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https://www.readbyqxmd.com/read/28320175/mechanical-embolectomy-for-acute-ischemic-stroke-beyond-six-hours-from-symptom-onset-using-mri-based-perfusion-imaging
#1
Ryan A McTaggart, Shadi Yaghi, Daniel C Sacchetti, Richard A Haas, Morgan Hemendinger, Daniel Arcuri, Jeffrey M Rogg, Karen L Furie, Mahesh V Jayaraman
INTRODUCTION: There is very limited data on the use of MRI based perfusion imaging to select patients with acute ischemic stroke and large vessel occlusion (LVO) for intraarterial therapy beyond 6h from onset. Our aim is to report the outcome of patients with acute ischemic stroke and large artery occlusion who presented beyond 6h from onset, had favorable MRI imaging profile, and underwent mechanical embolectomy. METHODS: This is a single institution (Rhode Island Hospital) retrospective study between December 1st, 2015, and July 30th, 2016 that included patients with acute ischemic stroke and proximal LVO with CT ASPECTS of 6 or more and 6-24h from symptom onset who were assessed for mechanical embolectomy using MRI based perfusion imaging...
April 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28320070/dexpramipexole-improves-bioenergetics-and-outcome-in-experimental-stroke
#2
Mirko Muzzi, Elisabetta Gerace, Daniela Buonvicino, Elisabetta Coppi, Francesco Resta, Laura Formentini, Riccardo Zecchi, Laura Tigli, Daniele Guasti, Martina Ferri, Emidio Camaioni, Alessio Masi, Domenico E Pellegrini-Giampietro, Guido Mannaioni, Daniele Bani, Anna M Pugliese, Alberto Chiarugi
BACKGROUND AND PURPOSE: To investigate the effects of dexpramipexole, a drug recently tested in ALS patients able to bind F1Fo ATP synthase and increase mitochondrial ATP production, on experimental ischemic brain injury. EXPERIMENTAL APPROACH: The effects of dexpramipexole on bioenergetics, Ca(2+) fluxes, electrophysiological functions and death were evaluated in primary neural cultures and hippocampal slices exposed to oxygen-glucose deprivation (OGD). The drug's impact on infarct volumes and neurological functions was also evaluated in mice subjected to proximal or distal MCAo...
March 20, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28318954/computed-tomography-perfusion-based-decision-making-for-acute-ischemic-stroke-missing-the-mismatch
#3
J A Molad, M Findler, E Auriel
The emerging use of mechanical thrombectomy for acute ischemic stroke treatment focuses on the importance of patient selection. Computed tomography perfusion (CTP) is one of widely used techniques. However, the accuracy and reliability of this modality is in debate among vascular neurologists. We present a case of an 80-year-old man admitted because of acute ischemic stroke. CT angiography demonstrated left proximal M2 occlusion. As CTP demonstrated signs of large ischemic core with no significant penumbra, mechanical thrombectomy was not performed following tPA administration...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28316869/forced-arterial-suction-thrombectomy-using-distal-access-catheter-in-acute-ischemic-stroke
#4
Ho-Cheol Lee, Dong-Hun Kang, Yang-Ha Hwang, Yong-Sun Kim, Yong-Won Kim
Historical innovations in mechanical thrombectomy devices and strategies for ischemic stroke have resulted in improved angiographic outcomes and better clinical outcomes. Various devices have been used, but the two most common approaches are aspiration thrombectomy and stent-retrieval thrombectomy. Aspiration thrombectomy has advanced from the traditional Penumbra system to forced arterial suction thrombectomy and a direct aspiration first-pass technique. Newer generation aspiration catheters with flexible distal tips and a larger bore have demonstrated faster and better recanalization relative to older devices...
March 2017: Neurointervention
https://www.readbyqxmd.com/read/28300551/role-of-caveolin-1-vascular-endothelial-growth-factor-pathway-in-basic-fibroblast-growth-factor-induced-angiogenesis-and-neurogenesis-after-treadmill-training-following-focal-cerebral-ischemia-in-rats
#5
Qiongyi Pang, Huimei Zhang, Zhenzhen Chen, Yudan Wu, Min Yidian Bai Liu, Yun Zhao, Fengxia Tu, Chan Liu, Xiang Chen
Exercise is known to aid functional recovery following ischemia, though the mechanisms responsible for the beneficial effects of exercise on recovery from ischemic stroke are not fully understood. Basic fibroblast growth factor (bFGF) contributes to angiogenesis and promotes neurologic functional recovery after stroke. The present study aimed to investigate the possible mechanisms whereby treadmill exercise ameliorated impaired angiogenesis and neurogenesis following transient cerebral ischemia in middle cerebral artery occlusion (MCAO) rats...
March 11, 2017: Brain Research
https://www.readbyqxmd.com/read/28286764/phase-i-and-phase-ii-therapies-for-acute-ischemic-stroke-an-update-on-currently-studied-drugs-in-clinical-research
#6
REVIEW
Cesar Reis, Onat Akyol, Wing Mann Ho, Camila Araujo, Lei Huang, Richard Applegate Ii, John H Zhang
Acute ischemic stroke is a devastating cause of death and disability, consequences of which depend on the time from ischemia onset to treatment, the affected brain region, and its size. The main targets of ischemic stroke therapy aim to restore tissue perfusion in the ischemic penumbra in order to decrease the total infarct area by maintaining blood flow. Advances in research of pathological process and pathways during acute ischemia have resulted in improvement of new treatment strategies apart from restoring perfusion...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28277465/understanding-the-neurophysiology-and-quantification-of-brain-perfusion
#7
Elizabeth Tong, Leo Sugrue, Max Wintermark
Newer neuroimaging technology has moved beyond pure anatomical imaging and ventured into functional and physiological imaging. Perfusion magnetic resonance imaging (PWI), which depicts hemodynamic conditions of the brain at the microvascular level, has an increasingly important role in clinical central nervous system applications. This review provides an overview of the established role of PWI in brain tumor and cerebrovascular imaging, as well as some emerging applications in neuroimaging. PWI allows better characterization of brain tumors, grading, and monitoring...
March 8, 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28277288/ct-imaging-selection-in-acute-stroke
#8
Laurie Bouchez, Roman Sztajzel, Maria Isabel Vargas, Paolo Machi, Zsolt Kulcsar, Pierre-Alexandre Poletti, Vitor Mendes Pereira, Karl-Olof Lövblad
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia...
October 26, 2016: European Journal of Radiology
https://www.readbyqxmd.com/read/28275555/endovascular-stroke-treatment-now-and-then-procedural-and-clinical-effectiveness-and-safety-of-different-mechanical-thrombectomy-techniques-over-time
#9
Niels von Gadow, Omid Nikoubashman, Jessica Freiherr, Frank Block, Arno Reich, Gunther Fesl, Martin Wiesmann
BACKGROUND: The most essential development in endovascular stroke treatment (EST) was the shift from intra-arterial thrombolysis to endovascular thrombectomy with dedicated thrombectomy devices, most notably the introduction of stent-retrievers. We evaluated procedural and clinical effectiveness and safety of different EST techniques over time. METHODS: We retrospectively analyzed EST cases that were treated by the same interventionalist before (n=36) and after (n=50) stent-retrievers were established as the treatment device of first choice...
February 2017: Quantitative Imaging in Medicine and Surgery
https://www.readbyqxmd.com/read/28261063/reduced-synaptic-vesicle-recycling-during-hypoxia-in-cultured-cortical-neurons
#10
Sergei Fedorovich, Jeannette Hofmeijer, Michel J A M van Putten, Joost le Feber
Improvement of neuronal recovery in the ischemic penumbra, an area around the core of a brain infarct with some remaining perfusion, has a large potential for the development of therapy against acute ischemic stroke. However, mechanisms that lead to either recovery or secondary damage in the penumbra largely remain unclear. Recent studies in cultured networks of cortical neurons showed that failure of synaptic transmission (referred to as synaptic failure) is a critical factor in the penumbral area, but the mechanisms that lead to synaptic failure are still under investigation...
2017: Frontiers in Cellular Neuroscience
https://www.readbyqxmd.com/read/28255345/a-specific-dietary-intervention-to-restore-brain-structure-and-function-after-ischemic-stroke
#11
Maximilian Wiesmann, Bastian Zinnhardt, Dirk Reinhardt, Sarah Eligehausen, Lydia Wachsmuth, Sven Hermann, Pieter J Dederen, Marloes Hellwich, Michael T Kuhlmann, Laus M Broersen, Arend Heerschap, Andreas H Jacobs, Amanda J Kiliaan
Occlusion of the middle cerebral artery (MCAo) is among the most common causes of ischemic stroke in humans. Cerebral ischemia leads to brain lesions existing of an irreversibly injured core and an ischemic boundary zone, the penumbra, containing damaged but potentially salvageable tissue. Using a transient occlusion (30 min) of the middle cerebral artery (tMCAo) mouse model in this cross-institutional study we investigated the neurorestorative efficacy of a dietary approach (Fortasyn) comprising docosahexaenoic acid, eicosapentaenoic acid, uridine, choline, phospholipids, folic acid, vitamins B12, B6, C, and E, and selenium as therapeutic approach to counteract neuroinflammation and impairments of cerebral (structural+functional) connectivity, cerebral blood flow (CBF), and motor function...
2017: Theranostics
https://www.readbyqxmd.com/read/28246507/differentiation-of-the-infarct-core-from-ischemic-penumbra-within-the-first-4-5-hours-using-diffusion-tensor-imaging-derived-metrics-a-rat-model
#12
Duen-Pang Kuo, Chia-Feng Lu, Michelle Liou, Yung-Chieh Chen, Hsiao-Wen Chung, Cheng-Yu Chen
OBJECTIVE: To investigate whether the diffusion tensor imaging-derived metrics are capable of differentiating the ischemic penumbra (IP) from the infarct core (IC), and determining stroke onset within the first 4.5 hours. MATERIALS AND METHODS: All procedures were approved by the local animal care committee. Eight of the eleven rats having permanent middle cerebral artery occlusion were included for analyses. Using a 7 tesla magnetic resonance system, the relative cerebral blood flow and apparent diffusion coefficient maps were generated to define IP and IC, half hour after surgery and then every hour, up to 6...
March 2017: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/28217292/oxygen-or-cooling-to-make-a-decision-after-acute-ischemia-stroke
#13
REVIEW
Wen-Cao Liu, Xin-Chun Jin
The presence of a salvageable penumbra, a region of ischemic brain tissue with sufficient energy for short-term survival, has been widely agreed as the premise for thrombolytic therapy with tissue plasminogen activator (tPA), which remains the only United States Food and Drug Administration (FDA) approved treatment for acute ischemia stroke. However, the use of tPA has been profoundly constrained due to its narrow therapeutic time window and the increased risk of potentially deadly hemorrhagic transformation (HT)...
October 2016: Medical Gas Research
https://www.readbyqxmd.com/read/28207602/spreading-depolarization-monitoring-in-neurocritical-care-of-acute-brain-injury
#14
Jed A Hartings
PURPOSE OF REVIEW: Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential. RECENT FINDINGS: Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28202414/lncrna-tug1-sponges-microrna-9-to-promote-neurons-apoptosis-by-up-regulated-bcl2l11-under-ischemia
#15
Shengcai Chen, Mengdie Wang, Hang Yang, Ling Mao, Quanwei He, Huijuan Jin, Zi-Ming Ye, Xue-Ying Luo, Yuan-Peng Xia, Bo Hu
Emerging studies have illustrated that LncRNAs TUG1 play critical roles in multiple biologic processes. However, the LncRNA TUG1 expression and function in ischemic stroke have not been reported yet. In this study, we found that LncRNA TUG1 expression was significantly up-regulated in brain ischemic penumbra from rat middle carotid artery occlusion (MCAO) model, while similar results were also observed in cultured neurons under oxygen-glucose deprivation (OGD) insult. Knockdown of TUG1 decreased the ratio of apoptotic cells and promoted cells survival in vitro, which may be regulated by the elevated miRNA-9 expression and decreased Bcl2l11 protein...
March 25, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/28192195/puerarin-provides-a-neuroprotection-against-transient-cerebral-ischemia-by-attenuating-autophagy-at-the-ischemic-penumbra-in-neurons-but-not-in-astrocytes
#16
He Hongyun, Guo Tao, Zhang Pengyue, Yang Liqiang, Deng Yihao
Puerarin is an isoflavone derived from the Chinese medical herb of Radix puerariae (kudzu root), and has been widely used in the treatment for ischemic stroke in China. However, its underlying pharmacological mechanisms are still not understood. This study was to investigate the efficacy of puerarin on autophagy in the ischemic penumbra after cerebral stroke. A model of cerebral stroke in Sprague-Dawley rats was prepared by middle cerebral artery occlusion (MCAO); rats were then randomly divided into 5 groups: MCAO+Pue group (rats were treated with puerarin), MCAO+Pue+Tat-Beclin-1 group (rats were administrated with both puerarin and autophagy inducer Tat-Beclin-1), MCAO+Tat-Beclin-1 group (rats were treated with Tat-Beclin-1), MCAO+saline group (rats were administrated with the same volume of physiological saline), and sham surgery group...
March 16, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28188261/role-of-genetic-variation-in-collateral-circulation-in-the-evolution-of-acute-stroke-a-multimodal-magnetic-resonance-imaging-study
#17
Yu-Chieh Jill Kao, Esteban A Oyarzabal, Hua Zhang, James E Faber, Yen-Yu Ian Shih
BACKGROUND AND PURPOSE: No studies have determined the effect of differences in pial collateral extent (number and diameter), independent of differences in environmental factors and unknown genetic factors, on severity of stroke. We examined ischemic tissue evolution during acute stroke, as measured by magnetic resonance imaging and histology, by comparing 2 congenic mouse strains with otherwise identical genetic backgrounds but with different alleles of the Determinant of collateral extent-1 (Dce1) genetic locus...
February 10, 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
#18
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/28154103/acute-ischemic-stroke-therapy-overview
#19
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/28114983/panaxatriol-saponins-promotes-angiogenesis-and-enhances-cerebral-perfusion-after-ischemic-stroke-in-rats
#20
Zhen Hui, Du-Juan Sha, Su-Lei Wang, Chao-Sheng Li, Jian Qian, Jing-Qing Wang, Yang Zhao, Jing-Hua Zhang, Hong-Yu Cheng, Hui Yang, Lin-Jie Yu, Yun Xu
BACKGROUND: Panaxatriol saponins (PTS), an extract from the traditional Chinese herb Panax notoginseng, which has been used to treat ischemic stroke for many years in China. However, the mechanism underlying the effects of PTS remains unclear. This study aimed to determine whether PTS can protect against ischemic brain injury by promoting angiogenesis and to explore the possible mechanism by which it promotes angiogenesis. METHODS: Middle cerebral artery occlusion (MCAO) was induced in rats, and neurological deficit scores and brain infarct volumes were assessed...
January 23, 2017: BMC Complementary and Alternative Medicine
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