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https://www.readbyqxmd.com/read/28812226/in-light-of-recently-published-clinical-trials-and-their-implication-for-clinical-practice-does-a-large-catchment-area-acute-hospital-require-24%C3%A2-hour-ct-neck-and-head-angiography-and-or-neuro-interventional-services-in-the-setting-of-acute-ischaemic-stroke
#1
REVIEW
J Halpin, C Peters, J O'Brien, T Scanlon, M Shelly, N Cunningham, L Hickey
BACKGROUND: Recently published clinical trials have resulted in a significant change in the guidelines used to manage patients suffering an acute ischaemic stroke. New neuro-interventional techniques have revolutionised stroke outcomes. Currently, such services are only available in two specialist centres. AIMS: We attempted to evaluate the need for the provision of routine computed tomography (CT) angiography and neuro-interventional services at a university teaching hospital in Limerick...
August 15, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28810647/limb-graft-occlusion-following-endovascular-aortic-repair-incidence-causes-treatment-and-prevention-in-a-study-cohort
#2
Guoquan Wang, Shuiting Zhai, Tianxiao Li, Xuan Li, Danghui Lu, Bo Wang, Dongbin Zhang, Shuaitao Shi, Zhidong Zhang, Kai Liang, Kewei Zhang, Xiaoyang Fu, Kun Li, Weixiao Li
The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28808918/idarucizumab-in-dabigatran-treated-patients-with-acute-ischemic-stroke-receiving-alteplase-a-systematic-review-of-the-available-evidence
#3
REVIEW
Slaven Pikija, Laszlo K Sztriha, J Sebastian Mutzenbach, Stefan M Golaszewski, Johann Sellner
BACKGROUND AND PURPOSE: Current guidelines do not recommend the use of intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke who receive direct oral anticoagulants. While the humanized monoclonal antibody idarucizumab can quickly reverse the anticoagulant effects of the thrombin inhibitor dabigatran, safety data for subsequent tissue plasminogen activator treatment are sparse. Here, we review current knowledge about dabigatran reversal prior to systemic reperfusion treatment in acute ischemic stroke...
August 14, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28806993/successful-intravenous-thrombolysis-for-ischemic-stroke-after-reversal-of-dabigatran-anticoagulation-with-idarucizumab-a-case-report
#4
Sergio Agosti, Laura Casalino, Enrico Rocci, Gabriele Zaccone, Eugenia Rota
BACKGROUND: Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment for immediate reversal of dabigatran-induced anticoagulation, has been introduced into the market to be used in life-threatening bleeding or urgent surgery, allowing for rapid normalization of clotting parameters. The use of idarucizumab is not yet well established in patients presenting with acute ischemic stroke on dabigatran who are candidates for thrombolytic therapy...
August 15, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28805341/treatment-options-for-severe-pulmonary-embolism-during-pregnancy-and-the-postpartum-period-a-systematic-review
#5
G Martillotti, F Boehlen, H Robert-Ebadi, N Jastrow, M Righini, M Blondon
BACKGROUND: Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. METHODS: We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or with ECMO, occurring during pregnancy or within 6 weeks of delivery...
August 14, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28804959/head-to-head-comparison-of-prasugrel-versus-ticagrelor-in-patients-undergoing-percutaneous-coronary-intervention-a-meta-analysis-of-randomized-controlled-trials
#6
Ryota Sakurai, Ivana Burazor, Heidi N Bonneau, Hideaki Kaneda
OBJECTIVES: We sought to compare the efficacy and safety of prasugrel and ticagrelor in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). BACKGROUND: Evidence from randomized head-to-head comparison between prasugrel and ticagrelor is rare regarding clinical endpoints. METHODS: PubMed, the Cochrane Library, and Web of Science were queried with the terms "prasugrel," "ticagrelor," and "randomized." Relevant randomized controlled trials (RCTs) or the same terms were also surveyed using clinicaltrials...
August 13, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28804875/prehospital-pathways-of-occipital-stroke-patients-with-mainly-visual-symptoms
#7
S Räty, K Silvennoinen, T Tatlisumak
OBJECTIVES: Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition...
August 13, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28802551/a-survey-of-submassive-pulmonary-embolism-treatment-preferences-among-medical-and-endovascular-physicians
#8
Bedros Taslakian, Daanish Chawala, Akhilesh K Sista
PURPOSE: To determine treatment preferences among endovascular and medical physicians who manage acute submassive pulmonary embolism (PE). MATERIALS AND METHODS: From July through August 2016, 83 sites across the United States were surveyed, and 60 completed the survey. Endovascular and medical physicians were asked to rate their predilection for catheter-directed thrombolysis (CDT) on a 5-point scale and for systemic thrombolysis (ST) as "yes" or "no" in seven case scenarios of submassive PE...
August 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28801387/microbubbles-and-ultrasound-accelerated-thrombolysis-must-for-peripheral-arterial-occlusions-protocol-for-a-phase-ii-single-arm-trial
#9
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/28801174/the-cerebral-collateral-circulation-relevance-to-pathophysiology-and-treatment-of-stroke
#10
REVIEW
Myron D Ginsberg
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome...
August 8, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28801136/outcomes-of-pharmacomechanical-catheter-directed-thrombolysis-for-acute-and-subacute-inferior-vena-cava-thrombosis-a-retrospective-evaluation-in-a-single-institution
#11
K Ye, J Qin, M Yin, X Liu, X Lu
OBJECTIVE/BACKGROUND: The objective was to assess the mid-term results of pharmacomechanical catheter-directed thrombolysis (PCDT) for symptomatic acute and subacute inferior vena cava (IVC) thrombosis; the risk factors of early thrombosis recurrence and iliocaval patency were also evaluated. METHODS: From January 2010 to December 2015, 54 patients (33 men; mean age 47.1 years) with symptomatic acute and subacute IVC thrombosis were treated with PCDT. Primary technical success (clot lysis ≥ 50% after PCDT), stent-assisted technical success (residual stenosis < 30% after stenting), clinical success (freedom from thrombosis recurrence within 30 days), complications, frequency of post-thrombotic syndrome (PTS; Villalta score ≥ 5), and iliocaval patency were recorded at follow-up evaluation...
August 8, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28798356/low-serum-albumin-level-as-a-predictor-of-hemorrhage-transformation-after-intravenous-thrombolysis-in-ischemic-stroke-patients
#12
Ruiwen Che, Xiaoqin Huang, Wenbo Zhao, Fang Jiang, Longfei Wu, Zhen Zhang, Tingting Bian, Qingfeng Ma, Zhipeng Yu, Qian Zhang, Kai Dong, Haiqing Song, Xunming Ji
Serum albumin levels has been shown to predict outcome in ischemic stroke patients. We aimed to investigate the relationship between serum albumin levels and hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute stroke. 428 patients receiving intravenous rt-PA therapy were included from 2013 to 2016 and were categorized into two groups: low level (<35 mmol/L) and normal level (35-55 mmol/L) group. Demographic, clinical and laboratory information, HT and functional outcomes were analyzed...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28798266/thrombectomy-of-calcified-emboli-in-stroke-does-histology-of-thrombi-influence-the-effectiveness-of-thrombectomy
#13
Tomas Dobrocky, Eike Piechowiak, Alessandro Cianfoni, Felix Zibold, Luca Roccatagliata, Pascal Mosimann, Simon Jung, Urs Fischer, Pasquale Mordasini, Jan Gralla
BACKGROUND AND PURPOSE: Thrombus composition has been postulated to affect the success of endovascular therapy. Calcified clots are composed of large amounts of calcium phosphate which influences their mechanical properties and may serve as a model for testing this hypothesis. The aim of this study was to evaluate the recanalization and complication rates of calcified thromboemboli in patients with acute ischemic stroke who underwent thrombectomy. MATERIAL AND METHODS: A retrospective analysis was performed of all calcified intracranial thromboemboli in patients suffering an acute ischemic stroke, referred for endovascular therapy at two centers between January 2013 and July 2016...
August 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28797661/patency-and-clinical-outcome-after-stent-placement-for-chronic-obstruction-of-the-inferior-vena-cava
#14
O Grøtta, T Enden, G Sandbæk, G F Gjerdalen, C-E Slagsvold, D Bay, N-E Kløw, A Rosales
OBJECTIVE/BACKGROUND: The objective was to assess the technical success, patency, and clinical outcome after stent placement for chronic obstruction of the inferior vena cava (IVC). METHODS: A retrospective analysis was carried out of patients with chronic IVC obstruction verified with computed tomography and/or magnetic resonance venography, accepted for stent placement at the Norwegian National Unit for Reconstructive Deep Venous Surgery from March 2010 to September 2015...
August 7, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28796540/recent-advances-in-targeted-delivery-of-tissue-plasminogen-activator-for-enhanced-thrombolysis-in-ischemic-stroke
#15
Masumeh Zamanlu, Mehdi Farhoudi, Morteza Eskandani, Javad Mahmoudi, Jaleh Barar, Mohammad Rafi, Yadollah Omidi
Tissue plasminogen activator (tPA) is the only FDA approved medical treatment for the ischemic stroke. However, it associates with some inevitable limitations, including: short therapeutic window, extremely short half-life and low penetration in large clots. Systemic administration (i.v./i.a.) may lead to complications such as hemorrhagic conversion in the brain and relapse in the form of re-occlusion. Furthermore, ultrasound has been utilized in combination with contrast agents, echogenic liposome, microspheres or nanoparticles carrying tPA for improving thrombolysis - an approach that has resulted in slight improvement of tPA delivery and facilitated thrombolysis...
August 10, 2017: Journal of Drug Targeting
https://www.readbyqxmd.com/read/28792139/sarpogrelate-based-triple-antiplatelet-therapy-improved-left-ventricular-systolic-function-in-acute-myocardial-infarction-retrospective-study
#16
Jae Hyuk Choi, Jung Rae Cho, Sang Min Park, Kunal Bikram Shaha, Floyd Pierres, Tserendavaa Sumiya, Kwang Jin Chun, Min Kyung Kang, Seonghoon Choi, Namho Lee
PURPOSE: The purpose of this study was to assess the potential benefit of a 5-hydroxytryptamine receptor antagonist, sarpogrelate-based triple antiplatelet therapy (TAPT) in comparison with dual antiplatelet therapy (DAPT) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: 119 patients of STEMI were retrospectively assessed. All patients received aspirin and clopidogrel per standard of care...
September 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28791192/dragon-score-predicts-functional-outcomes-in-acute-ischemic-stroke-patients-receiving-both-intravenous-tissue-plasminogen-activator-and-endovascular-therapy
#17
Arthur Wang, Noorie Pednekar, Rachel Lehrer, Akira Todo, Ramandeep Sahni, Stephen Marks, Michael F Stiefel
BACKGROUND: The DRAGON score, which includes clinical and computed tomographic (CT) scan parameters, predicts functional outcomes in ischemic stroke patients treated with intravenous tissue plasminogen activator (IV tPA). We assessed the utility of the DRAGON score in predicting functional outcome in stroke patients receiving both IV tPA and endovascular therapy. METHODS: A retrospective chart review of patients treated at our institution from February 2009 to October 2015 was conducted...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28783210/monocyte-count-at-onset-predicts-post-stroke-outcomes-during-a-90-day-follow-up
#18
Luca Liberale, Fabrizio Montecucco, Aldo Bonaventura, Ilaria Casetta, Silva Seraceni, Alessandro Trentini, Marina Padroni, Franco Dallegri, Enrico Fainardi, Federico Carbone
BACKGROUND: Acute ischemic stroke (AIS) triggers both systemic and neurovascular inflammation, influencing post-stroke recovery. In smokers with AIS inflammation might be further upregulated, increasing ischemia/reperfusion injury. Here, the predictive value of leukocyte and adhesion molecules levels on post-stroke outcomes was investigated. MATERIALS AND METHODS: 89 patients with AIS (n=30 smokers and n=59 non-smokers) were recruited and evaluated 1, 7 and 90 days after the onset to assess stroke severity by the National Institute of Health Stroke Scale (NIHSS) score as well as clinical recovery at 90 day by the modified Rankin Scale (mRS)...
August 7, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28780236/tenecteplase-versus-alteplase-for-management-of-acute-ischaemic-stroke-nor-test-a-phase-3-randomised-open-label-blinded-endpoint-trial
#19
Nicola Logallo, Vojtech Novotny, Jörg Assmus, Christopher E Kvistad, Lars Alteheld, Ole Morten Rønning, Bente Thommessen, Karl-Friedrich Amthor, Hege Ihle-Hansen, Martin Kurz, Håkon Tobro, Kamaljit Kaur, Magdalena Stankiewicz, Maria Carlsson, Åse Morsund, Titto Idicula, Anne Hege Aamodt, Christian Lund, Halvor Næss, Ulrike Waje-Andreassen, Lars Thomassen
BACKGROUND: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. METHODS: This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway...
August 2, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28777401/novel-use-of-the-clarivein%C3%A2-catheter-for-pharmacomechanical-thrombolysis-of-thrombosed-hemodialysis-grafts-a-case-series
#20
Darryl Lim, Derek C Ho, Lionel Chen, Michiel A Schreve, Yih Kai Tan, Steven Kum
INTRODUCTION: The aim of this prospectively collected case series is to demonstrate a novel technique of using the ClariVein® catheter for pharmacomechanical thrombolysis of thrombosed hemodialysis grafts. METHODS: The analysis comprised 11 procedures in 9 patients from 1 July to 31 December 2016 in which the ClariVein catheter was used in combination with urokinase. Demographic data, procedural data, technical and clinical success rates, and complications were evaluated...
July 27, 2017: Journal of Vascular Access
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