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https://www.readbyqxmd.com/read/28944694/tissue-plasminogen-activator-based-nanothrombolysis-for-ischemic-stroke
#1
Shan Liu, Xiaozhou Feng, Rong Jin, Guohong Li
Thrombolysis with intravenous tissue plasminogen activator (tPA) is the only FDA approved treatment for patients with acute ischemic stroke, but its use is limited by narrow therapeutic window, selective efficacy, and hemorrhagic complication. In the past two decades, extensive efforts have been undertaken to extend its therapeutic time window and explore alternative thrombolytic agents, but both show little progress. Nanotechnology has emerged as a promising strategy to improve the efficacy and safety of tPA...
September 23, 2017: Expert Opinion on Drug Delivery
https://www.readbyqxmd.com/read/28939674/thrombolysis-in-postoperative-stroke
#2
Nicolas Voelkel, Nikolai Dominik Hubert, Roland Backhaus, Roman Ludwig Haberl, Gordian Jan Hubert
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. METHODS: Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery...
September 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28939303/early-partial-recanalization-after-intravenous-thrombolysis-leads-to-prediction-of-favorable-outcome-in-cases-of-acute-ischemic-stroke-with-major-vessel-occlusion
#3
Jun Young Chang, Hyun Park, Se Young Jang, Seunguk Jung, Hee-Joon Bae, O-Ki Kwon, Moon-Ku Han
We investigated the association between early recanalization degree after intravenous thrombolysis (IVT), occurrence of hemorrhagic transformation, and functional outcome. We also evaluated whether recombinant tissue plasminogen activator (rTPA) dosing error could influence the outcome. Patients with ischemic stroke with major vessel occlusion (n=256) who underwent IVT were included. Recanalization status (no recanalization, partial recanalization, and complete recanalization) was confirmed by subsequent magnetic resonance or conventional angiography...
September 19, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28936196/anti-inflammatory-targets-for-the-treatment-of-reperfusion-injury-in-stroke
#4
REVIEW
Atsushi Mizuma, Midori A Yenari
While the mainstay of acute stroke treatment includes revascularization via recombinant tissue plasminogen activator or mechanical thrombectomy, only a minority of stroke patients are eligible for treatment, as delayed treatment can lead to worsened outcome. This worsened outcome at the experimental level has been attributed to an entity known as reperfusion injury (R/I). R/I is occurred when revascularization is delayed after critical brain and vascular injury has occurred, so that when oxygenated blood is restored, ischemic damage is increased, rather than decreased...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28935502/outcomes-of-nonagenarians-with-acute-ischemic-stroke-treated-with-intravenous-thrombolytics
#5
Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, Catharina J M Klijn, Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli
BACKGROUND: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established. MATERIALS AND METHODS: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28931617/normobaric-hyperoxia-reduces-blood-occludin-fragments-in-rats-and-patients-with-acute-ischemic-stroke
#6
Shuhai Shi, Zhifeng Qi, Qingfeng Ma, Rong Pan, Graham S Timmins, Yongmei Zhao, Wenjuan Shi, Yunzhou Zhang, Xunming Ji, Ke Jian Liu
BACKGROUND AND PURPOSE: Damage of the blood-brain barrier (BBB) increases the incidence of neurovascular complications, especially for cerebral hemorrhage after tPA (tissue-type plasminogen activator) therapy. Currently, there is no effective method to evaluate the extent of BBB damage to guide tPA use. Herein, we investigated whether blood levels of tight junction proteins could serve as biomarker of BBB damages in acute ischemic stroke (AIS) in both rats and patients. We examined whether this biomarker could reflect the extent of BBB permeability during cerebral ischemia/reperfusion and the effects of normobaric hyperoxia (NBO) on BBB damage...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28927686/temporal-trends-in-the-levels-of-peripherally-circulating-leukocyte-subtypes-in-the-hours-after-ischemic-stroke
#7
Dipender Gill, Prasanthi Sivakumaran, Adarsh Aravind, Atisha Tank, Roshni Dosh, Roland Veltkamp
BACKGROUND: Leukocyte-mediated neuroinflammation may affect outcomes after ischemic stroke. AIMS: To explore temporal changes in levels of peripherally circulating leukocyte subtypes in the early hours after ischemic stroke in humans. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for acute ischemic stroke (AIS). Multivariable regression analysis was used to explore temporal changes in the levels of peripherally circulating leukocyte subtypes in the hours immediately after ischemic stroke...
September 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28923278/can-adjunctive-therapies-augment-the-efficacy-of-endovascular-thrombolysis-a-potential-role-for-activated-protein-c
#8
REVIEW
Arun Paul Amar, Abhay P Sagare, Zhen Zhao, Yaoming Wang, Amy R Nelson, John H Griffin, Berislav V Zlokovic
In the management of acute ischemic stroke, vessel recanalization correlates with functional status, mortality, cost, and other outcome measures. Thrombolysis with intravenous tissue plasminogen activator has many limitations that restrict its applicability, but recent advances in the development of mechanical thrombectomy devices as well as improved systems of stroke care have resulted in greater likelihood of vessel revascularization. Nonetheless, there remains substantial discrepancy between rates of recanalization and rates of favorable outcome...
September 15, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28922363/predictors-of-post-thrombolysis-symptomatic-intracranial-hemorrhage-in-chinese-patients-with-acute-ischemic-stroke
#9
Mingyong Liu, Yuesong Pan, Lichun Zhou, Yongjun Wang
BACKGROUND AND PURPOSE: Predictors of symptomatic intracranial hemorrhage (sICH) in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator remain unclear. METHODS: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study were assessed to explore risk factors for symptomatic intracranial hemorrhage after intravenous thrombolysis. Three candidate sICH definitions were analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/28916667/cost-effectiveness-of-thrombectomy-in-patients-with-acute-ischemic-stroke-the-thrace-randomized-controlled-trial
#10
Hamza Achit, Marc Soudant, Kossar Hosseini, Aurélie Bannay, Jonathan Epstein, Serge Bracard, Francis Guillemin
BACKGROUND AND PURPOSE: The benefit of mechanical thrombectomy added to intravenous thrombolysis (IVT) in patients with acute ischemic stroke has been largely demonstrated. However, evidence of the economic incentive of this strategy is still limited, especially in the context of a randomized controlled trial. We aimed to analyze whether mechanical thrombectomy combined with IVT (IVMT) is cost-effective when compared with IVT alone. METHODS: Individual-level cost and outcome data were collected in the THRACE randomized controlled trial (Thrombectomie des Artères Cerébrales) including patients with acute ischemic stroke...
September 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28913720/emergency-neurological-life-support-acute-ischemic-stroke
#11
Hartmut Gross, Noah Grose
Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including both intravenous thrombolysis and endovascular approaches to thrombus removal. Extensive study has demonstrated that rapid, protocolized, assessment and treatment is essential to improving neurological outcome. For this reason, acute ischemic stroke was chosen as an emergency neurological life support protocol. The protocol focuses on the first hour of medical care following the acute onset of a neurological deficit...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28906581/is-there-a-benefit-of-mechanical-thrombectomy-in-patients-with-large-stroke-dwi-aspects%C3%A2-5
#12
Pierre-François Manceau, Sébastien Soize, Matthias Gawlitza, Guillaume Fabre, Serge Bakchine, Carole Durot, Isabelle Serre, Georgios-Emmanouil Metaxas, Laurent Pierot
BACKGROUND: Whether to withhold mechanical thrombectomy when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is undetermined. We aimed to identify markers that will help to select patients with large DWI lesions (DWI-Alberta Stroke Program Early CT Score, DWI-ASPECTS≤5) that may benefit from thrombectomy. METHODS: From May 2010 to November 2016, we studied 82 acute ischemic stroke patients with DWI-ASPECTS≤5 (43 men, 64.6±14.4 years, NIHSS 18...
September 14, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28904450/acute-ischemic-stroke-treatment-using-mechanical-thrombectomy-a-study-of-137-patients
#13
Rakeshsingh K Singh, Vishal Annaji Chafale, Rakesh Shyam Lalla, Keyurkumar Chandrakantbhai Panchal, Anil Pandurang Karapurkar, Satish Vasant Khadilkar, Pawan K Ojha, Yogesh Godge, Rakesh K Singh, Rajesh Benny
BACKGROUND: Mechanical thrombectomy (MT) is the most effective treatment in large vessel occlusion (LVO). We have analyzed our initial experience of MT of 137 patients in anterior circulation (AC) and posterior circulation (PC) LVO using Solitaire stent retriever device. METHODS: Retrospective cohort analysis of 112 AC and 25 PC acute ischemic strokes was done considering various baseline characteristics, risk factors, National Institute of Health Stroke Scale (NIHSS) change, revascularization rate, complications, and functional outcome at 3 months using modified Rankin score...
July 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28899866/subacute-endovascular-recanalization-of-symptomatic-cerebral-artery-occlusion-a-propensity-score-matched-analysis
#14
Sang Hun Lee, Dae Chul Suh, Su Hee Cho, Jae Jon Sheen, Deok Hee Lee, Jong S Kim
BACKGROUND: The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs). METHODS: Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion-perfusion mismatch...
September 12, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#15
REVIEW
B Kallmünzer, M Köhrmann
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h...
September 11, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28892656/plasma-let-7i-and-mir-15a-expression-are-associated-with-the-effect-of-recombinant-tissue-plasminogen-activator-treatment-in-acute-ischemic-stroke-patients
#16
Wei Xiang, Canhui Tian, Jingru Lin, Xiaohui Wu, Guanlai Pang, Liang Zhou, Suyue Pan, Zhen Deng
Circulating microRNAs (miRNAs) have been reported as diagnosis biomarkers and predictors in acute ischemic stroke (AIS). However, how the expression of circulating miRNAs changes after recombinant tissue plasminogen activator (rt-PA) treatment in AIS patients is still unknown. OBJECTIVE: To determine the expression of circulating miRNAs in AIS patients receiving rt-PA treatment and those not receiving it. METHODS: Blood samples were collected 24h after onset from 40 AIS patients receiving rt-PA treatment and 46 AIS patients (admission at 8-24h of onset) not receiving rt-PA treatment...
September 5, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28888075/intravenous-thrombolysis-for-patients-with-in-hospital-stroke-onset-propensity-matched-analysis-from-the-sits-east-registry
#17
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, Theodore Karapanayiotides, Sotirios Giannopoulos, Robert Mikulik
INTRODUCTION: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital (IHS) acute ischemic stroke (AIS) onset is associated with unfavourable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke onset (OHS) treated with IVT. We sought to compare outcomes between IVT treated IHS and OHS patients by analysing propensity score matched (PSM) data from the SITS-EAST registry. METHODS: We compared the following outcomes for all PSM patients: 1...
September 9, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28887393/white-matter-hyperintensity-volume-and-outcome-of-mechanical-thrombectomy-with-stentriever-in-acute-ischemic-stroke
#18
Kunakorn Atchaneeyasakul, Thabele Leslie-Mazwi, Kathleen Donahue, Anne-Katrin Giese, Natalia S Rost
BACKGROUND AND PURPOSE: Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices...
September 8, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28887377/outcome-after-stroke-thrombolysis-in-patients-80-years-treated-within-3-hours-vs-3-4-5-hours
#19
Niaz Ahmed, Kennedy R Lees, Peter A Ringleb, Christopher Bladin, David Collas, Danilo Toni, Gary A Ford
OBJECTIVE: To determine outcomes and risks of IV thrombolysis (IVT) in patients with acute ischemic stroke (AIS) >80 years of age within 3 hours compared to >3 to 4.5 hours recorded in the Safe Implementation of Treatment in Stroke (SITS) International Stroke Thrombolysis Registry. METHODS: A total of 14,240 (year 2003-2015) patients >80 years of age with AIS were treated with IVT ≤4.5 hours of stroke onset (3,558 in >3-4.5 hours). Of these, 8,658 (2,157 in >3-4...
September 8, 2017: Neurology
https://www.readbyqxmd.com/read/28886856/outcome-of-patients-receiving-thrombolytic-therapy-while-on-rivaroxaban-for-nonvalvular-atrial-fibrillation-from-rivaroxaban-once-daily-oral-direct-factor-xa-inhibition-compared-with-vitamin-k-antagonism-for-prevention-of-stroke-and-embolism-trial-in-atrial
#20
Sean T Chen, Anne S Hellkamp, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Keith A A Fox, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Christopher C Nessel, Jonathan P Piccini, Daniel E Singer, Manesh R Patel
The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). A review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used...
August 7, 2017: American Journal of Cardiology
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