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ischemic stroke and thrombolysis

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https://www.readbyqxmd.com/read/28220330/synchronous-cardiocerebral-infarction-in-the-era-of-endovascular-therapy-which-to-treat-first
#1
Leonard L L Yeo, Tommy Andersson, Kong Wan Yee, Benjamin Y Q Tan, Prakash Paliwal, Anil Gopinathan, Mahendran Nadarajah, Eric Ting, Hock L Teoh, Robin Cherian, Erik Lundström, Edgar L W Tay, Vijay K Sharma
A cardiocerebral ischemic attack (CCI) or a concurrent acute ischemic stroke (AIS) and myocardial infarction (AMI) is a severe event with no clear recommendations for ideal management because of the rarity of the scenario. The narrow time window for treatment and complexity of the treatment decision puts immense pressure on the treating physician. We evaluated this challenging situation at our tertiary center. Using our prospective stroke database out of a total of 555 patients with acute ischemic stroke between 2009 and 2014, we identified five consecutive cases with CCI (incidence 0...
February 20, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28210988/real-life-experience-with-the-specific-reversal-agent-idarucizumab-for-the-management-of-emergency-situations-in-dabigatran-treated-patients-a-series-of-11-cases
#2
Milan R Vosko, Christof Bocksrucker, Rafał Drwiła, Petr Dulíček, Tomas Hauer, Johannes Mutzenbach, Christoph J Schlimp, David Špinler, Thomas Wolf, Daša Zugwitz
Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28208130/factors-related-to-cardioembolism-as-major-predictors-of-poor-survival-after-first-ever-middle-cerebral-artery-stroke-treated-with-thrombolysis
#3
Renata Dal-Prá Ducci, Marcos Christiano Lange, Viviane de Hiroki Flumignan Zétola, Tatjana Rundek
BACKGROUND AND PURPOSE: Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). METHODS: A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015...
February 17, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28202431/thrombus-migration-in-the-middle-cerebral-artery-incidence-imaging-signs-and-impact-on-success-of-endovascular-thrombectomy
#4
Johannes Kaesmacher, Christian Maegerlein, Mirjam Kaesmacher, Claus Zimmer, Holger Poppert, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Thrombus migration (TM) in intracranial vessels during ischemic stroke has been reported in the form of case reports, but its incidence, impact on the technical success of subsequent endovascular thrombectomy and patients' outcome have never been studied systematically. METHODS AND RESULTS: Retrospective analysis was done of 409 patients with isolated middle cerebral artery occlusions treated with endovascular thrombectomy. TM was observed (1) by analyzing discrepancies between computed tomographic angiography and digital subtraction angiography and (2) by comparing infarct pattern in the striatocapsular region with exact, angiographically assessed thrombus location within the M1-segment and the involvement of the middle cerebral artery perforators...
February 15, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28194477/maximizing-first-pass-complete-reperfusion-with-save
#5
Volker Maus, Daniel Behme, Christoph Kabbasch, Jan Borggrefe, Ioannis Tsogkas, Omid Nikoubashman, Martin Wiesmann, Michael Knauth, Anastasios Mpotsaris, Marios Nikos Psychogios
BACKGROUND: Endovascular techniques for treatment of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) have advanced in recent years. We report a multicenter experience using a combined aspiration and stent retriever technique for mechanical thrombectomy (MT). METHODS: We retrospectively analyzed 32 consecutive MT patients using a novel, combined approach of Stent retriever Assisted Vacuum-locked Extraction (SAVE) by 3 operators at 3 stroke centers...
February 13, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28187798/critical-care-in-acute-ischemic-stroke
#6
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28185942/the-effects-of-pharmaceutical-thrombolysis-and-multi-modal-therapy-on-patients-with-acute-posterior-circulation-ischemic-stroke-results-of-a-one-center-retrospective-study
#7
Yang Yang, Chunyang Liang, Chunsen Shen, Hao Tang, Shang Ma, Qiang Zhang, Mou Gao, Qin Dong, Ruxiang Xu
BACKGROUND: The treatment method for acute ischemic stroke is rapidly developing, and the effects of endovascular modalities, when used alone or in combination, needs to be studied. We aimed to identify the difference between pharmaceutical thrombolysis and multi-modal therapy (MMT) used in acute posterior circulation ischemic stroke (APCIS) patients and also to detect the predictors for successful recanalization and favorable outcomes. METHODS: A retrospective analysis of patients with APCIS who received thrombolytic pharmaceuticals and MMT from 2011 to 2016 was performed at the stroke center...
February 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28183857/coexistent-sickle-cell-disease-has-no-impact-on-the-safety-or-outcome-of-lytic-therapy-in-acute-ischemic-stroke-findings-from-get-with-the-guidelines-stroke
#8
Robert J Adams, Margueritte Cox, Shelly D Ozark, Julie Kanter, Phillip J Schulte, Ying Xian, Gregg C Fonarow, Eric E Smith, Lee H Schwamm
BACKGROUND AND PURPOSE: The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD. METHODS: We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA...
February 9, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28178170/use-of-susceptibility-weighted-imaging-in-assessing-ischemic-penumbra-a-case-report
#9
Xiujuan Wu, Song Luo, Ying Wang, Yang Chen, Jun Liu, Jing Bai, Jiachun Feng, Hongliang Zhang
RATIONALE: The ischemic penumbra assessment is essential for the subsequent therapy and prediction of evolution in patients with acute ischemic infraction. Although controversial as a perfect equivalence to penumbra, perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance of PWI on contrast agents, noninvasive alternatives remain an unmet need. PATIENT CONCERNS: We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28174327/stroke-with-unknown-time-of-symptom-onset-baseline-clinical-and-magnetic-resonance-imaging-data-of-the-first-thousand-patients-in-wake-up
#10
Götz Thomalla, Florent Boutitie, Jochen B Fiebach, Claus Z Simonsen, Norbert Nighoghossian, Salvador Pedraza, Robin Lemmens, Pascal Roy, Keith W Muir, Martin Ebinger, Ian Ford, Bastian Cheng, Ivana Galinovic, Tae-Hee Cho, Josep Puig, Vincent Thijs, Matthias Endres, Jens Fiehler, Christian Gerloff
BACKGROUND AND PURPOSE: We describe clinical and magnetic resonance imaging (MRI) characteristics of stroke patients with unknown time of symptom onset potentially eligible for thrombolysis from a large prospective cohort. METHODS: We analyzed baseline data from WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke: A Randomized, Doubleblind, Placebo-Controlled Trial), an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset...
February 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28174326/intravenous-thrombolysis-in-unknown-onset-stroke-results-from-the-safe-implementation-of-treatment-in-stroke-international-stroke-thrombolysis-registry
#11
Laura Dorado, Niaz Ahmed, Götz Thomalla, Manuel Lozano, Branko Malojcic, Mushtaq Wani, Mònica Millán, Ales Tomek, Antoni Dávalos
BACKGROUND AND PURPOSE: Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS: Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014...
February 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28170316/medical-university-of-south-carolina-telestroke-a-telemedicine-facilitated-network-for-stroke-treatment-in-south-carolina-a-progress-report
#12
Sami Al Kasab, Robert J Adams, Ellen Debenham, David J Jones, Christine Ann Holmstedt
BACKGROUND: Patients in rural communities lack access to acute stroke therapies. Rapid administration of lytic therapy increases the likelihood of favorable functional outcome in acute ischemic stroke (AIS). At the Medical University of South Carolina (MUSC), we implemented a Web-based telestroke program that allows patients presenting with AIS at a rural hospital to receive expert stroke consultation within minutes. This increases their chances of receiving lytic therapy, and therefore increases the likelihood of good functional outcome...
February 7, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28162169/-efficacy-of-intravenous-thrombolysis-in-acute-ischemic-stroke-with-hyperdense-middle-cerebral-artery-sign
#13
L Peng, Y Guo, Y Wang, Y N Lin, C H Zhang, H Y Wang, R M Yu, X P Sun
Objective: To observe the efficacy and safety of recombinant tissue-type plasminogen activator (rtPA) intravenous thrombolysis (IVT) in the treatment of acute cerebral infarction with hyperdense middle cerebral artery sign (HMCAS). Methods: Acute cerebral infarction patients with HMCAS from July 2010 to November 2015 at the First Affiliated Hospital of Dalian Medical University were collected.These patients were divided into two groups depending on whether they received IVT or not.The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects...
January 17, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28157744/treatment-of-acute-ischemic-stroke
#14
Alejandro A Rabinstein
PURPOSE OF REVIEW: This article provides an update on the state of the art of the emergency treatment of acute ischemic stroke with particular emphasis on the alternatives for reperfusion therapy. RECENT FINDINGS: The results of several randomized controlled trials consistently and conclusively demonstrating that previously functional patients with disabling strokes from a proximal intracranial artery occlusion benefit from prompt recanalization with mechanical thrombectomy using a retrievable stent have changed the landscape of acute stroke therapy...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28154103/acute-ischemic-stroke-therapy-overview
#15
Luciana Catanese, Joseph Tarsia, Marc Fisher
The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28153014/towards-best-practice-in-acute-stroke-care-in-ghana-a-survey-of-hospital-services
#16
Leonard Baatiema, Michael Otim, George Mnatzaganian, Ama De-Graft Aikins, Judith Coombes, Shawn Somerset
BACKGROUND: Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice...
February 2, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28149079/intravenous-thrombolysis-for-acute-ischemic-stroke-review-of-97-patients
#17
Anish Mehta, Rohan Mahale, Kiran Buddaraju, Anas Majeed, Suryanarayana Sharma, Mahendra Javali, Purushottam Acharya, Rangasetty Srinivasa
BACKGROUND: Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. OBJECTIVE: To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. MATERIALS AND METHODS: Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015...
January 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28143921/sex-differences-and-functional-outcome-after-intravenous-thrombolysis-revision
#18
Fianne H Spaander, Sanne M Zinkstok, Irem M Baharoglu, Henrik Gensicke, Alexandros Polymeris, Christopher Traenka, Christian Hametner, Peter Ringleb, Sami Curtze, Nicolas Martinez-Majander, Karoliina Aarnio, Christian H Nolte, Jan F Scheitz, Didier Leys, Anais Hochart, Visnja Padjen, Georg Kägi, Alessandro Pezzini, Patrik Michel, Olivier Bill, Andrea Zini, Stefan T Engelter, Paul J Nederkoorn
BACKGROUND AND PURPOSE: Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care...
January 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28130471/thrombolysis-for-acute-ischemic-stroke-in-patients-with-leukoaraiosis-caution-needed
#19
EDITORIAL
Jonathan Streifler, Pauline Maillard
No abstract text is available yet for this article.
February 14, 2017: Neurology
https://www.readbyqxmd.com/read/28130468/leukoaraiosis-intracerebral-hemorrhage-and-functional-outcome-after-acute-stroke-thrombolysis
#20
Kannikar Kongbunkiat, Duncan Wilson, Narongrit Kasemsap, Somsak Tiamkao, Fatima Jichi, Vanessa Palumbo, Michael D Hill, Alastair M Buchan, Simon Jung, Heinrich P Mattle, Nils Henninger, David J Werring
OBJECTIVE: To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome. METHODS: We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI)...
February 14, 2017: Neurology
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