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https://www.readbyqxmd.com/read/29331961/combining-intravenous-thrombolysis-and-antithrombotic-agents-in-stroke-an-update
#1
REVIEW
Laurent Derex, Chloé Paris, Norbert Nighoghossian
No abstract text is available yet for this article.
January 13, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29329535/measurement-of-the-potential-geographic-accessibility-from-call-to-definitive-care-for-patient-with-acute-stroke
#2
J Freyssenge, F Renard, A M Schott, L Derex, N Nighoghossian, K Tazarourte, C El Khoury
BACKGROUND: The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility. METHODS: The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car...
January 12, 2018: International Journal of Health Geographics
https://www.readbyqxmd.com/read/29327997/mechanical-thrombectomy-in-basilar-artery-occlusion-influence-of-reperfusion-on-clinical-outcome-and-impact-of-the-first-line-strategy-adapt-vs-stent-retriever
#3
Benjamin Gory, Mikael Mazighi, Raphael Blanc, Julien Labreuche, Michel Piotin, Francis Turjman, Bertrand Lapergue
OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29327535/catheter-assisted-management-of-massive-pulmonary-embolism
#4
Amey Beedkar, Rohan Parikh, Bhavesh Patel, Mahendra Mhaske, Sunil Washimkar, Pradeep Deshmukh, Mukund Deshpande
Pulmonary thromboembolism is common and missed by clinicians. We report a case of massive pulmonary embolism which was life threatening treated by the catheter assisted technique. Anticoagulation is the mainstay of therapy for most patients, with thrombolytic therapy reserved for some patients.1 Recent studies have suggested a role for systemic or catheter-directed thrombolytic therapy in selected patients.2 We present a case of a patient who presented with an PE, was successfully treated with catheter-directed thrombolysis...
December 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29326820/a-case-of-intra-arterial-thrombolysis-with-alteplase-in-a-patient-with-hypothenar-hammer-syndrome-but-without-underlying-aneurysm
#5
Harshal Shukla, Vicken Yaghdjian, Issam Koleilat
Hypothenar hammer syndrome is a cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery in the setting of a complete or incomplete palmar arch. Acute occlusive thrombus or embolus of the hand represents a complex problem that often may require immediate surgical intervention. We report a case of acute unilateral arterial hand ischemia requiring catheter-directed thrombolysis with Alteplase therapy in a patient with acute occlusive arterial thrombosis of the left ulnar artery...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29322705/a-comparative-study-of-in-hospital-outcome-of-patients-with-st-segment-elevation-myocardial-infarction-with-and-without-diabetes-mellitus-after-thrombolytic-therapy-in-government-hospital-of-rajkot-gujarat-india
#6
Varshit Hathi, Meghal Anadkat
Background: Diabetes mellitus is considered as a major health problem and an epidemic throughout the world. The mortality of patients with diabetes is almost twice that of non-diabetic. The outcome of in-hospital patients with myocardial infarction with and without diabetes after thrombolytic therapy is presented here. Aim: To compare the outcome of patients with myocardial infarction after thrombolysis in diabetics and non-diabetics in government hospital of Rajkot, India...
November 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29322481/influence-of-thrombolysis-on-the-safety-and-efficacy-of-blocking-platelet-adhesion-or-secretory-activity-in-acute-ischemic-stroke-in-mice
#7
Michael K Schuhmann, Peter Kraft, Michael Bieber, Axel Haarmann, György A Homola, Mirko Pham, Bernhard Nieswandt, Guido Stoll
In acute ischemic stroke (AIS), there is an alarming discrepancy between recanalization rates of up to 70% by combined recombinant tissue-type plasminogen activator (rt-PA) therapy and mechanical thrombectomy, and no clinical benefit in at least every second stroke patient. This is partly due to ischemia/reperfusion (I/R) injury. In a translational approach, we used mice lacking dense- (Unc13d -/- ) or α-granules (Nbeal2 -/- ) and mice after blocking of platelet glycoprotein receptor (GP) Ib conferring protection from I/R injury...
January 10, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29322434/protection-from-reperfusion-injury-with-intracoronary-n-acetylcysteine-in-patients-with-stemi-undergoing-primary-percutaneous-coronary-intervention-in-a-cardiac-tertiary-center
#8
Younes Nozari, Azadeh Eshraghi, Azita Hajhossein Talasaz, Mostafa Bahremand, Jamshid Salamzadeh, Mojtaba Salarifar, Hamidreza Pourhosseini, Arash Jalali, Seyedeh Hamideh Mortazavi
BACKGROUND: Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this. OBJECTIVES: Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury. METHODS: We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose)...
January 10, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29322232/mechanical-thrombectomy-using-the-new-solitaire%C3%A2-platinum-stent-retriever-reperfusion-results-complication-rates-and-early-neurological-outcome
#9
Johannes Pfaff, Stefan Rohde, Tobias Engelhorn, Arnd Doerfler, Martin Bendszus, Markus Alfred Möhlenbruch
BACKGROUND AND PURPOSE: The application of radiopaque markers to the Solitaire™ stent-retriever for better visibility during mechanical thrombectomy (MT) has the potential to alter the well-known characteristics of the device; however, it is uncertain whether this adjustment influences efficacy or safety of the enhanced stent-retriever. METHODS: Retrospective analysis of stroke databases of three comprehensive stroke centers. Our investigation was focused on technical and angiographic parameters, including procedure times, reperfusion results (thrombolysis in cerebral infarction, TICI), periprocedural complications and favorable early neurological recovery at discharge (modified Rankin scale ≤2 or National Institutes of Health Stroke Scale, NIHSS = 0 or ∆NIHSS ≥ 10), from consecutive patients with acute anterior circulation ischemic stroke treated with a Solitaire™ Platinum stent-retriever between October 2016 and March 2017...
January 10, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29321338/improving-access-to-thrombolysis-and-inhospital-management-times-in-ischemic-stroke-a-stepped-wedge-randomized-trial
#10
Julie Haesebaert, Norbert Nighoghossian, Catherine Mercier, Anne Termoz, Sylvie Porthault, Laurent Derex, Pierre-Yves Gueugniaud, Estelle Bravant, Muriel Rabilloud, Anne-Marie Schott
BACKGROUND AND PURPOSE: A suboptimal number of ischemic stroke patients eligible for thrombolysis actually receive it, partly because of extended inhospital delays. We developed a comprehensive program designed for emergency unit staff and evaluated its effectiveness for reducing intrahospital times and improving access to thrombolysis. METHODS: We conducted a randomized stepped-wedge controlled trial in 18 emergency unit. The sequentially implemented training intervention, targeting emergency physicians and nurses, was based on specifically designed videos and interactive simulation workshops on intrahospital management optimization...
January 10, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29320987/effect-of-intracoronary-agents-on-the-no-reflow-phenomenon-during-primary-percutaneous-coronary-intervention-in-patients-with-st-elevation-myocardial-infarction-a-network-meta-analysis
#11
Xiaowei Niu, Jingjing Zhang, Ming Bai, Yu Peng, Shaobo Sun, Zheng Zhang
BACKGROUND: Despite the restoration of epicardial flow after primary percutaneous coronary intervention (PPCI), myocardial reperfusion remains impaired in a significant proportion of patients. We performed a network meta-analysis to assess the effect of 7 intracoronary agents (adenosine, anisodamine, diltiazem, nicorandil, nitroprusside, urapidil, and verapamil) on the no-reflow phenomenon in patients with ST-elevation myocardial infarction (STEMI) undergoing PPCI. METHODS: Database searches were conducted to identify randomized controlled trials (RCTs) comparing the 7 agents with each other or with standard PPCI...
January 10, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29320558/thrombolysis-in-stroke-patients-comparability-of-point-of-care-versus-central-laboratory-international-normalized-ratio
#12
Ramona C Dolscheid-Pommerich, Sarah Dolscheid, Lars Eichhorn, Birgit Stoffel-Wagner, Ingo Graeff
BACKGROUND: In acute stroke patients, thrombolysis is one gold standard therapy option within the first four hours after the ischemic event. A contraindication for thrombolysis is an International Normalized Ratio (INR) value >1.7. Since time is brain, rapid and reliable INR results are fundamental. Aim was to compare INR values determined by central laboratory (CL) analyzer and Point-of-Care Testing(POCT)-device and to evaluate the quality of POCT performance in cases of potential therapeutic thrombolysis at a certified stroke unit...
2018: PloS One
https://www.readbyqxmd.com/read/29319779/recovery-of-renal-function-after-bilateral-renal-vein-thrombo-sis-episode-as-complication-of-membranous-glomerulopa-thy-case-report
#13
Ana Larissa Pedrosa Ximenes, Elizabeth De Francesco Daher, Pedro Duarte Barreto Castillo, Francisco Eduardo Siqueira da Rocha, Camila Freire Salem de Miranda, Flavio Bezerra de Araujo
Renal vein thrombosis (RVT) is a complication often associated with nephrotic syndrome. It occurs due to a state of hypercoagulability common in the diseases that attend to this syndromic diagnosis. It should be suspected whenever there is nephrotic syndrome associated with sudden flank pain, hematuria and worsening of proteinuria. Bilateral RVT also presents with frequently oliguric renal dysfunction. This case reports a 33-year-old patient hospitalized for a nephrotic syndrome, with etiologic investigation suggestive of primary membranous glomerulopathy, which evolved with bilateral RVT associated with deterioration of renal function and need for renal replacement therapy...
October 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/29319407/malpractice-litigation-in-acute-stroke-care-where-are-we-now
#14
Gilberto Kk Leung, Gerard Porter
Acute stroke care has undergone momentous changes in recent years with the introduction of intravenous thrombolysis, mechanical thrombectomy and integrated stroke services. While these are welcome developments, they also carry unique medico-legal challenges. In 2015, a patient from Greater Manchester was awarded over £1 million in compensation after ambulance paramedics failed to admit her to a specialist unit. This paper explores the medico-legal implications of this first but over looked thrombolysis-related claim in the United Kingdom...
January 1, 2018: Medico-legal Journal
https://www.readbyqxmd.com/read/29317364/early-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-in-asian-patients-a-single-centre-study
#15
Prakash Paliwal, Farasat Kazmi, Hock Luen Teoh, Leonard Ll Yeo, Raymond Cs Seet, Tseng Tsai Yeo, Lwin Sein, Ning Chou, Thomas Tch, Bernard Pl Chan, Vijay K Sharma
INTRODUCTION: Early Decompression craniectomy(within 48-hours of stroke-onset) in acute and malignant middle cerebral artery(MCA) ischemic stroke(IS) reduces mortality and increases the proportion of patients with favourable functional outcome. Various cultural and social issues anong Asians lead to some differences in clinical practice specially when surgical interventions are involved. Accordingly decompressive craniectomy in Asian stroke patients is often delayed. MATERIALS & METHODS: Data for all acute IS patients hospitalized to our center were entered into a prospectively maintained registry...
January 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29316375/selection-criteria-for-endovascular-therapy-for-acute-ischaemic-stroke-are-patients-missing-out
#16
Julian Maingard, Leonid Churilov, Peter Mitchell, Richard Dowling, Bernard Yan
INTRODUCTION: Endovascular clot retrieval (ECR) following intravenous thrombolysis is superior to intravenous thrombolysis alone for acute stroke with large vessel occlusion. However, trial selection criteria may exclude potentially salvageable patients. We investigated the impact of published selection criteria on the different proportions of patients excluded and clinical outcome. METHODS: We included patients with anterior circulation stroke treated with ECR from a single centre...
January 9, 2018: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29314208/pretreatment-lesional-volume-impacts-clinical-outcome-and-thrombectomy-efficacy
#17
Yu Xie, Catherine Oppenheim, Francis Guillemin, Vincent Gautheron, Benjamin Gory, Hélène Raoult, Sébastien Soize, Jacques Felblinger, Gabriela Hossu, Serge Bracard
OBJECTIVE: We aimed to characterize the association between pretreatment lesional volume measured on diffusion-weighted images and functional outcome, and estimate the impact on thrombectomy efficacy for ischemic stroke with anterior proximal intracranial arterial occlusion. METHODS: Anterior circulation ischemic stroke patients who had pretreatment diffusion-weighted imaging in the THRACE study were included. Lesional volume was semi-automatically segmented. Logistic regression was applied to model clinical outcome as a function of lesional volume...
January 3, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29313576/pharmacological-reperfusion-therapy-with-tenecteplase-in-7-668-indian-patients-with-st-elevation-myocardial-infarction-a-real-world-indian-experience
#18
S S Iyengar, Tiny Nair, Jagdish Hiremath, Anjan Lal Dutta, Uday Jadhav, V K Katyal, Dayanand Kumbla, Immaneni Sathyamurthy, R K Jain, M Srinivasan, Prasant Kr Sahoo
Objective: This real-world, observational, prescription event monitoring study was conducted to evaluate safety and efficacy of indigenous tenecteplase (TNK-tPA) in Indian patients presenting with ST elevation myocardial infarction (STEMI). Methods: This is a multi-centric, observational, prescription event monitoring study. Data was collected for 7,668 patients from 1,307 investigator sites across India from January 2011 to February 2016. Results: Overall, 76...
September 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29313057/regional-differences-in-thrombectomy-rates-secondary-use-of-billing-codes-in-the-miracum-medical-informatics-for-research-and-care-in-university-medicine-consortium
#19
Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach
BACKGROUND AND PURPOSE: Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS: Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines...
January 8, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29311264/starting-sich-nomogram-to-predict-symptomatic-intracerebral-hemorrhage-after-intravenous-thrombolysis-for-stroke
#20
Manuel Cappellari, Gianni Turcato, Stefano Forlivesi, Cecilia Zivelonghi, Paolo Bovi, Bruno Bonetti, Danilo Toni
BACKGROUND AND PURPOSE: Symptomatic intracerebral hemorrhage (sICH) is a rare but the most feared complication of intravenous thrombolysis for ischemic stroke. We aimed to develop and validate a nomogram for individualized prediction of sICH in intravenous thrombolysis-treated stroke patients included in the multicenter SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register). METHODS: All patients registered in the SITS-ISTR by 179 Italian centers between May 2001 and March 2016 were originally included...
January 8, 2018: Stroke; a Journal of Cerebral Circulation
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