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Intra-arterial thrombolysis

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https://www.readbyqxmd.com/read/27920715/intra-arterial-mechanical-thrombectomy-an-effective-treatment-for-ischemic-stroke-caused-by-endocarditis
#1
Olafur Sveinsson, Lars Herrman, Staffan Holmin
Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27917359/protective-roles-of-intra-arterial-mild-hypothermia-and-arterial-thrombolysis-in-acute-cerebral-infarction
#2
Xiaoxiang Peng, Yue Wan, Wenjun Liu, Bitang Dan, Li Lin, Zhouping Tang
OBJECTIVE: Herein, we evaluated the efficacy and safety of intra-arterial mild hypothermia in combination with arterial thrombolysis to treat acute cerebral infarction due to middle cerebral artery occlusion. METHODS: A total of 26 patients with acute middle cerebral artery occlusion were divided into a normothermia group (n = 15) and a mild hypothermia group (n = 11). The infarct volumes at 24 h and 7 days after the operation were compared between the normothermia group and the mild hypothermia group...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27896904/contrast-induced-encephalopathy-following-cardiac-catheterization
#3
Roberto Spina, Neil Simon, Romesh Markus, David Wm Muller, Krishna Kathir
OBJECTIVES: To describe the epidemiology, pathophysiology, clinical presentation, and management of contrast-induced encephalopathy (CIE) following cardiac catheterization. BACKGROUND: CIE is an acute, reversible neurological disturbance directly attributable to the intra-arterial administration of iodinated contrast medium. METHODS: The PubMed database was searched and all cases in the literature were retrieved and reviewed. RESULTS: 52 reports of CIE following cardiac catheterization were found...
November 29, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27848280/intra-arterial-thrombolysis-of-digital-artery-occlusions-in-a-patient-with-polycythemia-vera
#4
Philipp Jud, Franz Hafner, Thomas Gary, Leyla Ghanim, Rainer Lipp, Marianne Brodmann
There are limited therapeutic options for the resolution of digital artery occlusions. Intra-arterial thrombolysis with anticoagulative and thrombolytic drugs successfully restored the blood flow in the affected digital arteries.
November 18, 2016: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/27847771/emergent-double-barrel-bypass-shortly-after-intravenous-administration-of-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke
#5
Joon-Ho Choi, Hyun-Seok Park
Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27803392/selecting-patients-for-intra-arterial-therapy-in-the-context-of-a-clinical-trial-for-neuroprotection
#6
Patrick Lyden, Sara Weymer, Chris Coffey, Merit Cudkowicz, Samantha Berg, Sarah O'Brien, Marc Fisher, E Clarke Haley, Pooja Khatri, Jeff Saver, Steven Levine, Howard Levy, Marilyn Rymer, Lawrence Wechsler, Ashutosh Jadhav, Elizabeth McNeil, Salina Waddy, Kent Pryor
BACKGROUND AND PURPOSE: The advent of intra-arterial neurothrombectomy (IAT) for acute ischemic stroke opens a potentially transformative opportunity to improve neuroprotection studies. Combining a putative neuroprotectant with recanalization could produce more powerful trials but could introduce heterogeneity and adverse event possibilities. We sought to demonstrate feasibility of IAT in neuroprotectant trials by defining IAT selection criteria for an ongoing neuroprotectant clinical trial...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27789150/a-case-of-contrast-leakage-mimicking-intraventricular-hemorrhage-in-a-patient-with-intravenous-thrombolysis
#7
Min-Gyu Park, Min-Kyeung Kim, Baik-Kyun Kim, Seung Kug Baik, Kyung-Pil Park
Contrast leakage on non-enhanced brain computed tomography (CT) is a common phenomenon after diagnostic or interventional cerebral angiography in patients with acute ischemic stroke. Contrast leakage is known to be related to the loosening of the blood-brain barrier. Sometimes, the contrast leakage on non-enhanced brain CT has been mistaken for intracranial hemorrhage. Differentiating the contrast leakage from the intracranial hemorrhage on non-enhanced brain CT is a very important issue, because subsequent treatment after intravenous thrombolysis (IVT) or intra-arterial thrombolysis would depend on the result of brain CT after thrombolysis...
October 24, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27781043/treatment-strategies-for-acute-ischemic-stroke-caused-by-carotid-artery-occlusion
#8
REVIEW
Wei Li, Qin Yin, Gelin Xu, Xinfeng Liu
Background: Acute ischemic stroke caused by internal carotid artery (ICA) occlusion usually has a poor prognosis, especially the T occlusion cases without functional collaterals. The efficacy of intravenous (IV) or intra-arterial (IA) thrombolysis with recombinant tissue plasminogen activator (rt-PA) remains ambiguous in these patients. Eendovascular recanalization of the occluded carotid has been attempted in recent years as a potential strategy. However, the different etiologies of ICA occlusion pose a significant challenge to neurointerventionists...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27781041/visual-improvement-after-intra-arterial-thrombolysis-for-central-retinal-artery-occlusion-does-not-correlate-with-time-to-treatment
#9
Paul S Page, Alexander C Cambon, Robert F James
BACKGROUND: Intra-arterial thrombolysis (IAT) for the treatment of acute central retinal artery occlusion (CRAO) has demonstrated variable results for improving visual acuity and remains controversial. Despite limited evidence, time from symptom onset to thrombolysis is believed to be an important factor in predicting visual improvement after IAT. METHODS: A comprehensive review of the literature was conducted and individual subject level data were extracted from relevant studies...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27781037/rescue-thrombectomy-in-large-vessel-occlusion-strokes-leads-to-better-outcomes-than-intravenous-thrombolysis-alone-a-real-world-applicability-of-the-recent-trials
#10
Raul G Nogueira, Osama O Zaidat, Alicia C Castonguay, Diogo C Haussen, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Tim W Malisch, Franklin A Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael T Froehler, Aamir Badruddin, Thanh N Nguyen, M Asif Taqi, Michael G Abraham, Vallabh Janardhan, Albert J Yoo, Hashem Shaltoni, Alex Abou-Chebl, Peng R Chen, Gavin W Britz, Roberta Novakovic, Ashish Nanda, Ritesh Kaushal, Mohammad A Issa, Michael R Frankel, Rishi Gupta
BACKGROUND: The Interventional Management of Stroke III (IMS-III) trial demonstrated no benefit for intravenous recombinant tissue plasminogen activator (IV rt-PA) followed by endovascular therapy versus IV rt-PA alone. However, IMS-III mostly included earlier generation devices. The recent thrombectomy trials have incorporated the stent-retriever technology, but their generalizability remains unknown. METHODS: The North American Solitaire Acute Stroke (NASA) registry recruited patients treated with the Solitaire FR™ device between March 2012 and February 2013...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27769189/the-collateral-circulation-determines-cortical-infarct-volume-in-anterior-circulation-ischemic-stroke
#11
Estelle Seyman, Hilla Shaim, Shani Shenhar-Tsarfaty, Tali Jonash-Kimchi, Natan M Bornstein, Hen Hallevi
BACKGROUND: Acute ischemic stroke (AIS) is a common neurological event that causes varying degrees of disability. AIS outcome varies considerably, from complete recovery to complete loss of tissue and function. This diversity is partly explained by the compensatory ability of the collateral circulation and the ensuing cerebral flow grade. The collateral flow to the anterior circulation largely supplies the cortical areas. The deep brain tissue is supplied by penetrating arteries and has little or no collateral supply...
October 21, 2016: BMC Neurology
https://www.readbyqxmd.com/read/27758942/cost-effectiveness-of-endovascular-stroke-therapy-a-patient-subgroup-analysis-from-a-us-healthcare-perspective
#12
Wolfgang G Kunz, M G Myriam Hunink, Wieland H Sommer, Sebastian E Beyer, Felix G Meinel, Franziska Dorn, Stefan Wirth, Maximilian F Reiser, Birgit Ertl-Wagner, Kolja M Thierfelder
BACKGROUND AND PURPOSE: Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location. METHODS: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with both strategies applied in a US setting...
November 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27756804/endovascular-therapy-for-acute-ischaemic-stroke-the-pragmatic-ischaemic-stroke-thrombectomy-evaluation-piste-randomised-controlled-trial
#13
Keith W Muir, Gary A Ford, Claudia-Martina Messow, Ian Ford, Alicia Murray, Andrew Clifton, Martin M Brown, Jeremy Madigan, Rob Lenthall, Fergus Robertson, Anand Dixit, Geoffrey C Cloud, Joanna Wardlaw, Janet Freeman, Philip White
OBJECTIVE: The Pragmatic Ischaemic Thrombectomy Evaluation (PISTE) trial was a multicentre, randomised, controlled clinical trial comparing intravenous thrombolysis (IVT) alone with IVT and adjunctive intra-arterial mechanical thrombectomy (MT) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography (CTA). DESIGN: Eligible patients had IVT started within 4.5 hours of stroke symptom onset. Those randomised to additional MT underwent thrombectomy using any Conformité Européene (CE)-marked device, with target interval times for IVT start to arterial puncture of <90 min...
October 18, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27621948/mechanical-solitaire-thrombectomy-with-low-dose-booster-tirofiban-injection
#14
Duck-Ho Goh, Sung-Chul Jin, Hae Woong Jeong, Sam Yeol Ha
PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection...
September 2016: Neurointervention
https://www.readbyqxmd.com/read/27601379/influence-of-device-choice-on-the-effect-of-intra-arterial-treatment-for-acute-ischemic-stroke-in-mr-clean-multicenter-randomized-clinical-trial-of-endovascular-treatment-for-acute-ischemic-stroke-in-the-netherlands
#15
Diederik W Dippel, Charles B Majoie, Yvo B Roos, Aad van der Lugt, Robert J van Oostenbrugge, Wim H van Zwam, Hester F Lingsma, Peter J Koudstaal, Kilian M Treurniet, Lucie A van den Berg, Debbie Beumer, Puck S Fransen, Olvert A Berkhemer
BACKGROUND AND PURPOSE: Intra-arterial treatment by means of retrievable stents has been proven safe and effective. In MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the choice of the type of thrombectomy device was left to the discretion of the interventionist. The aim of this study was to explore the differences in functional outcome, neurological recovery, reperfusion, extent of infarction, and adverse events according to stent type and make...
October 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27587969/endovascular-repair-of-blunt-popliteal-arterial-injuries
#16
Shan Zhong, Xiquan Zhang, Zhong Chen, Peng Dong, Yequan Sun, Wei Zhu, Xiaolin Pan, Deming Qi
OBJECTIVE: To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. MATERIALS AND METHODS: A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up...
September 2016: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/27532477/safety-and-outcome-of-intra-arterial-treatment-for-basilar-artery-occlusion
#17
Reinier C van Houwelingen, Gert-Jan Luijckx, Aryan Mazuri, Reinoud P H Bokkers, Omid S Eshghi, Maarten Uyttenboogaart
Importance: After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO). Objective: To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome. Design, Setting, and Participants: Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center...
October 1, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27523596/thrombolysis-for-ischemic-stroke-during-pregnancy-a-case-report-and-review-of-the-literature
#18
Steven Tversky, Richard B Libman, Marina L Reppucci, Andrea M Tufano, Jeffrey M Katz
BACKGROUND AND PURPOSE: Our knowledge of the safety of thrombolytic therapy in pregnancy stems from individual case reports and series. We report the successful use of intravenous alteplase (tissue plasminogen activator; tPA) thrombolysis in a pregnant woman with acute cardioembolic stroke presumed to be paradoxical embolism through a patent foramen ovale. METHODS: A literature review found several case reports and case series of pregnant patients treated with either intravenous or intra-arterial tPA for acute ischemic stroke...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27495833/intravenous-thrombolysis-and-passes-of-thrombectomy-as-predictors-for-endovascular-revascularization-in-ischemic-stroke
#19
Anselm Angermaier, Patrik Michel, Alexander V Khaw, Michael Kirsch, Christof Kessler, Soenke Langner
BACKGROUND: Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT. METHODS: Consecutive stroke patients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27481496/day-case-treatment-of-peripheral-arterial-disease-results-from-a-multi-center-european-study
#20
Stavros Spiliopoulos, Dimitrios Karnabatidis, Konstantinos Katsanos, Athanasios Diamantopoulos, Tariq Ali, Panagiotis Kitrou, Alessandro Cannavale, Miltiadis Krokidis
PURPOSE: The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. MATERIALS AND METHODS: This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals...
December 2016: Cardiovascular and Interventional Radiology
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