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https://www.readbyqxmd.com/read/28944694/tissue-plasminogen-activator-based-nanothrombolysis-for-ischemic-stroke
#1
Shan Liu, Xiaozhou Feng, Rong Jin, Guohong Li
Thrombolysis with intravenous tissue plasminogen activator (tPA) is the only FDA approved treatment for patients with acute ischemic stroke, but its use is limited by narrow therapeutic window, selective efficacy, and hemorrhagic complication. In the past two decades, extensive efforts have been undertaken to extend its therapeutic time window and explore alternative thrombolytic agents, but both show little progress. Nanotechnology has emerged as a promising strategy to improve the efficacy and safety of tPA...
September 23, 2017: Expert Opinion on Drug Delivery
https://www.readbyqxmd.com/read/28944131/ultrasound-assisted-catheter-directed-thrombolysis-of-acute-pulmonary-embolism-a-review-of-current-literature
#2
REVIEW
Muhammad A Mangi, Hiba Rehman, Vikas Bansal, Omer Zuberi
Pulmonary embolism continues as a very common and also presumably life-threatening disorder. For affected individuals with intermediate- as well as high-risk pulmonary embolism, catheter-based revascularization procedures have developed a possible substitute for systemic thrombolysis or for surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is an innovative catheter-based approach; which is the main purpose of the present review article. Ultrasound-assisted catheter-directed thrombolysis is much more efficacious in reversing right ventricular dysfunction as well as dilatation in comparison to anticoagulation alone in individuals at intermediate risk...
July 19, 2017: Curēus
https://www.readbyqxmd.com/read/28942971/survival-and-recurrence-after-acute-pulmonary-embolism-treated-with-pulmonary-embolectomy-in-thrombolysis-in-new-york-state-1999-to-2013
#3
Timothy Lee, Shinobu Itagaki, Yuting P Chiang, Natalia N Egorova, David H Adams, Joanna Chikwe
BACKGROUND: Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy...
August 31, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28942880/predictors-of-high-killip-class-after-st-segment-elevation-myocardial-infarction-in-the-era-of-primary-reperfusion
#4
Lourdes Vicent, Jesús Velásquez-Rodríguez, María Jesús Valero-Masa, Felipe Díez-Delhoyo, Hugo González-Saldívar, Vanessa Bruña, Carolina Devesa, Miriam Juárez, Iago Sousa-Casasnovas, Francisco Fernández-Avilés, Manuel Martínez-Sellés
BACKGROUND/INTRODUCTION: Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥II need a closer monitoring in a specialized cardiac care unit. PURPOSE: We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI. METHODS: Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28941605/prevention-of-left-ventricular-thrombus-formation-and-systemic-embolism-after-anterior-myocardial-infarction-a%C3%A2-systematic-literature-review
#5
REVIEW
Alexandra Bastiany, Marie-Eve Grenier, Alexis Matteau, Samer Mansour, Benoit Daneault, Brian J Potter
BACKGROUND: Anterior myocardial infarction (MI) with apical dysfunction is associated with an increased risk of left ventricular thrombus (LVT) formation and systemic embolism (SE). However, the role for prophylactic anticoagulation in current practice is a matter of debate. METHODS: We conducted a systematic review of peer-reviewed original articles in either English or French on the benefit of combining anticoagulation with standard therapy for the prevention of LVT/SE after MI by searching PubMed, Ovid/MedLine/Embase, the Cochrane Library, and Google Scholar...
October 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28941516/continuous-aspiration-mechanical-thrombectomy-for-the-management-of-submassive-pulmonary-embolism-a-single-center-experience
#6
Ramsey Al-Hakim, Alok Bhatt, James F Benenati
The Indigo Mechanical Thrombectomy System (Penumbra, Inc, Alameda, California) was used to treat 6 patients with submassive pulmonary embolism (PE) and a contraindication to thrombolysis. Systolic pulmonary artery pressure (58.2 mm Hg vs 43.0 mm Hg, P < .05), right ventricular/left ventricular ratio (1.7 vs 1.1, P < .05), Miller index (15.0 vs 9.8, P < 0.01), and CT obstructive index (60.4% vs 47.0%, P < .01) were significantly reduced after mechanical thrombectomy. There were no procedural or periprocedural complications...
October 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/28939674/thrombolysis-in-postoperative-stroke
#7
Nicolas Voelkel, Nikolai Dominik Hubert, Roland Backhaus, Roman Ludwig Haberl, Gordian Jan Hubert
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. METHODS: Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery...
September 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28939567/association-between-gender-and-short-term-outcome-in-patients-with-st-elevation-myocardial-infraction-participating-in-the-international-prospective-randomised-administration-of-ticagrelor-in-the-catheterisation-laboratory-or-in-the-ambulance-for-new-st-elevation
#8
Dimitrios Venetsanos, Sofia Sederholm Lawesson, Joakim Alfredsson, Magnus Janzon, Angel Cequier, Mohamed Chettibi, Shaun G Goodman, Arnoud W Van't Hof, Gilles Montalescot, Eva Swahn
OBJECTIVES: To evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI). SETTINGS: A prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery. PARTICIPANTS: Between September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included...
September 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28939303/early-partial-recanalization-after-intravenous-thrombolysis-leads-to-prediction-of-favorable-outcome-in-cases-of-acute-ischemic-stroke-with-major-vessel-occlusion
#9
Jun Young Chang, Hyun Park, Se Young Jang, Seunguk Jung, Hee-Joon Bae, O-Ki Kwon, Moon-Ku Han
We investigated the association between early recanalization degree after intravenous thrombolysis (IVT), occurrence of hemorrhagic transformation, and functional outcome. We also evaluated whether recombinant tissue plasminogen activator (rTPA) dosing error could influence the outcome. Patients with ischemic stroke with major vessel occlusion (n=256) who underwent IVT were included. Recanalization status (no recanalization, partial recanalization, and complete recanalization) was confirmed by subsequent magnetic resonance or conventional angiography...
September 19, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28939193/prognostic-impact-of-prepercutaneous-coronary-intervention-timi-flow-in-patients-with-st-segment-and-non-st-segment-elevation-myocardial-infarction-results-from-the-fast-mi-2010-registry
#10
Clotilde Bailleul, Nadia Aissaoui, Guillaume Cayla, Jean-Guillaume Dillinger, Bernard Jouve, François Schiele, Jean Ferrières, Tabassome Simon, Nicolas Danchin, Etienne Puymirat
BACKGROUND: Thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3 before percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) is associated with improved outcomes. However, no recent data are available on its impact beyond 1 year and/or by type of AMI. AIMS: To assess the prognostic impact of prePCI TIMI flow at 30 days and 3 years in patients with ST-segment elevation (STEMI) or non-ST-segment elevation (NSTEMI) AMI. METHODS: We compared long-term outcomes associated with TIMI flow grade 2/3 versus 0/1 in patients referred for PCI in the nationwide French registry of acute ST-segment elevation or non-ST-segment elevation myocardial infarction (FAST-MI) 2010...
September 19, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28938239/absence-of-a-correlation-between-the-abo-blood-group-and-thrombus-burden-in-patients-with-st-segment-elevation-myocardial-infarction
#11
Lutfu Askin, Mustafa Cetin, Serdar Turkmen
OBJECTIVE: ABO antigens are highly abundant in many human cell types, including platelets, vascular endothelium, and red blood cells. The presence of a thrombus is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). We reviewed the relationship between ABO blood groups and thrombus burden in patients with STEMI. PATIENTS AND METHODS: We carried out a retrospective study of 396 patients with STEMI who did not have an ABO blood group or thrombus burden...
September 21, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28936196/anti-inflammatory-targets-for-the-treatment-of-reperfusion-injury-in-stroke
#12
REVIEW
Atsushi Mizuma, Midori A Yenari
While the mainstay of acute stroke treatment includes revascularization via recombinant tissue plasminogen activator or mechanical thrombectomy, only a minority of stroke patients are eligible for treatment, as delayed treatment can lead to worsened outcome. This worsened outcome at the experimental level has been attributed to an entity known as reperfusion injury (R/I). R/I is occurred when revascularization is delayed after critical brain and vascular injury has occurred, so that when oxygenated blood is restored, ischemic damage is increased, rather than decreased...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28935502/outcomes-of-nonagenarians-with-acute-ischemic-stroke-treated-with-intravenous-thrombolytics
#13
Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, Catharina J M Klijn, Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli
BACKGROUND: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established. MATERIALS AND METHODS: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28933782/cardiovascular-disease-in-the-eastern-mediterranean-region-epidemiology-and-risk-factor-burden
#14
REVIEW
Karam Turk-Adawi, Nizal Sarrafzadegan, Ibtihal Fadhil, Kathryn Taubert, Masoumeh Sadeghi, Nanette K Wenger, Nigel S Tan, Sherry L Grace
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa...
September 21, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28931617/normobaric-hyperoxia-reduces-blood-occludin-fragments-in-rats-and-patients-with-acute-ischemic-stroke
#15
Shuhai Shi, Zhifeng Qi, Qingfeng Ma, Rong Pan, Graham S Timmins, Yongmei Zhao, Wenjuan Shi, Yunzhou Zhang, Xunming Ji, Ke Jian Liu
BACKGROUND AND PURPOSE: Damage of the blood-brain barrier (BBB) increases the incidence of neurovascular complications, especially for cerebral hemorrhage after tPA (tissue-type plasminogen activator) therapy. Currently, there is no effective method to evaluate the extent of BBB damage to guide tPA use. Herein, we investigated whether blood levels of tight junction proteins could serve as biomarker of BBB damages in acute ischemic stroke (AIS) in both rats and patients. We examined whether this biomarker could reflect the extent of BBB permeability during cerebral ischemia/reperfusion and the effects of normobaric hyperoxia (NBO) on BBB damage...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28930804/venous-thromboembolism-in-gynecological-malignancy
#16
Abigail Cohen, Chung Sim Lim, Alun Huw Davies
OBJECTIVE: Venous thromboembolism (VTE) is a recognized complication of gynecological malignancy and represents a leading cause of morbidity and mortality in these patients. The review aimed to discuss the incidence, risk factors, and clinical presentation of VTE before examining the literature on the diagnosis, prevention, and management in the context of uterine, cervical, ovarian, and vulval cancers. METHODS/MATERIALS: A literature search was performed using Ovid Medline and Embase with the following words: "gynecological malignancy," "pelvic tumor," "venous thromboembolism," "deep vein thrombosis" and "pulmonary embolism...
September 19, 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28928186/recombinant-human-tnk-tissue-type-plasminogen-activator-rhtnk-tpa-versus-alteplase-rt-pa-as-fibrinolytic-therapy-for-acute-st-segment-elevation-myocardial-infarction-china-tnk-stemi-protocol-for-a-randomised-controlled-non-inferiority-trial
#17
Hai-Bo Wang, Ping Ji, Xing-Shan Zhao, Haiyan Xu, Xiao-Yan Yan, Qin Yang, Chen Yao, Run-Lin Gao, Yang-Feng Wu, Shu-Bin Qiao
AIM: To evaluate the efficacy and safety of recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) in lowering major adverse cardiovascular and cerebrovascular events (MACCEs) in Chinese acute ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND ANALYSIS: The study is designed as a multicentre, randomised, controlled non-inferiority phase IV trial with balanced randomisation (1:1) in patients with STEMI. The planned sample size is 6200 participants (or 3100 per arm)...
September 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28927686/temporal-trends-in-the-levels-of-peripherally-circulating-leukocyte-subtypes-in-the-hours-after-ischemic-stroke
#18
Dipender Gill, Prasanthi Sivakumaran, Adarsh Aravind, Atisha Tank, Roshni Dosh, Roland Veltkamp
BACKGROUND: Leukocyte-mediated neuroinflammation may affect outcomes after ischemic stroke. AIMS: To explore temporal changes in levels of peripherally circulating leukocyte subtypes in the early hours after ischemic stroke in humans. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for acute ischemic stroke (AIS). Multivariable regression analysis was used to explore temporal changes in the levels of peripherally circulating leukocyte subtypes in the hours immediately after ischemic stroke...
September 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28923278/can-adjunctive-therapies-augment-the-efficacy-of-endovascular-thrombolysis-a-potential-role-for-activated-protein-c
#19
REVIEW
Arun Paul Amar, Abhay P Sagare, Zhen Zhao, Yaoming Wang, Amy R Nelson, John H Griffin, Berislav V Zlokovic
In the management of acute ischemic stroke, vessel recanalization correlates with functional status, mortality, cost, and other outcome measures. Thrombolysis with intravenous tissue plasminogen activator has many limitations that restrict its applicability, but recent advances in the development of mechanical thrombectomy devices as well as improved systems of stroke care have resulted in greater likelihood of vessel revascularization. Nonetheless, there remains substantial discrepancy between rates of recanalization and rates of favorable outcome...
September 15, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28923277/animal-models-of-ischaemic-stroke-and-characterisation-of-the-ischaemic-penumbra
#20
REVIEW
Christopher McCabe, Mariana M Arroja, Emma Reid, I Mhairi Macrae
Over the past forty years, animal models of focal cerebral ischaemia have allowed us to identify the critical cerebral blood flow thresholds responsible for irreversible cell death, electrical failure, inhibition of protein synthesis, energy depletion and thereby the lifespan of the potentially salvageable penumbra. They have allowed us to understand the intricate biochemical and molecular mechanisms within the 'ischaemic cascade' that initiate cell death in the first minutes, hours and days following stroke...
September 16, 2017: Neuropharmacology
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