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Ischemic stroke thrombolysis

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https://www.readbyqxmd.com/read/27932197/crucial-role-of-carotid-ultrasound-for-the-rapid-diagnosis-of-hyperacute-aortic-dissection-complicated-by-cerebral-infarction-a-case-report-and-literature-review
#1
Eglė Sukockienė, Kristina Laučkaitė, Antanas Jankauskas, Dalia Mickevičienė, Giedrė Jurkevičienė, Antanas Vaitkus, Edgaras Stankevičius, Kęstutis Petrikonis, Daiva Rastenytė
Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset...
November 19, 2016: Medicina
https://www.readbyqxmd.com/read/27928063/could-advanced-drug-delivery-systems-be-the-future-in-cardiovascular-revascularization-medicine
#2
Marco Zuin, Gianluca Rigatelli, Giuseppe Faggian, Roberto L'Erario, Mauro Chinaglia, Loris Roncon
Acute myocardial infarction, stroke and pulmonary embolism required a prompt revascularization to restore the normal blood flow as soon as possible. Fibrinolytic treatment has gradually become both dated and underused in the treatment of acute myocardial infarction, after the wide diffusion of cathlab and percutaneous transluminal coronary angioplasty. Conversely, the use of systemic thrombolysis remained a benchmark in the treatment of both ischemic stroke and massive pulmonary embolism. In daily clinical practice, the use of thrombolytic agents is often limited by absolute and/or relative contraindications and possible adverse events after the drug administration, as intracranial and/or extracranial bleeding events...
December 6, 2016: Vascular
https://www.readbyqxmd.com/read/27924212/combined-administration-of-the-gpvi-fc-fusion-protein-revacept-with-low-dose-thrombolysis-in-the-treatment-of-stroke
#3
Andreas Reimann, Zhongmin Li, Silvia Goebel, Julia Fassbender, Hans-Peter Holthoff, Meinrad Gawaz, Götz Münch, Martin Ungerer
BACKGROUND: Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) remains the only approved medication for acute ischemic stroke, but incurs significant bleeding risks. Therefore, approaches to combine lower doses of thrombolytic therapy with other effective drugs aim at improving efficacy and reducing bleeding rates. We examined the safety and therapeutic effects of various dosings of rtPA, either alone or combined with glycoprotein VI-Fc fusion protein (GPVI-Fc, Revacept) on experimental stroke in mice...
January 2016: Heart International
https://www.readbyqxmd.com/read/27920715/intra-arterial-mechanical-thrombectomy-an-effective-treatment-for-ischemic-stroke-caused-by-endocarditis
#4
Olafur Sveinsson, Lars Herrman, Staffan Holmin
Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27919793/inter-rater-reliability-for-thrombolysis-in-cerebral-infarction-with-tici-2c-category
#5
Ondrej Volny, Petra Cimflova, Viktor Szeder
BACKGROUND AND PURPOSE: Thrombolysis in cerebral infarction (TICI) with 2b/3 (>50% of occluded territory/complete reperfusion) has been regarded as a successful angiographic outcome. To account for near-perfect angiographic results, the category TICI 2c (near-complete reperfusion) has been introduced. As the degree of inter-rater reliability for TICI with 2c category remains poorly studied, we strived to evaluate the agreement among stroke-treating specialists. METHODS: All consecutive patients, who underwent stent-retriever thrombectomy for acute ischemic stroke in the period between January 2014 and April 2016 at the Department of Neurointerventional Radiology, were analyzed...
December 2, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27917948/association-of-cortical-vein-filling-with-clot-location-and-clinical-outcomes-in-acute-ischaemic-stroke-patients
#6
Sonu Bhaskar, Andrew Bivard, Peter Stanwell, John R Attia, Mark Parsons, Michael Nilsson, Christopher Levi
Delay in cortical vein filling during the late-venous phase (delayed-LCVF) is characterized by opacification of cerebral veins despite contrast clearance from contralateral veins on dynamic computed tomography angiography (dCTA) in acute ischemic stroke (AIS) patients. The aim of the study was to investigate the associations of delayed-LCVF with clot location, reperfusion status at 24 hours, and 90-days functional outcome in AIS patients who received reperfusion therapy. A prospective cohort of AIS patients treated with intravenous thrombolysis was studied...
December 5, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#7
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27899756/coagulation-testing-in-acute-ischemic-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants
#8
Jan C Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Sven Poli, Peter Kraft, Christoph Kleinschnitz, Rainer Dziewas, Andreas Binder, Frederick Palm, Sebastian Jander, Hassan Soda, Peter U Heuschmann, Roland Veltkamp
BACKGROUND AND PURPOSE: In patients who present with acute ischemic stroke while on treatment with non-vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. METHODS: Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants; February 2012-2015)...
November 29, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27899519/initial-clinical-experience-using-the-two-stage-aspiration-technique-tsat-with-proximal-flow-arrest-by-a-balloon-guiding-catheter-for-acute-ischemic-stroke-of-the-anterior-circulation
#9
Hiroyuki Matsumoto, Hirokazu Nishiyama, Yoshiaki Tetsuo, Hideki Takemoto, Naoyuki Nakao
BACKGROUND: Our initial experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter is presented. In TSAT, aspiration is applied with the 5MAX ACE and also with the 3MAX catheter with a Penumbra aspiration pump, while arresting proximal flow by balloon inflation. METHODS: In patients treated with TSAT, clinical data including National Institutes of Health Stroke Scale (NIHSS) score at admission and the modified Rankin Scale (mRS) score at discharge, as well as procedural data including the Thrombolysis in Cerebral Infarction (TICI) score, procedural time, and complications were analyzed...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27899517/endovascular-management-of-cerebral-septic-embolism-three-recent-cases-and-review-of-the-literature
#10
Eugene L Scharf, Tia Chakraborty, Alejandro Rabinstein, Amrendra S Miranpuri
Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#11
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27887976/the-establishment-of-a-telestroke-service-using-multimodal-ct-imaging-decision-assistance-turning-on-the-fog-lights
#12
REVIEW
Jelle Demeestere, Claire Sewell, Jennifer Rudd, Timothy Ang, Louise Jordan, James Wills, Carlos Garcia-Esperon, Ferdinand Miteff, Venkatesh Krishnamurthy, Neil Spratt, Longting Lin, Andrew Bivard, Mark Parsons, Christopher Levi
Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes...
November 22, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27887792/edaravone-with-and-without-6%C3%A2-mg-kg-alteplase-within-4-5-hours-after-ischemic-stroke-a-prospective-cohort-study-protect4-5
#13
Takenori Yamaguchi, Hideto Awano, Hiroaki Matsuda, Norio Tanahashi
BACKGROUND: Edaravone is widely used to treat acute ischemic stroke (AIS) within 24 hours of onset. We aimed to evaluate current edaravone treatment practices and the efficacy and safety of edaravone used with recombinant tissue plasminogen activator (tPA) in AIS patients within 4.5 hours of onset. The results were compared with those of the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Registry (SITS-ISTR) study. METHODS: PROTECT4...
November 22, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27885484/the-impact-of-cerebral-microbleeds-on-intracerebral-hemorrhage-and-poor-functional-outcome-of-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-systematic-review-and-meta-analysis
#14
REVIEW
Shuang Wang, Yan Lv, Xin Zheng, Jing Qiu, Hui-Sheng Chen
It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis...
November 24, 2016: Journal of Neurology
https://www.readbyqxmd.com/read/27881907/retinal-safety-of-intravitreal-rtpa-in-healthy-rats-and-under-excitotoxic-conditions
#15
Alejandra Daruich, Jérôme Parcq, Kimberley Delaunay, Marie-Christine Naud, Quentin Le Rouzic, Emilie Picard, Patricia Crisanti, Denis Vivien, Marianne Berdugo, Francine Behar-Cohen
PURPOSE: Intravitreal recombinant tissue plasminogen activator (rtPA) is used off-label for the surgical management of submacular hemorrhage, a severe complication of neovascular age-related macular degeneration. rtPA is approved for coronary and cerebral thrombolysis. However, in ischemic stroke rtPA is known to increase excitotoxic neural cell death by interacting with the N-methyl-D-aspartate (NMDA) receptor. We therefore investigated the retinal toxicity of rtPA in healthy rats and in a model of NMDA-induced retinal excitotoxicity...
2016: Molecular Vision
https://www.readbyqxmd.com/read/27881425/relationship-between-language-preference-and-intravenous-thrombolysis-among-acute-ischemic-stroke-patients
#16
Betty Luan Erfe, Khawja Ahmeruddin Siddiqui, Lee H Schwamm, Nicte I Mejia
BACKGROUND: Approximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients' receipt of intravenous (IV) thrombolysis. METHODS AND RESULTS: We analyzed data from 3894 AIS patients who participated in the American Heart Association "Get With The Guidelines(®)-Stroke" program at our hospital from January 1, 2003 to April 30, 2014...
November 23, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27871433/regional-variation-in-acute-stroke-care-organisation
#17
Paula Muñoz Venturelli, Thompson Robinson, Pablo M Lavados, Verónica V Olavarría, Hisatomi Arima, Laurent Billot, Maree L Hackett, Joyce Y Lim, Sandy Middleton, Octavio Pontes-Neto, Bin Peng, Liying Cui, Lily Song, Gillian Mead, Caroline Watkins, Ruey-Tay Lin, Tsong-Hai Lee, Jeyaraj Pandian, H Asita de Silva, Craig S Anderson
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27867486/effects-of-normobaric-versus-hyperbaric-oxygen-on-cell-injury-induced-by-oxygen-and-glucose-deprivation-in-acute-brain-slices
#18
Laurent Chazalviel, Jean-Eric Blatteau, Nicolas Vallée, Jean-Jacques Risso, Stéphane Besnard, Jacques H Abraini
Normobaric oxygen (NBO) and hyperbaric oxygen (HBO) are emerging as a possible co-treatment of acute ischemic stroke. Both have been shown to reduce infarct volume, to improve neurologic outcome, to promote endogenous tissue plasminogen activator-induced thrombolysis and cerebral blood flow, and to improve tissue oxygenation through oxygen diffusion in the ischemic areas, thereby questioning the interest of HBO compared to NBO. In the present study, in order to investigate and compare the oxygen diffusion effects of NBO and HBO on acute ischemic stroke independently of their effects at the vascular level, we used acute brain slices exposed to oxygen and glucose deprivation, an ex vivo model of brain ischemia that allows investigating the acute effects of NBO (partial pressure of oxygen (pO2) = 1 atmospheres absolute (ATA) = 0...
July 2016: Medical Gas Research
https://www.readbyqxmd.com/read/27867477/hyperbaric-oxygen-therapy-in-experimental-and-clinical-stroke
#19
REVIEW
Wei-Wei Zhai, Liang Sun, Zheng-Quan Yu, Gang Chen
Stroke, which is defined as a neurologic deficit caused by sudden impaired blood supply, has been considered as a common cause of death and disability for decades. The World Health Organization has declared that almost every 5 seconds a new stroke occurs, placing immense socioeconomic burdens. However, the effective and available treatment strategies are still limited. Additionally, the most effective therapy, such as thrombolysis and stenting for ischemic stroke, generally requires a narrow therapeutic time window after the event...
April 2016: Medical Gas Research
https://www.readbyqxmd.com/read/27866732/impact-of-a-direct-admission-stroke-pathway-on-delays-of-admission-care-and-rates-of-intravenous-thrombolysis
#20
REVIEW
C Mouthon-Reignier, I Bonnaud, M Gaudron, S Vannier-Bernard, J-F Bodin, J-P Cottier, B De Toffol, S Debiais
INTRODUCTION: This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA. METHODS: This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data...
December 2016: Revue Neurologique
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