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Penumbra stroke

Carlos Garcia-Esperon, Andrew Bivard, Christopher Levi, Mark Parsons
Background Computed tomography perfusion is becoming widely accepted and used in acute stroke treatment. Computed tomography perfusion provides pathophysiological information needed in the acute decision making. Moreover, computed tomography perfusion shows excellent correlation with diffusion-weighted imaging and perfusion-weighted sequences to evaluate core and penumbra volumes. Multimodal computed tomography perfusion has practical advantages over magnetic resonance imaging, including availability, accessibility, and speed...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Kelly M DeMars, Austin O McCrea, David M Siwarski, Brian D Sanz, Changjun Yang, Eduardo Candelario-Jalil
Ischemic stroke occurs when a clot forms in the brain vasculature that starves downstream tissue of oxygen and nutrients resulting in cell death. The tissue immediately downstream of the blockage, the core, dies within minutes, but the surrounding tissue, the penumbra is potentially salvageable. Prostaglandin E2 binds to four different G-protein coupled membrane receptors EP1-EP4 mediating different and sometimes opposing responses. Pharmacological activation of the EP4 receptor has already been established as neuroprotective in stroke, but the mechanism(s) of protection are not well-characterized...
2018: Frontiers in Neuroscience
Jonathan T Caranfa, Elaine Nguyen, Rafay Ali, Iregi Francis, Albert Zichichi, Elliott Bosco, Craig I Coleman, William L Baker, Christine G Kohn
BACKGROUND: Randomized controlled trials (RCTs) have compared mechanical endovascular therapy (MET) in addition to intravenous tissue plasminogen activator (IVtPA) to IVtPA alone for the management of acute ischemic stroke (AIS). Direct comparative studies between individual METs are not available. In lieu of head-to-head randomized control trials, we performed an adjusted indirect treatment comparison (ITC) meta-analysis to assess the comparative efficacy and safety of different METs, Solitaire+IVtPA and Penumbra+IVtPA in AIS patients...
2018: PloS One
Chenglin Tian, Xiangyu Cao, Jun Wang
Various mechanisms underlie causative large artery occlusion (LAO) in patients with acute ischaemic stroke. Cardioembolic and atherosclerotic occlusions are the two most common types. The pathophysiological changes and responses to mechanical thrombectomy (MT) and antithrombotic treatments including thrombolysis, antiplatelet and anticoagulation therapy may vary among patients with different aetiological mechanisms of occlusion. Atherosclerotic occlusion is inclined to have relatively abundant collaterals and larger area of penumbra, hence a relatively wider time window for reperfusion therapy, while poor response to medical thrombolysis and MT...
December 2017: Stroke and Vascular Neurology
Daniel C Sacchetti, Shawna M Cutting, Ryan A McTaggart, Andrew D Chang, Morgan Hemendinger, Brian Mac Grory, Matthew S Siket, Tina Burton, Bradford Thompson, Sara K Rostanski, Shyam Prabhakaran, Joshua Z Willey, Randolph S Marshall, Mitchell Sv Elkind, Pooja Khatri, Karen L Furie, Mahesh V Jayaraman, Shadi Yaghi
Background Large vessel disease stroke subtype carries the highest risk of early recurrent stroke. In this study we aim to look at the association between impaired perfusion and early stroke recurrence in patients with intracranial atherosclerotic disease or total cervical carotid occlusion. Methods This is a retrospective study from a comprehensive stroke center where we included consecutive patients 18 years or older with intracranial atherosclerotic disease or total cervical carotid occlusion admitted with a diagnosis of ischemic stroke within 24 h from symptom onset with National Institute Health Stroke Scale < 15, between 1 December 2016 and 30 June 2017...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Meiling Wu, Huadan Zhang, Jiejing Kai, Feng Zhu, Jingyin Dong, Ziwei Xu, Michael Wong, Ling-Hui Zeng
Objective: Whether activation or inhibition of the mTOR pathway is beneficial to ischemic injury remains controversial. It may result from the different reaction of ischemic penumbra and core to modulation of mTOR pathway after cerebral ischemia-reperfusion injury in rats. Methods: Longa's middle cerebral artery occlusion (MCAO) method was conducted to induce the focal cerebral ischemia-reperfusion. Western blot analysis was used to examine the protein expression involving mTOR pathway, apoptosis, and autophagy-related proteins...
February 2018: Annals of Clinical and Translational Neurology
Alexander Seiler, Arne Lauer, Ralf Deichmann, Ulrike Nöth, Se-Jong You, Waltraud Pfeilschifter, Oliver C Singer, Ulrich Pilatus, Marlies Wagner
PURPOSE: Endovascular thrombectomy is highly effective in patients with proximal large artery occlusion but the relevance of reperfusion injury after recanalization is a matter of debate. The aim of this study was to investigate potential residual metabolic distress and microstructural tissue damage or edema after reperfusion using quantitative oxygen-sensitive T2' and T2-mapping in patients successfully treated by thrombectomy. METHODS: Included in this study were 11 patients (mean age 70 ± 11...
February 19, 2018: Clinical Neuroradiology
Alessandro Pezzini, Giorgio Busto, Marialuisa Zedde, Massimo Gamba, Andrea Zini, Loris Poli, Filomena Caria, Valeria De Giuli, Anna Maria Simone, Rosario Pascarella, Alessandro Padovani, Marina Padroni, Roberto Gasparotti, Stefano Colagrande, Enrico Fainardi
BACKGROUND AND PURPOSE: Cerebral hyperexcitability in migraine experiencers might sensitize brain tissue to ischemia. We investigated whether a personal history of migraine is associated with vulnerability to brain ischemia in humans. METHODS: Multicenter cohort study of patients with acute ischemic stroke who underwent a brain computed tomography perfusion and were scheduled to undergo reperfusion therapy. In a case-control design, we compared the proportion of subjects with no-mismatch, the volume of penumbra salvaged, as well as the final infarct size in a group of patients with migraine and a group of patients with no history of migraine...
February 19, 2018: Stroke; a Journal of Cerebral Circulation
Ronan Motyer, John Thornton, Sarah Power, Paul Brennan, Alan O'Hare, Seamus Looby, David J Williams, Barry Moynihan, Sean Murphy
BACKGROUND: Selected patients with proximal anterior circulation ischemic stroke who demonstrate limited infarct and sufficient penumbra may benefit from endovascular thrombectomy (EVT) beyond conventional time limits. OBJECTIVE: To perform a retrospective review of all cases of EVT performed at our institution for proximal anterior circulation acute ischemic stroke with onset >12 hours. MATERIALS AND METHODS: Patients were assessed with non-contrast CT brain and multiphase CT angiography, with Alberta Stroke Program Early CT Score (ASPECTS) and collateral grade informing patient selection...
February 19, 2018: Journal of Neurointerventional Surgery
Chan-Chan Li, Xiao-Zhu Hao, Jia-Qi Tian, Zhen-Wei Yao, Xiao-Yuan Feng, Yan-Mei Yang
Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days (National Institutes of Health Stroke Scale) and 90 days (modified Rankin Scale) to determine short-term clinical outcomes...
January 2018: Neural Regeneration Research
Jia-Yu Cao, Yong Lin, Yan-Fei Han, Sheng-Hao Ding, Yi-Ling Fan, Yao-Hua Pan, Bing Zhao, Qin-Hua Guo, Wen-Hua Sun, Jie-Qing Wan, Xiao-Ping Tong
AIMS: Nerve growth factor (NGF) has been reported to prevent neuronal damage and contributes to the functional recovery in animal brain injury models and human ischemic disease as well. We aimed to investigate a potential therapeutic effect of NGF gene treatment in ischemic stroke and to estimate the functional recovery both at the cellular and cognitive levels in an ischemia rat model. METHODS: After microinjection of pseudolentivirus-delivered β-NGF into an established ischemic stroke model in rats (tMCAO), we estimated neuronal cell apoptosis with TUNEL labeling and neurogenesis by cell proliferation marker Ki67 staining in both ischemic core and penumbra of striatum...
February 6, 2018: CNS Neuroscience & Therapeutics
Sabrina Trippoli, Erminia Caccese, Claudio Marinai, Andrea Messori
OBJECTIVES: In the acute ischemic stroke, endovascular devices have shown promising clinical results and are also likely to represent value for money, as several modeling studies have shown. Pharmacoeconomic evaluations in this field, however, have little impact on the procurement of these devices. The present study explored how complex pharmacoeconomic models that evaluate effectiveness and cost can be incorporated into the in-hospital procurement of thrombectomy devices. PATIENTS AND METHODS: As regards clinical modeling, we extracted outcomes at three months from randomized trials conducted for four thrombectomy devices, and we projected long-term results using standard Markov modeling...
January 29, 2018: Clinical Neurology and Neurosurgery
Mahesh Kate, Robert Wannamaker, Harsha Kamble, Parnian Riaz, Laura C Gioia, Brian Buck, Thomas Jeerakathil, Penelope Smyth, Ashfaq Shuaib, Kenneth Butcher, Derek Emery
BACKGROUND AND PURPOSE: Thrombolysis >4.5 hours after ischemic stroke onset is unproven. We assessed the feasibility of tenecteplase (TNK) treatment in patients with evidence of an ischemic penumbra 4.5 to 24 hours after onset. METHODS: Acute ischemic stroke patients underwent perfusion computed tomography (CT)/magnetic resonance imaging. Patients with cerebral blood volume (CBV) or diffusion weighted imaging Alberta Stroke Program Early CT Scores (ASPECTS) >6 and mismatch score >2 (defined as >2 ASPECTS regions with delay on mean transit time maps and normal CBV) were eligible for treatment with TNK (0...
January 2018: Journal of Stroke
Alimu Wufuer, Atikaimu Wubuli, Peierdun Mijiti, Jun Zhou, Shabier Tuerxun, Jian Cai, Jianhua Ma, Xiaoning Zhang
Collateral circulation affects the prognosis of patients with acute ischemic stroke (AIS) treated by thrombolysis. The present study performed a systematic assessment of the impact of the collateral circulation status on the outcomes of patients receiving thrombolysis treatment. Relevant full-text articles from the Cochrane Library, Ovid, Medline, Embase and PubMed databases published from January 1, 2000 to November 1, 2016 were retrieved. The quality of the studies was assessed and data were extracted by 2 independent investigators...
January 2018: Experimental and Therapeutic Medicine
Yi Ding, Danjun Ren, Hang Xu, Wenxing Liu, Tianlong Liu, Liang Li, Jianguang Li, Yuwen Li, AiDong Wen
The nuclear factor erythroid-2-related factor 2 (Nrf2) pathway has been considered as a potential target for neuroprotection in stroke. The aim of present study was to determine whether corilagin, a novel Nrf2 activator, can protect against ischemia-reperfusion injury and explore the underlying mechanism involved. In vivo, rats exposed to middle cerebral artery occlusion were applied to establish an ischemic stroke model. Posttreatment of corilagin significantly reduced infarct volumes and apoptotic cells as well as improved neurologic score after reperfusion, together with increased vascular density in the ischemic penumbra...
December 29, 2017: Oncotarget
M Jake Pushie, Andrew Crawford, Nicole J Sylvain, Huishu Hou, Mark J Hackett, Graham N George, Michael E Kelly
Stroke exacts a heavy financial and economic burden, is a leading cause of death, and the leading cause of long term disability in those who survive. The penumbra surrounds the ischemic core of the stroke lesion and is comprised of metabolically stressed cells that may become part of the growing infarct or can potentially recover. Preserving the penumbra to promote functional recovery is a central goal in stroke research. Using synchrotron-based X-ray fluorescence imaging the elemental changes in brain tissue following ischemic stroke can be visualized...
January 25, 2018: ACS Chemical Neuroscience
Schuichi Koizumi, Yuri Hirayama, Yosuke M Morizawa
The brain consists of neurons and much higher number of glial cells. They communicate each other, by which they control brain functions. The brain is highly vulnerable to several insults such as ischemia, but has a self-protective and self-repairing mechanisms against these. Ischemic tolerance or preconditioning is an endogenous neuroprotective phenomenon, where a mild non-lethal ischemic episode can induce resistance to a subsequent severe ischemic injury in the brain. Because of its neuroprotective effects against cerebral ischemia or stroke, ischemic tolerance has been widely studied...
January 19, 2018: Neurochemistry International
Jung Ho Lee, Jisoo Lim, Yong Eun Chung, Sung Phil Chung, Incheol Park, Chul Hoon Kim, Je Sung You
Targeted temperature management (TTM, 32°C to 36°C) is one of the most successful achievements in modern resuscitation medicine. It has become standard treatment for survivors of sudden cardiac arrest to minimize secondary brain damage. TTM at 36°C is just as effective as TTM at 33°C and is actually preferred because it reduces adverse TTM-associated effects. TTM also likely has direct neuroprotective effects in ischemic brains in danger of stroke. It remains unclear, however, whether higher temperature TTM is equally effective in protecting the brain from the effects of stroke...
January 15, 2018: Shock
Daniel Komnig, Karen Gertz, Pardes Habib, Kay W Nolte, Tareq Meyer, Marc A Brockmann, Matthias Endres, Birgit Rathkolb, Martin Hrabě de Angelis, Jörg B Schulz, Björn H Falkenburger, Arno Reich
Delayed cell death in the penumbra region of acute ischemic stroke occurs through apoptotic mechanisms, making it amenable to therapeutic interventions. Fas/CD95 mediates apoptotic cell death in response to external stimuli. In mature neurons, Fas/CD95 signaling is modulated by Fas-apoptotic inhibitory molecule 2 (Faim2), which reduces cell death in animal models of stroke, meningitis, and Parkinson disease. Erythropoietin (EPO) has been studied as a therapeutic strategy in ischemic stroke. Erythropoietin stimulates the phosphatidylinositol-3 kinase/Akt (PI3K/Akt) pathway, which regulates Faim2 expression...
January 8, 2018: Journal of Neurochemistry
Beibei Dong, Zhishen Zhang, Keliang Xie, Yongyan Yang, Yuan Shi, Chenxu Wang, Yonghao Yu
BACKGROUND: Ischemia-reperfusion (I/R) is a critical pathophysiological change of ischemic stroke. Heme-oxygenase-1 (HO-1) is a rate-limiting enzyme of eliminating excessive free heme by combining with hemopexin (HPX), a plasma protein contributing to alleviating infarct size due to ischemia stroke. This study was to investigate whether HPX could improve angiogenesis after cerebral ischemia-reperfusion via up-regulating HO-1. METHODS: Rats were randomly divided into five groups: sham, MCAO, MCAO + Vehicle, MCAO + HPX and MCAO + HPX + protoporphyrin IX (ZnPPIX, an HO-1 inhibitor)...
January 3, 2018: BMC Anesthesiology
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