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https://www.readbyqxmd.com/read/29140185/thrombolysis-improving-door-to-needle-times-for-ischemic-stroke-treatment-a-narrative-review
#1
Noreen Kamal, Eric E Smith, Thomas Jeerakathil, Michael D Hill
Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29137770/numerical-investigation-of-the-inertial-cavitation-threshold-under-multi-frequency-ultrasound
#2
Dingjie Suo, Bala Govind, Shengqi Zhang, Yun Jing
Through the introduction of multi-frequency sonication in High Intensity Focused Ultrasound (HIFU), enhancement of efficiency has been noted in several applications including thrombolysis, tissue ablation, sonochemistry, and sonoluminescence. One key experimental observation is that multi-frequency ultrasound can help lower the inertial cavitation threshold, thereby improving the power efficiency. However, this has not been well corroborated by the theory. In this paper, a numerical investigation on the inertial cavitation threshold of microbubbles (MBs) under multi-frequency ultrasound irradiation is conducted...
March 2018: Ultrasonics Sonochemistry
https://www.readbyqxmd.com/read/29137061/low-free-triiodothyronine-levels-predict-symptomatic-intracranial-hemorrhage-and-worse-short-term-outcome-of-thrombolysis-in-patients-with-acute-ischemia-stroke
#3
Mingjing Qiu, Min Fang, Xueyuan Liu
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29136204/thrombolysis-is-an-independent-risk-factor-for-poor-outcome-after-carotid-revascularization
#4
Ananth K Vellimana, Chad W Washington, Chester K Yarbrough, Thomas K Pilgram, Brian L Hoh, Colin P Derdeyn, Gregory J Zipfel
BACKGROUND: Thrombolysis is the standard of care for acute ischemic stroke patients presenting in the appropriate time window. Studies suggest that the risk of recurrent ischemia is lower if carotid revascularization is performed early after the index event. The safety of early carotid revascularization in this patient population is unclear. OBJECTIVE: To evaluate the safety of carotid revascularization in patients who received thrombolysis for acute ischemic stroke...
November 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29136121/mechanical-thrombectomy-for-acute-ischemic-stroke-secondary-to-infective-endocarditis
#5
Juan Ambrosioni, Xabier Urra, Marta Hernández-Meneses, Manel Almela, Carlos Falces, Adrian Tellez, Eduard Quintana, David Fuster, Elena Sandoval, Barbara Vidal, Jose M Tolosana, Asunción Moreno, Angel Chamorro, José M Miró
Intravenous thrombolysis is contraindicated in acute ischemic stroke secondary to infective endocarditis. We report our initial experience of six cases with proximal vessel occlusion treated with mechanical thrombectomy. It was safe (no bleeding) and effective (significant, early neurological improvement) and might therefore be useful in this clinical setting.
November 9, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29134925/effects-of-ssri-exposure-on-hemorrhagic-complications-and-outcome-following-thrombolysis-in-ischemic-stroke
#6
Schellen Christoph, Ferrari Julia, Lang Wilfried, Sykora Marek
Background Selective serotonin reuptake inhibitors (SSRI) may interfere with platelet function, and pre-stroke SSRI treatment has been associated with increased hematoma volumes and mortality in hemorrhagic stroke patients. The effects of SSRI on the risk of hemorrhagic complications after thrombolysis in ischemic stroke patients are unclear. Aims To examine the effects of pre-stroke SSRI exposure on bleeding complications, functional outcome, and mortality following thrombolysis in ischemic stroke. Methods Data including standard demographic and clinical variables as well as baseline and follow-up stroke severity (measured by National Institutes of Health Stroke Score), functional outcome (measured by modified Rankin Scale) at 3 months, and mortality at 7 and 90 days were extracted from the Virtual International Stroke Trials Archive...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29133351/efficacy-and-safety-outcomes-of-recanalisation-procedures-in-patients-with-acute-symptomatic-pulmonary-embolism-systematic-review-and-network-meta-analysis
#7
David Jimenez, Carlos Martin-Saborido, Alfonso Muriel, Javier Zamora, Raquel Morillo, Deisy Barrios, Frederikus A Klok, Menno V Huisman, Victor Tapson, Roger D Yusen
BACKGROUND: We aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE. METHODS: We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation...
November 13, 2017: Thorax
https://www.readbyqxmd.com/read/29132407/frequency-and-determinants-for-hemorrhagic-transformation-of-posterior-cerebral-stroke-posterior-ischemic-stroke-and-hemorrhagic-transformation
#8
Francesca Valentino, Luana Gentile, Valeria Terruso, Sergio Mastrilli, Paolo Aridon, Paolo Ragonese, Caterina Sarno, Giovanni Savettieri, Marco D'Amelio
BACKGROUND: hemorrhagic transformation is a threatening ischemic stroke complication. Frequency of hemorrhagic transformation differs greatly among studies, and its risk factors have been usually studied in patients with anterior ischemic stroke who received thrombolytic therapy. We evaluated, in a hospital-based series of patients with posterior ischemic stroke not treated with thrombolysis, frequency and risk factors of hemorrhagic transformation. Patients with posterior circulation stroke were seen in our Department during the period January 2004 to December 2009...
November 13, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29132220/catheter-directed-thrombolysis-versus-standard-anticoagulation-for-acute-lower-extremity-deep-vein-thrombosis-a-meta-analysis-of-clinical-trials
#9
Yongming Lu, Linyi Chen, Jinhui Chen, Tao Tang
Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29132090/the-potential-use-of-transdermal-drug-delivery-for-the-prophylaxis-and-management-of-stroke-and-coronary-artery-disease
#10
REVIEW
Kevin Ita
In 2013, cardiovascular disease was responsible for 30.8% (800,937) of all 2,596,993 deaths, or approximately 1 of every 3 deaths while stroke caused about 1 of every 20 deaths in the United States [1]. To put it in context, about 795,000 people continue to have a new or recurrent stroke (ischemic or hemorrhagic) [1] in the USA. Mechanical vascular recanalization and thrombolysis with tissue plasminogen activator are the only clinically useful approaches available now for the management of ischemic stroke [2]...
June 4, 2017: Pharmacological Reports: PR
https://www.readbyqxmd.com/read/29131095/intracranial-internal-carotid-artery-wall-calcification-in-ischemic-strokes-treated-with-thrombolysis
#11
Miguel Tábuas-Pereira, João Sargento-Freitas, Fernando Silva, Joana Parra, Patrícia Mendes, Vera Seara, Miguel Mesquita, Mariana Baptista, Gustavo Cordeiro, Luis Cunha
BACKGROUND: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. OBJECTIVES: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death...
November 13, 2017: European Neurology
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#12
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/29129254/does-renal-function-affect-the-efficacy-or-safety-of-a-pharmacoinvasive-strategy-in-patients-with-st-elevation-myocardial-infarction-a-meta-analysis
#13
Juan J Russo, Shaun G Goodman, Warren J Cantor, Dennis T Ko, Akshay Bagai, Mary K Tan, Carlo Di Mario, Sigrun Halvorsen, Michel Le May, Francisco Fernandez-Avilés, Bruno Scheller, Paul W Armstrong, Francesco Borgia, Federico Piscione, Pedro L Sanchez, Andrew T Yan
BACKGROUND: The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established. METHODS: Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1...
November 2017: American Heart Journal
https://www.readbyqxmd.com/read/29128608/a-retrospective-comparison-of-survivors-and-non-survivors-of-massive-pulmonary-embolism-receiving-veno-arterial-extracorporeal-membrane-oxygenation-support
#14
Bennet George, Marc Parazino, Hesham R Omar, George Davis, Maya Guglin, John Gurley, Susan Smyth
INTRODUCTION: While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE. The purpose of this project was to evaluate ECMO-treated patients with massive PE at an academic medical center and report shortterm mortality outcomes...
November 8, 2017: Resuscitation
https://www.readbyqxmd.com/read/29128156/utility-of-a-power-aspiration-based-extraction-technique-as-an-initial-and-secondary-approach-in-the-treatment-of-peripheral-arterial-thromboembolism-results-of-the-multicenter-prism-trial
#15
Richard R Saxon, James F Benenati, Corey Teigen, George L Adams, Luke E Sewall
PURPOSE: To investigate the safety and initial efficacy of XTRACT, a power aspiration-based extraction technique for treatment of peripheral arterial thromboembolism with the use of the Penumbra/Indigo system. MATERIALS AND METHODS: A total of 79 patients were enrolled: 39 (49.4%) underwent XTRACT as the initial therapy and 40 (50.6%) underwent XTRACT after failed catheter-directed thrombolysis or other mechanical intervention or for removal of distal emboli that occurred during an intervention...
November 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29128152/intravenous-thrombolytic-therapy-for-acute-anterior-ischemic-stroke-experience-at-the-french-military-teaching-hospital-in-toulon-from-2003-to-2014
#16
P Sahuc-Rodrigues, E Sagui, D Wybrecht, J-B Veyrières, S Gazzola, A Dagain, J Valance, P Alla, A Faivre
INTRODUCTION: Intravenous thrombolysis with rt-PA is the key treatment for acute ischemic stroke (IS), and has largely been developed at the Military Teaching Hospital in Toulon since 2003. This report is of the results of our practices compared with those in the literature, as well as our attempts to identify factors predictive of a favorable outcome after thrombolysis. METHODS: All patients treated with rt-PA for IS in the carotid territory between 2003 and 2014 were prospectively included...
November 8, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29128044/incidence-of-left-ventricular-thrombus-in-patients-with-acute-st-segment-elevation-myocardial-infarction-treated-with-percutaneous-coronary-intervention
#17
Tiffany F Mao, Ata Bajwa, Preetham Muskula, Tina R Coggins, Kevin Kennedy, Anthony Magalski, David G Skolnick, Michael L Main
Previous studies using 2-dimensional non-contrast echocardiography have reported a post-ST segment elevation myocardial infarction (STEMI) left ventricular (LV) thrombus incidence of 3% to 24%. However, these studies were not performed with ultrasound contrast agents (UCAs), which improve accuracy in the diagnosis of LV thrombus. We aimed to determine the early incidence and clinical correlates of LV thrombus in a large consecutive cohort of patients with STEMI. This study included consecutive patients admitted to Saint Luke's Mid America Heart Institute with STEMI who also underwent early percutaneous coronary intervention (PCI) and an echocardiogram...
October 10, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29127269/intracerebral-hemorrhage-and-outcome-after-thrombolysis-in-stroke-patients-using-selective-serotonin-reuptake-inhibitors
#18
Jan F Scheitz, Guillaume Turc, Linda Kujala, Alexandros A Polymeris, Mirjam R Heldner, Thomas P Zonneveld, Hebun Erdur, Sami Curtze, Christopher Traenka, Céline Brenière, Roland Wiest, Andrea Rocco, Gerli Sibolt, Henrik Gensicke, Matthias Endres, Nicolas Martinez-Majander, Yannick Béjot, Paul J Nederkoorn, Catherine Oppenheim, Marcel Arnold, Stefan T Engelter, Daniel Strbian, Christian H Nolte
BACKGROUND AND PURPOSE: Selective serotonin-reuptake inhibitors (SSRIs) impair platelet function and have been linked to a higher risk of spontaneous intracerebral hemorrhage-an association that may be augmented by oral anticoagulants (OAC). We aimed to assess whether preadmission treatment with SSRIs in patients with acute ischemic stroke is associated with post-thrombolysis symptomatic intracerebral hemorrhage (sICH) and functional outcome. METHODS: A multicenter retrospective analysis was conducted in prospective registries of patients treated by thrombolysis within 4...
November 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29127196/mechanical-thrombectomy-for-acute-ischemic-stroke-with-occlusion-of-the-m2-segment-of-the-middle-cerebral-artery-a-meta-analysis
#19
Hamidreza Saber, Sandra Narayanan, Mohan Palla, Jeffrey L Saver, Raul G Nogueira, Albert J Yoo, Sunil A Sheth
BACKGROUND: Endovascular thrombectomy has demonstrated benefit for patients with acute ischemic stroke from proximal large vessel occlusion. However, limited evidence is available from recent randomized trials on the role of thrombectomy for M2 segment occlusions of the middle cerebral artery (MCA). METHODS: We conducted a systematic review and meta-analysis to investigate clinical and radiographic outcomes, rates of hemorrhagic complications, and mortality after M2 occlusion thrombectomy using modern devices, and compared these outcomes against patients with M1 occlusions...
November 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29127194/dump-the-pump-manual-aspiration-thrombectomy-mat-with-a-syringe-is-technically-effective-expeditious-and-cost-efficient
#20
Bradley A Gross, Ashutosh P Jadhav, Tudor G Jovin, Brian Thomas Jankowitz
INTRODUCTION: Syringe aspiration for manual aspiration thrombectomy (MAT) is a cost- and time-efficient alternative to an aspiration pump with likely similar efficacy. It is counterintuitive to expect the pump to perform better than direct vacuum with a syringe, as the pump must deliver vacuum additionally through a canister and meters of tubing. OBJECTIVE: To present in vitro and clinical results of MAT with a syringe. METHODS: An in vitro analysis was performed comparing vacuum pressures generated by syringe aspiration and with pump aspiration...
November 10, 2017: Journal of Neurointerventional Surgery
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