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https://www.readbyqxmd.com/read/29790991/understanding-delays-in-acute-stroke-care-a-systematic-review-of-reviews
#1
Yacine Lachkhem, Stéphane Rican, Étienne Minvielle
Background: Stroke is the leading cause of adult long-term disability in Western countries. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator is safe and effective within the first 4.5 h after the onset of stroke. Various factors delaying acute stroke care have been identified in the literature. This review aimed to provide an overview of factors delaying acute stroke care and attempted to show how they interact in a synthetic framework. Methods: We conducted a systematic review of literature reviews published in Medline and DORIS until 2016 on factors influencing acute stroke pathway timeframe...
June 1, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29788103/post-ischaemic-administration-of-the-murine-canakinumab-surrogate-antibody-improves-outcome-in-experimental-stroke
#2
Luca Liberale, Candela Diaz-Cañestro, Nicole R Bonetti, Francesco Paneni, Alexander Akhmedov, Jürg H Beer, Fabrizio Montecucco, Thomas F Lüscher, Giovanni G Camici
Aims: The CANTOS trial underscored the efficacy of selective antibody-based interleukin (IL)-1β inhibition with Canakinumab in secondary prevention of cardiovascular events. Despite the success of the trial, incidence of stroke was not reduced likely due to the low number of events and the relatively young age of patients enrolled. Given the established role of IL-1β in stroke, we tested the efficacy of the murine Canakinumab-equivalent antibody in a mouse model of ischaemic stroke...
May 16, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29787575/safety-of-intravenous-alteplase-within-4-5-hours-for-patients-awakening-with-stroke-symptoms
#3
Victor C Urrutia, Roland Faigle, Steven R Zeiler, Elisabeth B Marsh, Mona Bahouth, Mario Cerdan Trevino, Jennifer Dearborn, Richard Leigh, Susan Rice, Karen Lane, Mustapha Saheed, Peter Hill, Rafael H Llinas
BACKGROUND: Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria. METHODS: The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety trial of standard dose IV tPA in patients who presented with stroke symptoms within 0-4...
2018: PloS One
https://www.readbyqxmd.com/read/29787393/recanalization-of-chronic-occlusion-of-the-middle-cerebral-artery-with-tissue-plasminogen-activator-treatment-a-case-report
#4
Seung Jae Lee, Jin Sung Cheong, Han Uk Ryu, Hyun Goo Kang
OBJECTIVES: Patients with chronic proximal middle cerebral artery (MCA) occlusion do not present with severe symptoms, but early recanalization of acute occlusion is associated with high morbidity and mortality. Tissue plasminogen activator (tPA) is a recombinant thrombolytic agent approved for treating ischemic stroke, although only a few cases of tPA administration in chronic MCA occlusion have yielded positive results. METHODS: A 71-year-old patient had a history of right MCA territorial infarction with the occlusion occurring 12 years ago (November 2005)...
May 21, 2018: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/29773569/mobile-stroke-unit-reduces-time-to-image-acquisition-and-reporting
#5
E M Nyberg, J R Cox, R G Kowalski, D V Duarte, B Schimpf, W J Jones
Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy...
May 17, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29768935/catheter-directed-thrombolysis-with-a-continuous-infusion-of-low-dose-alteplase-for-subacute-proximal-venous-thrombosis-efficacy-and-safety-compared-to-urokinase
#6
Maofeng Gong, Xu He, Jinhua Song, Boxiang Zhao, Wanyin Shi, Guoping Chen, Jianping Gu
The purpose of this study was to compare the efficacy and safety associated with catheter-directed thrombolysis (CDT) using either recombinant tissue plasminogen activator (rt-PA) or urokinase (UK) for subacute deep venous thrombosis (DVT). From January 2014 to December 2016, we conducted a retrospective analysis on a total of 49 patients who underwent consistent CDT with either rt-PA (rt-PA-CDT group) or UK (UK-CDT group) treatment. The thrombolytic rate of the rt-PA-CDT group was significantly higher than that of the UK-CDT group (87...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29755795/double-bolus-alteplase-therapy-during-cardiopulmonary-resuscitation-for-cardiac-arrest-due-to-massive-pulmonary-embolism-guided-by-focused-bedside-echocardiography
#7
Hafiz B Mahboob, Bruce W Denney
Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR)...
2018: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29752695/sodium-tanshinone-ii-a-sulfonate-for-coronary-heart-disease-a-systematic-review-of-randomized-controlled-trials
#8
Mei-Li Yu, Si-Ming Li, Xiang Gao, Jin-Gen Li, Hao Xu, Ke-Ji Chen
OBJECTIVE: To assess whether an adjunctive therapy of Sodium Tanshinone II A Sulfonate Injection (STS) is effective and safe in improving clinical outcomes in patients with coronary heart disease (CHD). METHODS: literature search was conducted through PubMed, the Cochrane Library, Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2017...
May 11, 2018: Chinese Journal of Integrative Medicine
https://www.readbyqxmd.com/read/29749281/is-the-removal-of-a-central-venous-catheter-always-necessary-in-the-context-of-catheter-related-right-atrial-thrombosis
#9
Luigi Rossi, Pasquale Libutti, Francesco Casucci, Piero Lisi, Annalisa Teutonico, Carlo Basile, Carlo Lomonte
Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available...
May 1, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29724190/association-between-different-acute-stroke-therapies-and-development-of-post-stroke-seizures
#10
Jillian Naylor, Arthur Thevathasan, Leonid Churilov, Ruibing Guo, Yunyun Xiong, Miriam Koome, Ziyi Chen, Ziyuan Chen, Xinfeng Liu, Patrick Kwan, Bruce C V Campbell
BACKGROUND: Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up. METHODS: This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing...
May 3, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29718846/high-risk-pulmonary-embolism-assessed-by-transthoracic-echocardiography-a-case-report
#11
Jiahong Wu, Jing Zhang, Fangfang Yang, Chuanbao Li, Mei Ni
RATIONALE: Acute pulmonary embolism (APE) as a life-threatening illness may present with a wide range of manifestations. APE was diagnosed using computed tomographic pulmonary angiography (CTPA); however, transthoracic echocardiography (TTE) can reveal hemodynamic status. Early thrombolysis is the most effective therapy for the treatment of massive pulmonary embolism. PATIENTS CONCERNS: Herein, we report a case of high-risk APE with a wide range of manifestations, including chest pain, dyspnea, low-blood pressure, and syncope...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29717825/treatment-of-nonarteritic-acute-central-retinal-artery-occlusion
#12
Rahul A Sharma, Michael Dattilo, Nancy J Newman, Valerie Biousse
Central retinal artery occlusion (CRAO) is an event most often caused by an embolus originating in the ipsilateral carotid artery, aortic arch, or heart. CRAO may result from partial or complete occlusion of the central retinal artery (CRA), which acts as the primary blood supply to the inner neurosensory retina, and typically results in profound vision loss and permanent visual disability. No consensus has emerged regarding the optimal treatment of CRAO. All proposed treatments are of questionable efficacy and many have uncertain risk profiles...
May 2, 2018: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/29708218/stroke-code-simulation-benefits-advanced-practice-providers-similar-to-neurology-residents
#13
Muhib Khan, Grayson L Baird, Theresa Price, Tricia Tubergen, Omran Kaskar, Michelle De Jesus, Joseph Zachariah, Adam Oostema, Raymond Scurek, Robert R Coleman, Wendy Sherman, Cynthia Hingtgen, Tamer Abdelhak, Brien Smith, Brian Silver
Background: Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents. Methods: This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage...
April 2018: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/29707581/an-overview-of-meta-analyses-of-endovascular-bridging-therapies-for-acute-ischemic-stroke
#14
REVIEW
Si-Yan Chen, Xing-Ru Zhang, Jie Chen, Wan-Qian Ge, Wen-Wen Wang, Xin-Shi Wang, Cheng-Long Xie
Background: Acute Ischemic Stroke (AIS) is a common cause of death worldwide and the leading cause of long-term severe disability. Endovascular bridging therapies (EBT), including endovascular thrombectomy (ET) and intra-arterial thrombolytic (IAT), have been recommended to realize a favorable functional outcome for AIS patients. Methods: An overview of meta-analyses of primary randomized controlled trial (RCT) studies was performed evaluating EBT for AIS patients compared with usual care...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29707340/antiplatelet-and-anticoagulant-for-prevention-of-reocclusion-in-patients-with-atrial-fibrillation-undergoing-endovascular-treatment-for-low-extremity-ischemia
#15
Liangxi Yuan, Cheng Chen, Ziyuan Li, Guanglang Zhu, Junmin Bao, Zhiqing Zhao, Qingsheng Lu, Zaiping Jing
Background: The purpose of this study is to report the efficacy of the mono antiplatelet plus anticoagulation therapy for prevention of reocclusion in patients with atrial fibrillation (AF) undergoing endovascular treatment for lower extremity ischemia. Methods: From March 2014 to July 2016, 32 (21 males; range, 68-84 years) patients were submitted to endovascular therapy for low extremity ischemia with AF and all were treated with endovascular treatments to correct underlying lesions...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29701417/surgical-thrombectomy-fibrinolysis-angioplasty-and-stenting-a-combined-approach-for-treatment-of-a-may-thurner-syndrome-presenting-as-phlegmasia-cerulea-dolens
#16
Carlos Veiga, João Gonçalves, Pedro Sousa, Carolina Vaz, Ivone Silva, Pedro Sá-Pinto, Rui Almeida
INTRODUCTION: Phlegmasia cerulea dolens (PCD) is a rare complication of deep venous thrombosis (DVT). Massive ileo-femoral DVT is usually the cause and prompt treatment is mandatory as it represents a medical emergency. Reported amputation rates range from 12% to 25% and mortality ranges from 25% to 40%. Limb ischemia results from obstruction to arterial inflow secondary to extreme levels of venous hypertension. Primary treatment goal is restoration of venous outflow and can be achieved by endovascular or surgical techniques...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701341/outcomes-after-catheter-direct-thrombolysis-for-acute-limb-ischaemia-single-center-experience
#17
Tiago Soares, João Rocha Neves, Ricardo Castro Ferreira, Pedro Almeida, Paulo Dias, Sérgio Sampaio, José Fernando Teixeira
INTRODUCTION: The aim of this study is to evaluate the outcome of catheter directed thrombolysis (CDT) in acute lower limb ischaemia depending on the underlying etiology. METHODS: Retrospective single center analysis of electronic clinical data on patients with acute lower limb ischaemia treated with CDT. Between January 2011 and September 2017, 128 procedures in 106 patients were included. The etiology of ischaemia was native artery thrombosis in 39 procedures (30,5%), PTFE graft thrombosis in 56 (43,8%), intra-stent thrombosis in 11 (8,6%), emboly in 9 (7%), popliteal aneurysm thrombosis in 9 (7%), vein graft thrombosis in 2 (1,6%) and popliteal artery entrapment in 2 (1,6%)...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29692535/t-pa-power-pulse-spray-with-rheolytic-mechanical-thrombectomy-using-cross-sectional-image-guided-portal-vein-access-for-single-setting-treatment-of-subacute-superior-mesenteric-vein-thrombosis
#18
Mubin I Syed, Ryan M Gallagher, Rukan S Ahmed, Azim Shaikh, Edward Roberto, Sumeet Patel
Background: Isolated superior mesenteric vein (SMV) thrombosis is a rare but potentially fatal condition if untreated. Current treatments include transjugular or transhepatic approaches for rheolytic mechanical thrombectomy and subsequent infusions of thrombolytics. Tissue plasminogen activator (t-PA) power-pulse spray can provide benefit in a single setting without thrombolytic infusions. Computed tomography (CT) guidance for portal vein access is underutilized in this setting. Materials and Methods: Case 1 discusses acute SMV thrombosis treated with rheolytic mechanical thrombectomy alone using ultrasound guidance for portal vein access...
January 2018: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/29686907/diagnosis-and-thrombolytic-management-of-massive-intraoperative-pulmonary-embolism-guided-by-point-of-care-transthoracic-echocardiography
#19
Roman Dudaryk, Julio Benitez Lopez, Jack Louro
Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29683506/noncoding-rnas-in-ischemic-stroke-time-to-translate
#20
REVIEW
Harpreet Kaur, Deepaneeta Sarmah, Jackson Saraf, Kanchan Vats, Kiran Kalia, Anupom Borah, Dileep R Yavagal, Kunjan R Dave, Zhumur Ghosh, Pallab Bhattacharya
Stroke is devastating and a major cause of morbidity and mortality around globe. Current interventions for ischemic stroke include thrombolytics, clot retrieval devices and/or intravenous tissue plasminogen activators (tPA), the latter two becoming the first line of treatment. Owing to the limitations of tPA to elicit therapeutic benefits in a narrow time window, new pharmacological interventions are needed. Exploring noncoding RNAs (ncRNAs) may be a promising option for stroke treatment. ncRNAs are endogenous molecules that play key roles in the pathophysiology of many functions and diseases, including during ischemic stroke...
April 23, 2018: Annals of the New York Academy of Sciences
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