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Penumbra stroke

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https://www.readbyqxmd.com/read/28445478/delayed-histochemical-alterations-within-the-neurovascular-unit-due-to-transient-focal-cerebral-ischemia-and-experimental-treatment-with-neurotrophic-factors
#1
Dominik Michalski, Roman Pitsch, Deepu R Pillai, Bianca Mages, Susanne Aleithe, Jens Grosche, Henrik Martens, Felix Schlachetzki, Wolfgang Härtig
Current stroke therapy is focused on recanalizing strategies, but neuroprotective co-treatments are still lacking. Modern concepts of the ischemia-affected neurovascular unit (NVU) and surrounding penumbra emphasize the complexity during the transition from initial damaging to regenerative processes. While early treatment with neurotrophic factors was shown to result in lesion size reduction and blood-brain barrier (BBB) stabilization, cellular consequences from these treatments are poorly understood. This study explored delayed cellular responses not only to ischemic stroke, but also to an early treatment with neurotrophic factors...
2017: PloS One
https://www.readbyqxmd.com/read/28443061/a-linear-temporal-increase-in-thrombin-activity-and-loss-of-its-receptor-in-mouse-brain-following-ischemic-stroke
#2
Doron Bushi, Efrat Shavit Stein, Valery Golderman, Ekaterina Feingold, Orna Gera, Joab Chapman, David Tanne
BACKGROUND: Brain thrombin activity is increased following acute ischemic stroke and may play a pathogenic role through the protease-activated receptor 1 (PAR1). In order to better assess these factors, we obtained a novel detailed temporal and spatial profile of thrombin activity in a mouse model of permanent middle cerebral artery occlusion (pMCAo). METHODS: Thrombin activity was measured by fluorescence spectroscopy on coronal slices taken from the ipsilateral and contralateral hemispheres 2, 5, and 24 h following pMCAo (n = 5, 6, 5 mice, respectively)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28442781/spreading-depolarization-remarkably-exacerbates-ischemia-induced-tissue-acidosis-in-the-young-and-aged-rat-brain
#3
Ákos Menyhárt, Dániel Zölei-Szénási, Tamás Puskás, Péter Makra, M Tóth Orsolya, Borbála É Szepes, Réka Tóth, Orsolya Ivánkovits-Kiss, Tihomir P Obrenovitch, Ferenc Bari, Eszter Farkas
Spreading depolarizations (SDs) occur spontaneously in the cerebral cortex of subarachnoid hemorrhage, stroke or traumatic brain injury patients. Accumulating evidence prove that SDs exacerbate focal ischemic injury by converting zones of the viable but non-functional ischemic penumbra to the core region beyond rescue. Yet the SD-related mechanisms to mediate neurodegeneration remain poorly understood. Here we show in the cerebral cortex of isoflurane-anesthetized, young and old laboratory rats, that SDs propagating under ischemic penumbra-like conditions decrease intra and- extracellular tissue pH transiently to levels, which have been recognized to cause tissue damage...
April 25, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28436705/pharmacologically-increasing-collateral-perfusion-during-acute-stroke-using-a-carboxyhemoglobin-gas-transfer-agent-sanguinate%C3%A2-in-spontaneously-hypertensive-rats
#4
Marilyn J Cipolla, Italo Linfante, Abe Abuchowski, Ronald Jubin, Siu-Lung Chan
Similar to patients with chronic hypertension, spontaneously hypertensive rats (SHR) develop fast core progression during middle cerebral artery occlusion (MCAO) resulting in large final infarct volumes. We investigated the effect of Sanguinate™ (SG), a PEGylated carboxyhemoglobin (COHb) gas transfer agent, on changes in collateral and reperfusion cerebral blood flow and brain injury in SHR during 2 h of MCAO. SG (8 mL/kg) or vehicle ( n = 6-8/group) was infused i.v. after 30 or 90 min of ischemia with 2 h reperfusion...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28430183/neuroprotectin-d1-upregulates-iduna-expression-and-provides-protection-in-cellular-uncompensated-oxidative-stress-and-in-experimental-ischemic-stroke
#5
Ludmila Belayev, Pranab K Mukherjee, Veronica Balaszczuk, Jorgelina M Calandria, Andre Obenaus, Larissa Khoutorova, Sung-Ha Hong, Nicolas G Bazan
Ring finger protein 146 (Iduna) facilitates DNA repair and protects against cell death induced by NMDA receptor-mediated glutamate excitotoxicity or by cerebral ischemia. Neuroprotectin D1 (NPD1), a docosahexaenoic acid (DHA)-derived lipid mediator, promotes cell survival under uncompensated oxidative stress (UOS). Our data demonstrate that NPD1 potently upregulates Iduna expression and provides remarkable cell protection against UOS. Iduna, which was increased by the lipid mediator, requires the presence of the poly(ADP-ribose) (PAR) sites...
April 21, 2017: Cell Death and Differentiation
https://www.readbyqxmd.com/read/28414895/the-impact-of-ct-perfusion-threshold-on-predicted-viable-and-nonviable-tissue-volumes-in-acute-ischemic-stroke
#6
Xuya Huang, Dheeraj Kalladka, Bharath Kumar Cheripelli, Fiona Catherine Moreton, Keith W Muir
BACKGROUND AND PURPOSE: Perfusion imaging is used for patient selection in clinical practice and trials. Postprocessing and definitions of tissue viability are nevertheless not standardized. We compared the lesion volumes generated with two well-recognized perfusion tissue definitions in a single-center phase 2 thrombolysis study. METHODS: We analyzed perfusion imaging data from the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study using two popular tissue viability thresholds (ischemic core definition: (1) cerebral blood volume < 2...
April 17, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28412316/differentiating-stroke-and-seizure-in-acute-setting-perfusion-computed-tomography
#7
Katarzyna Kubiak-Balcerewicz, Urszula Fiszer, Ewa Nagańska, Cezary Siemianowski, Aleksander Sobieszek, Agnieszka Witak-Grzybowska, Aldona Kosińska-Szot
BACKGROUND: Perfusion computed tomography (PCT) is part of acute stroke protocol in many hospitals; however, its clinical utility is still being disputed. Beyond its use in core and penumbra estimation, there is also a question about PCT role in stroke mimics diagnosis. Case series or small, retrospective studies showed equivocal results. This is the first published prospective, comparative study on PCT in differentiating stroke and seizure in acute setting. METHODS: Patients with acute focal neurologic deficits and without acute ischemic lesions on routine CT underwent PCT and electroencephalography (EEG) within 12 hours after symptom onset...
April 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28398927/triggering-receptor-expressed-on-myeloid-cells-2-a-novel-regulator-of-immunocyte-phenotypes-confers-neuroprotection-by-relieving-neuroinflammation
#8
Qian Zhai, Feng Li, Xiyao Chen, Ji Jia, Sisi Sun, Dandan Zhou, Lei Ma, Tao Jiang, Fuhai Bai, Lize Xiong, Qiang Wang
BACKGROUND: Microglia can not only detrimentally augment secondary injury but also potentially promote recovery. However, the mechanism underlying the regulation of microglial phenotypes after stroke remains unclear. METHODS: Mice were subjected to middle cerebral artery occlusion for 60 min. At 3 days after reperfusion, the effects of activation and suppression of triggering receptor expressed on myeloid cells 2 on immunocyte phenotypes (n = 5), neurobehavioral scores (n = 7), infarct volumes (n = 8), and neuronal apoptosis (n = 7) were analyzed...
April 10, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28392777/efficacy-of-cerebral-autoregulation-in-early-ischemic-stroke-predicts-smaller-infarcts-and-better-outcome
#9
Pedro Castro, Jorge Manuel Serrador, Isabel Rocha, Farzaneh Sorond, Elsa Azevedo
BACKGROUND AND PURPOSE: Effective cerebral autoregulation (CA) may protect the vulnerable ischemic penumbra from blood pressure fluctuations and minimize neurological injury. We aimed to measure dynamic CA within 6 h of ischemic stroke (IS) symptoms onset and to evaluate the relationship between CA, stroke volume, and neurological outcome. METHODS: We enrolled 30 patients with acute middle cerebral artery IS. Within 6 h of IS, we measured for 10 min arterial blood pressure (Finometer), cerebral blood flow velocity (transcranial Doppler), and end-tidal-CO2...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28386041/prevalence-of-imaging-biomarkers-to-guide-the-planning-of-acute-stroke-reperfusion-trials
#10
Bin Jiang, Robyn L Ball, Patrik Michel, Tudor Jovin, Manisha Desai, Ashraf Eskandari, Zack Naqvi, Max Wintermark
BACKGROUND AND PURPOSE: Imaging biomarkers are increasingly used as selection criteria for stroke clinical trials. The goal of our study was to determine the prevalence of commonly studied imaging biomarkers in different time windows after acute ischemic stroke onset to better facilitate the design of stroke clinical trials using such biomarkers for patient selection. METHODS: This retrospective study included 612 patients admitted with a clinical suspicion of acute ischemic stroke with symptom onset no more than 24 hours before completing baseline imaging...
April 6, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28381652/treatment-outcome-of-carotid-artery-stenting-underwent-within-14-days-of-stroke-onset-consideration-of-safety-and-efficacy-of-urgent-carotid-artery-stenting-for-neurologically-progressing-patients
#11
Yasuhisa Kanematsu, Junichiro Satomi, Kazuyuki Kuwayama, Izumi Yamaguchi, Shotaro Yoshioka, Tomoya Kinouchi, Yoshiteru Tada, Nobuaki Yamamoto, Shunji Matsubara, Koichi Satoh, Shinji Nagahiro
As the safety and effectiveness of urgent carotid artery stenting (CAS) for neurologically progressing patients remain controversial, we retrospectively analyzed the outcome of urgent CAS based on the patients' pathophysiological condition and neuroimaging findings. We divided 71 patients who underwent CAS within 14 days of stroke onset into two groups. Group 1 (n = 35) was comprised of patients with progressing neurologic signs and a reversible ischemic penumbra on magnetic resonance images (MRI). They were treated by urgent CAS...
April 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28366057/development-of-a-recalcitrant-large-clot-burden-bifurcation-occlusion-model-for-mechanical-thrombectomy
#12
Visish M Srinivasan, Stephen R Chen, Kevin M Camstra, Gouthami Chintalapani, Peter Kan
OBJECTIVE Stroke is a major cause of disability and death in adults. Several large randomized clinical trials have shown the significant benefit of mechanical thrombectomy with modern stent retrievers in the treatment of large-vessel occlusions. However, large clots located at bifurcations remain challenging to treat. An in vivo model of these recalcitrant clots needs to be developed to test future generations of devices. METHODS Autologous blood was drawn from anesthetized swine via a femoral sheath. Blood was then mixed with thrombin, calcium chloride, and saline, and injected into silicone tubing to form cylindrical clots in the standard fashion...
April 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28363834/endovascular-stenting-for-symptomatic-carotid-dissection-with-hemodynamic-insufficiency
#13
Youngsoo Kim, Chang Hwa Choi, Tae Hong Lee, Han Jin Cho, Sang Min Sung, Seung Kug Baik, Jun Kyeung Ko
OBJECTIVE: To date, no controlled studies on the treatment of carotid artery dissection (CAD) have been reported. The purpose of this study was to demonstrate the technical feasibility and clinical efficacy of stent-supported angioplasty (SSA) as primary treatment for acute stroke due to CAD. METHODS: Review of medical records identified 21 patients who underwent SSA as primary treatment for acute stroke related to CAD between 2008 and 2014. The inclusion criteria were recent transient ischemic attack (TIA; n=7, 33...
March 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28345479/imaging-the-physiological-evolution-of-the-ischemic-penumbra-in-acute-ischemic-stroke
#14
Richard Leigh, Linda Knutsson, Jinyuan Zhou, Peter Cm van Zijl
We review the hemodynamic, metabolic and cellular parameters affected during early ischemia and their changes as a function of approximate cerebral blood flow ( CBF) thresholds. These parameters underlie the current practical definition of an ischemic penumbra, namely metabolically affected but still viable brain tissue. Such tissue is at risk of infarction under continuing conditions of reduced CBF, but can be rescued through timely intervention. This definition will be useful in clinical diagnosis only if imaging techniques exist that can rapidly, and with sufficient accuracy, visualize the existence of a mismatch between such a metabolically affected area and regions that have suffered cell depolarization...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28343073/breviscapine-confers-a-neuroprotective-efficacy-against-transient-focal-cerebral-ischemia-by-attenuating-neuronal-and-astrocytic-autophagy-in-the-penumbra
#15
Zhang Pengyue, Guo Tao, He Hongyun, Yang Liqiang, Deng Yihao
Breviscapine is a flavonoid derived from a traditional Chinese herb Erigerin breviscapus (Vant.) Hand-Mazz, and has been extensively used in clinical treatment for cerebral stroke in China, but the underlying pharmacological mechanisms are still unclear. In present study, we investigated whether breviscapine could confer a neuroprotection against cerebral ischemia injury by targeting autophagy mechanisms. A cerebral stroke model in Sprague-Dawley rats was prepared by middle cerebral artery occlusion (MCAO), rats were then randomly divided into 5 groups: MCAO+Bre group, rats were treated with breviscapine; MCAO+Tat-Beclin-1 group, animals were administrated with specific autophagy inducer Tat-Beclin-1; MCAO+Bre+Tat-Beclin-1 group, rats were treated with both breviscapine and Tat-Beclin-1, MCAO+saline group, rats received the same volume of physiological saline, and Sham surgery group...
March 23, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28328241/perfusion-ct-in-acute-stroke-effectiveness-of-automatically-generated-colour-maps
#16
Maja Ukmar, Ferruccio Degrassi, Roberta Antea Pozzi Mucelli, Francesca Neri, Fabio Pozzi Mucelli, Maria Assunta Cova
OBJECTIVE: To evaluate the accuracy of perfusion CT (pCT) in the definition of the infarcted core and the penumbra, comparing the data obtained from the evaluation of parametric maps [cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT)] with software-generated colour maps. METHODS: A retrospective analysis was performed to identify patients with suspected acute ischaemic strokes and who had undergone unenhanced CT and pCT carried out within 4...
April 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28320175/mechanical-embolectomy-for-acute-ischemic-stroke-beyond-six-hours-from-symptom-onset-using-mri-based-perfusion-imaging
#17
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
#18
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
#19
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
#20
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
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