that has resulted in slight improvement of tPA delivery and facilitated thrombolysis...
August 10, 2017: Journal of Drug Targeting
https://www.readbyqxmd.com/read/28791192/dragon-score-predicts-functional-outcomes-in-acute-ischemic-stroke-patients-receiving-both-intravenous-tissue-plasminogen-activator-and-endovascular-therapy
#8
Arthur Wang, Noorie Pednekar, Rachel Lehrer, Akira Todo, Ramandeep Sahni, Stephen Marks, Michael F Stiefel
BACKGROUND: The DRAGON score, which includes clinical and computed tomographic (CT) scan parameters, predicts functional outcomes in ischemic stroke patients treated with intravenous tissue plasminogen activator (IV tPA). We assessed the utility of the DRAGON score in predicting functional outcome in stroke patients receiving both IV tPA and endovascular therapy. METHODS: A retrospective chart review of patients treated at our institution from February 2009 to October 2015 was conducted...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28783210/monocyte-count-at-onset-predicts-post-stroke-outcomes-during-a-90-day-follow-up
#9
Luca Liberale, Fabrizio Montecucco, Aldo Bonaventura, Ilaria Casetta, Silva Seraceni, Alessandro Trentini, Marina Padroni, Franco Dallegri, Enrico Fainardi, Federico Carbone
BACKGROUND: Acute ischemic stroke (AIS) triggers both systemic and neurovascular inflammation, influencing post-stroke recovery. In smokers with AIS inflammation might be further upregulated, increasing ischemia/reperfusion injury. Here, the predictive value of leukocyte and adhesion molecules levels on post-stroke outcomes was investigated. MATERIALS AND METHODS: 89 patients with AIS (n=30 smokers and n=59 non-smokers) were recruited and evaluated 1, 7 and 90 days after the onset to assess stroke severity by the National Institute of Health Stroke Scale (NIHSS) score as well as clinical recovery at 90 day by the modified Rankin Scale (mRS)...
August 7, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28775140/predictors-for-cerebral-edema-in-acute-ischemic-stroke-treated-with-intravenous-thrombolysis
#10
Magnus Thorén, Elsa Azevedo, Jesse Dawson, Jose A Egido, Anne Falcou, Gary A Ford, Staffan Holmin, Robert Mikulik, Jyrki Ollikainen, Nils Wahlgren, Niaz Ahmed
BACKGROUND AND PURPOSE: Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis. METHODS: We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans...
August 3, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28775134/emergency-coagulation-assessment-during-treatment-with-direct-oral-anticoagulants-limitations-and-solutions
#11
Matthias Ebner, Ingvild Birschmann, Andreas Peter, Florian Härtig, Charlotte Spencer, Joachim Kuhn, Gunnar Blumenstock, Christine S Zuern, Ulf Ziemann, Sven Poli
BACKGROUND AND PURPOSE: In patients receiving direct oral anticoagulants (DOACs), emergency treatment like thrombolysis for acute ischemic stroke is complicated by insufficient availability of DOAC-specific coagulation tests. Conflicting recommendations have been published concerning the use of global coagulation assays for ruling out relevant DOAC-induced anticoagulation. METHODS: Four hundred eighty-one samples from 96 DOAC-treated patients were tested using prothrombin time (PT), activated partial thromboplastin time (aPTT) and thrombin time (TT), DOAC-specific assays (anti-Xa activity, diluted TT), and liquid chromatography-tandem mass spectrometry...
August 3, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28768462/approaches-to-the-field-recognition-of-potential-thrombectomy-candidates
#12
Stephen C van Gaal, Noreen Kamal, Michael J Betzner, Renee L Vilneff, Balraj Mann, Eddy S Lang, Andrew Demchuk, Brian Buck, Thomas Jeerakathil, Michael D Hill
Systems of care for acute ischemic stroke are being challenged to implement processes that ensure rapid access to endovascular thrombectomy. Optimizing existing regionalized stroke thrombolysis programs for endovascular thrombectomy will require accurate field recognition of treatment candidates. We begin with a review of the development of early clinical tests for ischemic stroke, illustrating challenges relevant to future field tests for large vessel occlusion. Second, we discuss aspects of diagnosis, eligibility, feasibility, and system organization that are potentially relevant to the development and implementation of field tests and diversion criteria...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28763693/validation-of-simplified-fabs-scale-to-predict-stroke-mimics-in-a-chinese-population-undergoing-intravenous-thrombolysis
#13
Xiaoming Qin, Songyao Zhao, Liujie Yin, Hailing Dou, Jing Fu, Yifan Wang, Mingzhe Li, Ruifang Chen, Jie Chen, Wei Liu, Gaiqing Yang, Xin Liu, Runqing Wang, Xinzhou Jia, Shufang Bu, Dongpu Ma, Baoyu Wang, Shize Li
OBJECTIVES: A large number of suspected stroke patients undergoing intravenous thrombolysis are stroke mimics (SMs). In this study, we sought to revise the FABS scale for screening and stratifying SMs from acute ischemic stroke (AIS) in a Chinese stroke population receiving fibrinolytic therapy. PATIENTS AND METHODS: The simplified FABS (sFABS) scale includes 4 items with 1 point for each item present: absence of facial droop, negative history of atrial fibrillation, age <50years, systolic blood pressure <150mm Hg at presentation...
July 25, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28763550/effect-of-endovascular-contact-aspiration-vs-stent-retriever-on-revascularization-in-patients-with-acute-ischemic-stroke-and-large-vessel-occlusion-the-aster-randomized-clinical-trial
#14
RANDOMIZED CONTROLLED TRIAL
Bertrand Lapergue, Raphael Blanc, Benjamin Gory, Julien Labreuche, Alain Duhamel, Gautier Marnat, Suzana Saleme, Vincent Costalat, Serge Bracard, Hubert Desal, Mikael Mazighi, Arturo Consoli, Michel Piotin
Importance: The benefits of endovascular revascularization using the contact aspiration technique vs the stent retriever technique in patients with acute ischemic stroke remain uncertain because of lack of evidence from randomized trials. Objective: To compare efficacy and adverse events using the contact aspiration technique vs the standard stent retriever technique as a first-line endovascular treatment for successful revascularization among patients with acute ischemic stroke and large vessel occlusion...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28754806/impact-of-balloon-guide-catheter-on-technical-and-clinical-outcomes-a-systematic-review-and-meta-analysis
#15
Waleed Brinjikji, Robert M Starke, M Hassan Murad, David Fiorella, Vitor M Pereira, Mayank Goyal, David F Kallmes
BACKGROUND AND PURPOSE: Flow arrest with balloon guide catheters (BGCs) is becoming increasingly recognized as critical to optimizing patient outcomes for mechanical thrombectomy. We performed a systematic review and meta-analysis of the literature for studies that compared angiographic and clinical outcomes for patients who underwent mechanical thrombectomy with and without BGCs. MATERIALS AND METHODS: In April 2017 a literature search on BGC and mechanical thrombectomy for stroke was performed...
July 28, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28754235/mechanical-thrombectomy-for-acute-ischemic-stroke-patients-aged-80-years-or-older
#16
Taichiro Imahori, Kazuhiro Tanaka, Atsushi Arai, Ryoji Shiomi, Daigo Fujiwara, Tatsuya Mori, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
BACKGROUND: There are limited data about the prognostic factors predicting outcomes after mechanical thrombectomy with stent retrievers for the elderly. Here, we evaluated outcomes in elderly patients in a real-world setting. METHODS: Between April 2015 and January 2017, 80 patients with anterior intracranial acute large vessel occlusion, who had lived independently before ictus, were treated with mechanical thrombectomy using a stent retriever at our institute...
July 25, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28752508/safety-and-effectiveness-of-intravenous-thrombolysis-for-acute-ischemic-stroke-outside-the-coverage-of-national-health-insurance-in-taiwan
#17
Yu-Hsiang Su, Chih-Hung Chen, Huey-Juan Lin, Yu-Wei Chen, Mei-Chiun Tseng, Han-Chieh Hsieh, Chih-Hung Chen, Sheng-Feng Sung
PURPOSE: Only a small percentage of ischemic stroke patients were treated with intravenous thrombolysis in Taiwan, partly because of the narrow reimbursement criteria of the National Health Insurance (NHI). We aimed to assess the safety and effectiveness of intravenous thrombolysis not covered by the NHI. METHODS: This is a retrospective analysis of register data from four hospitals. All patients who received intravenous tissue plasminogen activator and fulfilled the American Heart Association/American Stroke Association (AHA/ASA) thrombolysis guidelines between January 2007 and June 2012 were distinguished into two groups: those in accordance (reimbursement group) and those not in accordance (non-reimbursement group) with the NHI reimbursement criteria...
March 15, 2017: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/28752507/intravenous-alteplase-for-acute-ischemic-stroke-in-taiwan-can-we-expand-the-national-health-insurance-s-reimbursement-criteria
#18
Cheng-Yang Hsieh
lization of intravenous thrombolysis with alteplase was very low in Taiwanese patients with acute ischemic stroke(1). One of the reasons is the strict reimbursement guideline made by the Bureau of National Health Insurance (NHI) in 2004(2). In this issue of the Acta Neurologica Taiwanica, Yu-Hsiang Su and co-authors(3) retrospectively evaluated outcomes of their thrombolysed stroke patients who were "mismatched" between updated clinical practice guideline and NHI reimbursement criteria. They concluded that the outcomes of patients treated according to guidelines were comparable between the reimbursement and non-reimbursement groups...
March 15, 2017: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/28748994/-intravenous-thrombolysis-for-acute-ischemic-stroke-a-four-years%C3%A2-experience-in-a-chilean-public-hospital
#19
Álvaro Soto V, Gladys Morales I, Marcela Grandjean B, Débora Pollak W, Carolina Del Castillo C, Pía García F, Alexis Von Johnn A, Alfonso Riquelme G
BACKGROUND: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. AIM: To report the results a thrombolysis protocol during four years in a regional public hospital. MATERIAL AND METHODS: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed...
April 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/28747462/mechanical-thrombectomy-outcomes-with-and-without-intravenous-thrombolysis-in-stroke-patients-a-meta-analysis
#20
Eva A Mistry, Akshitkumar M Mistry, Mohammad Obadah Nakawah, Rohan V Chitale, Robert F James, John J Volpi, Matthew R Fusco
BACKGROUND AND PURPOSE: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT-IVT) pre-treatment with intravenous thrombolysis...
July 26, 2017: Stroke; a Journal of Cerebral Circulation
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