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Intra-arterial thrombolysis

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https://www.readbyqxmd.com/read/29167386/ischemic-stroke-profile-risk-factors-and-outcomes-in-india-the-indo-us-collaborative-stroke-project
#1
P N Sylaja, Jeyaraj Durai Pandian, Subhash Kaul, M V Padma Srivastava, Dheeraj Khurana, Lee H Schwamm, Praveen Kesav, Deepti Arora, Aman Pannu, Tijy K Thankachan, Aneesh B Singhal
BACKGROUND AND PURPOSE: The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. METHODS: From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted <2 weeks after onset. Investigator training and supervision and data monitoring were conducted by the US site (Massachusetts General Hospital, Boston)...
November 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29144166/imaging-assessment-of-acute-ischaemic-stroke-a-review-of-radiological-methods
#2
Aubrey Smith, Chris Rowland Hill
Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that maybe harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain...
November 16, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#3
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29069141/intra-arterial-fibrinolysis-for-the-management-of-acute-ischemia-on-a-below-knee-amputation-stump-case-report
#4
Breno Boueri Affonso, Joaquim Maurício da Motta Leal, Rafael Noronha Cavalcante, Priscila Mina Falsarella, Francisco Leonardo Galastri, Rodolfo Souza Cardoso, Felipe Nasser
Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion...
October 23, 2017: Einstein
https://www.readbyqxmd.com/read/28982494/techniques-for-endovascular-treatment-of-acute-ischemic-stroke
#5
REVIEW
L Pierot, M Gawlitza, S Soize
Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28981224/-endovascular-treatment-of-ischemic-strokes-outcomes-and-practical-issues
#6
N Ligot, B Lubicz, G Naeije
Ischemic stroke is a leading cause of disability and death due to brain arterial occlusion and subsequent ischemia. Acute treatment aims to recanalize the occluded artery as soon as possible. Treatment to achieve recanalization of the occluded artery has evolved during the last couple of years. First therapeutic improvement : intra-veinous thrombolysis (IV rt-PA) was the first validated treatment to achieve reduction in ischemic stroke morbi-mortality. However, rt-PA is efficient in the first hours of stroke onset and for small calibers occluded vessels...
2017: Revue Médicale de Bruxelles
https://www.readbyqxmd.com/read/28980181/outcome-of-intra-arterial-thrombolysis-in-patients-with-diabetes-and-acute-lower-limb-ischemia-a-propensity-score-adjusted-analysis
#7
Talha Butt, Anders Gottsäter, Jan Apelqvist, Gunnar Engström, Stefan Acosta
The presence of diabetes mellitus is rarely addressed in acute lower limb ischaemia (ALLI). The aim of this study was to evaluate the outcome of local intra-arterial thrombolysis for ALLI in patients with diabetes mellitus (DM). Outcome of all thrombolytic events performed in an endovascular first-strategy centre during a 13-year period between 2001 and 2013 in patients with ALLI were followed to January 2017. A propensity score adjusted analysis was performed to evaluate results in patients with (n = 83) versus without (n = 316) DM...
November 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28899866/subacute-endovascular-recanalization-of-symptomatic-cerebral-artery-occlusion-a-propensity-score-matched-analysis
#8
Sang Hun Lee, Dae Chul Suh, Su Hee Cho, Jae Jon Sheen, Deok Hee Lee, Jong S Kim
BACKGROUND: The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs). METHODS: Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion-perfusion mismatch...
September 12, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28881141/elongated-plant-virus-based-nanoparticles-for-enhanced-delivery-of-thrombolytic-therapies
#9
Andrzej S Pitek, Yunmei Wang, Sahil Gulati, Huiyun Gao, Phoebe L Stewart, Daniel I Simon, Nicole F Steinmetz
Thrombotic cardiovascular disease, including acute myocardial infarction, ischemic stroke, and venous thromboembolic disease, is the leading cause of morbidity and mortality worldwide. While reperfusion therapy with thrombolytic agents reduces mortality from acute myocardial infarction and disability from stroke, thrombolysis is generally less effective than mechanical reperfusion and is associated with fatal intracerebral hemorrhage in up to 2-5% of patients. To address these limitations, we propose the tobacco mosaic virus (TMV)-based platform technology for targeted delivery of thrombolytic therapies...
November 6, 2017: Molecular Pharmaceutics
https://www.readbyqxmd.com/read/28881114/intra-arterial-and-intravenous-tirofiban-infusion-for-thromboembolism-during-endovascular-coil-embolization-of-cerebral-aneurysm
#10
Sang Heum Kim, Tae Gon Kim, Min Ho Kong
OBJECTIVE: Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. METHODS: We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014...
September 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28843804/intra-arterial-alteplase-thrombolysis-during-mechanical-thrombectomy-for-acute-ischemic-stroke
#11
Daniel M Heiferman, Daphne D Li, Nathan C Pecoraro, Angela M Smolenski, Asterios Tsimpas, William W Ashley
BACKGROUND: Intra-arterial alteplase (IA tPA) is commonly used during mechanical thrombectomy for acute ischemic stroke in patients with large-vessel occlusion, but specific indications and applications for its use remain undefined. METHODS: We analyzed 40 patients who underwent stent-retriever mechanical thrombectomy, 28 of whom received adjunctive IA tPA. To our knowledge, this is the largest cohort with this concomitant treatment reported in the literature in the post-mechanical thrombectomy trial era...
August 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28801387/microbubbles-and-ultrasound-accelerated-thrombolysis-must-for-peripheral-arterial-occlusions-protocol-for-a-phase-ii-single-arm-trial
#12
Harm P Ebben, Johanna H Nederhoed, Rutger J Lely, Willem Wisselink, Kakkhee Yeung
INTRODUCTION: Acute peripheral arterial occlusions can be treated with intra-arterial catheter-directed thrombolysis as an alternative to surgical thromboembolectomy. Although less invasive, this treatment is time-consuming and carries a significant risk of haemorrhagic complications. Contrast-enhanced ultrasound using microbubbles could accelerate dissolution of thrombi by thrombolytic medications due to mechanical effects caused by oscillation; this could allow for lower dosages of thrombolytics and faster thrombolysis, thereby reducing the risk of haemorrhagic complications...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28761235/renal-artery-thrombosis-with-renal-infarction-a-rare-cause-of-acute-abdomen
#13
A Nandwani, D Pathania, P K Jha, V Kher
Renal artery thrombosis with renal infarction is a rare entity. Due to the nonspecific clinical presentation, the diagnosis is usually delayed. We describe such a case in a middle-aged man with membranous nephropathy who was in remission and presented with severe abdominal pain. He was managed with selective intra-arterial thrombolysis with a good outcome.
July 2017: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/28735256/comparison-of-multimodal-intra-arterial-treatment-versus-intravenous-thrombolysis-for-hypertensive-patients-with-severe-large-vessel-cerebral-infarction
#14
Zuojun Tian, Geng Liao, Shaoming Li, Yuechun Shen, Changbing Chen, Lei Liu, Yiheng Li
Since intravenous thrombolysis (IVT) is often associated with poor outcomes in hypertensive patients with severe acute cerebral infarction (ACI) due to occlusions of the internal carotid, basilar, or proximal middle cerebral artery, we evaluated whether multimodal intra-arterial treatment (IAT) might improve functional outcomes in this patient population. We retrospectively reviewed the charts of eligible patients who underwent multimodal IAT including intra-arterial thrombolysis, mechanical thrombectomy, balloon and/or stent angioplasty (IAT group) or IVT alone (IVT group)...
July 21, 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/28725968/microglial-mediated-pdgf-cc-activation-increases-cerebrovascular-permeability-during-ischemic-stroke
#15
Enming Joseph Su, Chunzhang Cao, Linda Fredriksson, Ingrid Nilsson, Christina Stefanitsch, Tamara K Stevenson, Juanjuan Zhao, Margret Ragsdale, Yu-Yo Sun, Manuel Yepes, Chia-Yi Kuan, Ulf Eriksson, Dudley K Strickland, Daniel A Lawrence, Li Zhang
Treatment of acute ischemic stroke with the thrombolytic tissue plasminogen activator (tPA) can significantly improve neurological outcomes; however, thrombolytic therapy is associated with an increased risk of intra-cerebral hemorrhage (ICH). Previously, we demonstrated that during stroke tPA acting on the parenchymal side of the neurovascular unit (NVU) can increase blood-brain barrier (BBB) permeability and ICH through activation of latent platelet-derived growth factor-CC (PDGF-CC) and signaling by the PDGF receptor-α (PDGFRα)...
October 2017: Acta Neuropathologica
https://www.readbyqxmd.com/read/28721323/endovascular-management-of-stroke-patients-with-large-vessel-occlusion-and-minor-stroke-symptoms
#16
REVIEW
Saeed A Alqahtani, Andrew B Stemer, Michael F McCullough, Randy S Bell, Jeffrey Mai, Ai-Hsi Liu, Rocco A Armonda
Endovascular mechanical thrombectomy for stroke patients with large vessel occlusion (LVO) in the anterior circulation has become the standard of care based on several major randomized clinical trials. The successful result reported by these trials constitutes what may be the largest achievement in the history of neurological sciences. However, most of these mechanical thrombectomy trials (except for the multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands, i...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28705822/focal-low-and-global-high-permeability-predict-the-possibility-risk-and-location-of-hemorrhagic-transformation-following-intra-arterial-thrombolysis-therapy-in-acute-stroke
#17
Y Li, Y Xia, H Chen, N Liu, A Jackson, M Wintermark, Y Zhang, J Hu, B Wu, W Zhang, J Tu, Z Su, G Zhu
BACKGROUND AND PURPOSE: The contrast volume transfer coefficient (K(trans)), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS: We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment...
July 13, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28702878/recent-trends-in-clot-retrieval-devices-a-review
#18
REVIEW
Aamir Hameed, Haroon Zafar, Darren Mylotte, Faisal Sharif
Stroke is the second leading cause of death worldwide and in Europe. Even with gold standard medical management of acute ischemic stroke, which is intravenous (IV) thrombolysis by administration of recombinant tissue plasminogen activator (rt-PA), the mortality rate remains the same. Intra-arterial (IA) thrombolysis therapy also did not achieve significant results and was not approved by the US Food and Drug Administration (FDA) because of limited sample size. This encouraged scientists and engineers to develop endovascular clot retrieval devices for the mechanical recanalization of the occluded arteries in stroke patients...
December 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28702681/intra-arterial-thrombolysis-for-extremity-frostbite-decreases-digital-amputation-rates-and-hospital-length-of-stay
#19
Nishant Patel, Dhivya R Srinivasa, Ravi N Srinivasa, Joseph J Gemmete, Venkat Krishnamurthy, Narasimham Dasika, Shilpa N Reddy, Matthew L Osher, Erika D Sears, Jeffrey Forris Beecham Chick
PURPOSE: To report outcomes of intra-arterial thrombolysis versus non-thrombolytic management of severe frostbite with respect to digital amputation rates and hospital length of stay (LOS). MATERIALS AND METHODS: Seventeen patients with severe frostbite were identified from 2000 to 2017. Eight (47%) patients with mean age of 40 years underwent intra-arterial thrombolysis and served as the treatment group. Nine (53%) patients with mean age of 53 years received non-thrombolytic management and served as the control group...
July 12, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28666803/intra-arterial-treatment-for-patients-with-severe-acute-vertebrobasilar-occlusion-a-single-center-retrospective-study
#20
Jie Cao, Jinggang Xuan, Ronghua Chen, Xucheng Zhu, Huaming Shao, Xiaofeng Chao, Feng Zhi, Naiyuan Shao, Ya Peng
BACKGROUND: Recently, favorable outcomes from several randomized controlled trials of rapid endovascular treatment for acute ischemic stroke has emerged. OBJECTIVE: The aim of this retrospective study is to present our clinical experience in severe acute vertebrobasilar occlusion (AVBO) using intra-arterial treatment (IAT). METHODS: Twenty patients with ischemic stroke in the vertebrobasilar circulation treated by IAT between March 2011 and December 2014 were included...
June 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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