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Penumbra stroke

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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
#1
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/27894149/2-3-5-4-tetrahydroxystilbene-2-o-%C3%AE-d-glucoside-attenuates-ischemia-reperfusion-induced-brain-injury-in-rats-by-promoting-angiogenesis
#2
Ying Mu, Zhaohui Xu, Xuanxuan Zhou, Huinan Zhang, Qian Yang, Yunlong Zhang, Yanhua Xie, Juan Kang, Feng Li, Siwang Wang
Cerebral ischemia can cause brain infarcts, which are difficult to recover due to poor angiogenesis. 2,3,5,4'-Tetrahydroxystilbene-2-O-β-D-glucoside is a natural polyphenol, has antioxidant and anti-inflammatory activity, and can protect from ischemic neuronal injury. However, little is known about the effect of 2,3,5,4'-tetrahydroxystilbene-2-O-β-D-glucoside on brain microcirculation after stroke. This study aimed at investigating the influence of 2,3,5,4'-tetrahydroxystilbene-2-O-β-D-glucoside on brain lesions and angiogenesis after stroke...
November 28, 2016: Planta Medica
https://www.readbyqxmd.com/read/27879370/validation-of-mri-determination-on-pet-measurements-in-ischemic-stroke
#3
Wolf-Dieter Heiss, Olivier Zaro Weber
The concept of the ischemic penumbra was formulated based on animal experiments showing functional impairment and electrophysiological disturbances with decreasing flow to the brain below defined values (the threshold for function) and irreversible tissue damage with blood supply further decreased (the threshold for infarction). The perfusion range between these thresholds was termed "penumbra", and restitution of flow above the functional threshold was able to reverse the deficits without permanent damage...
November 22, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/27864462/collateral-status-and-tissue-outcome-after-intra-arterial-therapy-for-patients-with-acute-ischemic-stroke
#4
Anna Mm Boers, Ivo Gh Jansen, Olvert A Berkhemer, Albert J Yoo, Hester F Lingsma, Cornelis H Slump, Yvo Bwem Roos, Robert J van Oostenbrugge, Diederik Wj Dippel, Aad van der Lugt, Wim H van Zwam, Henk A Marquering, Charles Blm Majoie
*These authors contributed equally to this work. †A list of all MR CLEAN Investigators is given in Appendix 1Intra-arterial therapy (IAT) for ischemic stroke aims to save brain tissue. Collaterals are thought to contribute to prolonged penumbra sustenance. In this study, we investigate the effect of collateral status on brain tissue salvage with IAT. In 500 patients randomized between IAT and standard care, collateral status was graded from 0 (absent) to 3 (good). Final infarct volumes (FIV) were calculated on post-treatment CT...
November 18, 2016: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/27859886/collateral-blood-flow-in-different-cerebrovascular-hierarchy-provides-endogenous-protection-in-cerebral-ischemia
#5
Chuanming Luo, Fengyin Liang, Huixia Ren, Xiaoli Yao, Qiang Liu, Mingyue Li, Dajiang Qin, Ti-Fei Yuan, Zhong Pei, Huanxing Su
Collateral blood flow as vascular adaptions to focal cerebral ischemia is well recognized. However, few studies directly investigate the dynamics of collateral vessel recruitment in vivo and little is known about the effect of collateral blood flow in different cerebrovascular hierarchy on the neuropathology after focal ischemic stroke. Here, we report that collateral blood flow is critically involved in blood vessel compensations following regional ischemia. We occluded a pial arteriole using femtosecond laser ablating under the intact thinned skull and documented the changes of collateral flow around the surface communication network and between the surface communication network and subsurface microcirculation network using in vivo two photon microscopy imaging...
November 15, 2016: Brain Pathology
https://www.readbyqxmd.com/read/27847778/pseudoaneurysm-formation-after-repetitive-suction-thrombectomy-using-a-penumbra-suction-catheter
#6
Eun-Oh Jeong, Hyon-Jo Kwon, Seung-Won Choi, Hyeon-Song Koh
With the recent advent of suction catheters, the use of manual aspiration thrombectomy (MAT) for patients with acute ischemic stroke with large vessel occlusion has increased. Although contrast leakage and subarachnoid hemorrhage have been reported during MAT procedures, pseudoaneurysm formation due to vessel injury by suction catheters has not been. We discuss the case of a 60-year-old woman who presented to our emergency room with dysarthria and left-sided weakness. She underwent suction thrombectomy 5 times for acute middle cerebral artery occlusion and significant contrast leakage occurred during the procedure...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27846459/simplifying-electrocardiographic-assessment-in-stemi-reperfusion-management-pros-and-cons
#7
REVIEW
Cheuk-Kit Wong
Current guidelines on STEMI reperfusion management do not incorporate further electrocardiographic details over the presence of significant ST elevation. Fibrinolysis is considered an alternative therapy to primary PCI if there is a long PCI-related delay, but the 2 therapies should not be combined. Meanwhile, reperfusion for ischemic stroke has evolved on mechanistic understanding - reperfusion benefit being greatest in the patient with small "core" infarct and large ischemic "penumbra". Fibrinolysis is not regarded as an alternative to mechanical thrombectomy, and the 2 therapies can be combined...
November 11, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27832728/gonadal-steroids-block-the-calpain-1-dependent-intrinsic-pathway-of-apoptosis-in-an-experimental-rat-stroke-model
#8
Zeinab Vahidinia, Nasim Alipour, Mohammad Ali Atlasi, Homayoun Naderian, Cordian Beyer, Abolfazl Azami Tameh
OBJECTIVES: Apoptosis plays an important role in the progression of the ischemic penumbra after reperfusion. Estrogen and progesterone have neuroprotective effects against ischemic brain damage, however the exact mechanisms of neuroprotection and signaling pathways is not completely understood. In this study, we investigated the possible regulatory effects of a combined steroid treatment on extrinsic and intrinsic apoptotic signaling pathways after cerebral ischemia. METHODS: Adult male Wistar rats were subjected to transient middle cerebral artery occlusion (tMCAO) using an intraluminal filament technique for 1 h followed by 23 h reperfusion...
November 11, 2016: Neurological Research
https://www.readbyqxmd.com/read/27823556/apoptosis-and-acute-brain-ischemia-in-ischemic-stroke
#9
Djordje Radak, Niki Katsiki, Ivana Resanovic, Aleksandra Jovanovic, Emina Sudar-Milovanovic, Sonja Zafirovic, Shaker A Mousa, Esma R Isenovic
Apoptosis may contribute to a significant proportion of neuron death following acute brain ischemia (ABI), but the underlying mechanisms are still not fully understood. Brain ischemia may lead to stroke, which is one of the main causes of long-term morbidity and mortality in both developed and developing countries. Therefore, stroke prevention and treatment is clinically important. There are two important separate areas of the brain during ABI: the ischemic core and the ischemic penumbra. The ischemic core of the brain experiences a sudden reduction of blood flow, just minutes after ischemic attack with irreversible injury and subsequent cell death...
November 3, 2016: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/27813048/neuroactive-steroids-in-acute-ischemic-stroke-association-with-cognitive-functional-and-neurological-outcomes
#10
S Casas, M C Gonzalez Deniselle, G M Gargiulo-Monachelli, A F Perez, M Tourreilles, M Mattiazzi, C Ojeda, D G Lotero Polesel, A F De Nicola
Despite several scientific and technological advances, there is no single neuroprotective treatment that can reverse the brain damage after acute ischemic stroke (AIS). Neuroactive steroids are cholesterol-derived hormones that have the ability to modulate the normal and pathologic nervous system employing genomic and nongenomic mechanisms. In this work, we first investigated if AIS affects the plasma concentration of 5 neuroactive steroids (cortisol, estradiol, progesterone, testosterone, and 3α-androstenediol glucuronide)...
November 3, 2016: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/27807278/number-needed-to-screen-for-acute-revascularization-trials-in-stroke-prognostic-and-predictive-imaging-biomarkers
#11
Qinghua Hou, James L Patrie, Wenjun Xin, Patrik Michel, Tudor Jovin, Ashraf Eskandari, Max Wintermark
OBJECTIVE: To systematically assess imaging biomarkers on CT-based multimodal imaging for their being predictive versus prognostic biomarkers for intravenous and endovascular (IA) revascularization therapy, and for their prevalence. METHODS: Our retrospective study included patients suspected of acute ischemic stroke with admission work-up including a non-contrast head CT, perfusion CT, and CT angiography. Modified Rankin scores at 90 days were used as outcomes...
November 2, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27807197/venous-imaging-based-biomarkers-in-acute-ischaemic-stroke
#12
REVIEW
Josep Munuera, Gerard Blasco, María Hernández-Pérez, Pepus Daunis-I-Estadella, Antoni Dávalos, David S Liebeskind, Max Wintermark, Andrew Demchuk, Bijoy K Menon, Götz Thomalla, Kambiz Nael, Salvador Pedraza, Josep Puig
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography...
November 2, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27798267/fully-automated-stroke-tissue-estimation-using-random-forest-classifiers-faster
#13
Richard McKinley, Levin Häni, Jan Gralla, M El-Koussy, S Bauer, M Arnold, U Fischer, S Jung, Kaspar Mattmann, Mauricio Reyes, Roland Wiest
Several clinical trials have recently proven the efficacy of mechanical thrombectomy for treating ischemic stroke, within a six-hour window for therapy. To move beyond treatment windows and toward personalized risk assessment, it is essential to accurately identify the extent of tissue-at-risk ("penumbra"). We introduce a fully automated method to estimate the penumbra volume using multimodal MRI (diffusion-weighted imaging, a T2w- and T1w contrast-enhanced sequence, and dynamic susceptibility contrast perfusion MRI)...
October 19, 2016: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/27796760/downregulation-of-nad-dependent-deacetylase-sirt2-protects-mouse-brain-against-ischemic-stroke
#14
Xiao Qiang Xie, Pei Zhang, Bo Tian, Xiao Qian Chen
Sirtuin 2 (SIRT2) is a member of NAD(+)-dependent protein deacetylases involved in a wide range of pathophysiological processes including myocardial injury, Parkinson's disease, and Huntington's disease. However, the direct implication of SIRT2 in ischemic stroke is still unclear. In the present study, we observed that SIRT2 protein was mainly expressed in the cytoplasm of neurons, but not in astrocyte and microglia. SIRT2 was upregulated in ischemic neurons in the oxygen-glucose deprivation cell model and in the transient middle cerebral artery occlusion (tMCAo) mouse model...
October 29, 2016: Molecular Neurobiology
https://www.readbyqxmd.com/read/27789149/noncontrast-computed-tomography-versus-computed-tomography-angiography-source-images-for-predicting-final-infarct-size-in-anterior-circulation-acute-ischemic-stroke-a-prospective-cohort-study
#15
Amritendu Mukherjee, Prakash Muthusami, Aneesh Mohimen, Srinivasan K, Babunath B, Sylaja Pn, Chandrasekharan Kesavadas
BACKGROUND: There has been a recent debate regarding the superiority of computed tomography angiography source images (CTASIs) over noncontrast computed tomography (NCCT) to predict the final infarct size in acute ischemic stroke (AIS). We hypothesized that the parenchymal abnormality on CTASI in faster scanners would overestimate ischemic core. METHODS: This prospective study assessed the correlation of Alberta Stroke Program Early CT Score (ASPECTS) on NCCT, CTASI, and computed tomography perfusion (CTP) with final infarct size in patients within 8 hours of AIS...
October 24, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27771897/profiling-of-signaling-proteins-in-penumbra-after-focal-photothrombotic-infarct-in-the-rat-brain-cortex
#16
Svetlana Demyanenko, Anatoly Uzdensky
In ischemic stroke, cell damage propagates from infarct core to surrounding tissue. To reveal proteins involved in neurodegeneration and neuroprotection, we explored the protein profile in penumbra surrounding the photothrombotic infarct core induced in rat cerebral cortex by local laser irradiation after Bengal Rose administration. Using antibody microarrays, we studied changes in expression of 224 signaling proteins 1, 4, or 24 h after photothrombotic infarct compared with untreated contralateral cortex...
October 22, 2016: Molecular Neurobiology
https://www.readbyqxmd.com/read/27758774/body-temperature-modulates-infarction-growth-following-endovascular-reperfusion
#17
S Dehkharghani, M Bowen, D C Haussen, T Gleason, A Prater, Q Cai, J Kang, R G Nogueira
BACKGROUND AND PURPOSE: The neuronal substrate is highly sensitive to temperature elevation; however, its impact on the fate of the ischemic penumbra has not been established. We analyzed interactions between temperature and penumbral expansion among successfully reperfused patients with acute ischemic stroke, hypothesizing infarction growth and worse outcomes among patients with fever who achieve full reperfusion. MATERIALS AND METHODS: Data from 129 successfully reperfused (modified TICI 2b/3) patients (mean age, 65 ± 15 years) presenting within 12 hours of onset were examined from a prospectively collected acute ischemic stroke registry...
October 6, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27717681/efficiency-of-the-penumbra-5max-ace-reperfusion-catheter-in-acute-ischemic-stroke-patients
#18
Kentaro Suzuki, Junya Aoki, Yuki Sakamoto, Takuya Kanamaru, Arata Abe, Satoshi Suda, Seiji Okubo, Kazumi Kimura
OBJECTIVE: This study was performed to investigate whether the Penumbra 5MAX ACE is superior to other Penumbra systems. MATERIALS AND METHODS: We performed a retrospective, single center analysis of patients with acute ischemic stroke with occlusion of the internal carotid artery or middle cerebral artery (M1 segment) who underwent endovascular therapy using a Penumbra system. The reperfusion success rate, puncture-to-revascularization time, and number of passes were assessed...
October 4, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27699105/imaging-hemodynamic-response-after-ischemic-stroke-in-mouse-cortex-using-visible-light-optical-coherence-tomography
#19
Siyu Chen, Qi Liu, Xiao Shu, Brian Soetikno, Shanbao Tong, Hao F Zhang
Visible-light optical coherence tomography (Vis-OCT) is an emerging technology that can image hemodynamic response in microvasculature. Vis-OCT can retrieve blood oxygen saturation (sO2) mapping using intrinsic optical absorption contrast while providing high-resolution anatomical vascular structures at the same time. To improve the accuracy of Vis-OCT oximetry on vessels embedded in highly scattering medium, i.e., brain cortex, we developed and formulated a novel dual-depth sampling and normalization strategy that allowed us to minimize the detrimental effect of ubiquitous tissue scattering...
September 1, 2016: Biomedical Optics Express
https://www.readbyqxmd.com/read/27693471/serine-racemase-inhibition-induces-nitric-oxide-mediated-neurovascular-protection-during-cerebral-ischemia
#20
Akihiro Watanabe, Tsutomu Sasaki, Toshiro Yukami, Hideaki Kanki, Manabu Sakaguchi, Hiroshi Takemori, Kazuo Kitagawa, Hideki Mochizuki
There are no effective neuroprotectant drugs for acute cerebral ischemia. Serine racemase (SR) synthesizes d-serine, which is involved in N-methyl-d-aspartate (NMDA) receptor-induced neurotoxicity. Recently, SR deletion was reported to protect against focal cerebral ischemia. However, regulatory mechanisms controlling SR-activity in the neurovascular unit (NVU) during cerebral ischemia remain to be clarified. We investigated the effects of SR inhibition on neurovascular protection after ischemia. The SR inhibitor phenazine methosulfate (PMS) alleviated neuronal damage in an ex vivo ischemic model (oxygen glucose deprivation [OGD]) using primary neuronal cultures, and in an in vivo mouse model of ischemia (middle cerebral artery occlusion [MCAO])...
December 17, 2016: Neuroscience
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