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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/29163743/comparison-of-endovascular-treatment-with-intravenous-thrombolysis-for-isolated-m2-segment-of-middle-cerebral-artery-occlusion-in-acute-ischemic-stroke
#1
Adnan I Qureshi, Muhammad A Saleem, Emrah Aytac
Background: The benefit of endovascular treatment for distal large artery ischemic occlusions such as M2 segment of middle cerebral artery is not clear. Methods: We retrospectively analyzed data from 51 subjects who had an isolated M2 segment occlusion on baseline computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) followed by endovascular treatment or IV rt-PA alone in a multicenter trial...
October 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/29162447/co-administration-of-liposomal-fasudil-and-tissue-plasminogen-activator-ameliorated-ischemic-brain-damage-in-occlusion-model-rats-prepared-by-photochemically-induced-thrombosis
#2
Tatsuya Fukuta, Yosuke Yanagida, Tomohiro Asai, Naoto Oku
Delivery of neuroprotectants with liposomes has been shown to be effective for the treatment of ischemic stroke. We have recently revealed that intravenous administration of liposomal fasudil (Fasudil-Lip), a Rho-kinase inhibitor, prior to thrombolysis with tissue plasminogen activator (t-PA) can extend the narrow therapeutic time window (TTW) of t-PA. In the present study, we examined the influence of t-PA treatment on liposomal accumulation into the ischemic region and cerebroprotective effect of combined treatment with Fasudil-Lip and t-PA performed at the same timing after the onset of ischemia in middle cerebral artery occlusion (MCAO) prepared by photochemically induced thrombosis...
November 18, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/29157263/ldl-receptor-blockade-reduces-mortality-in-a-mouse-model-of-ischaemic-stroke-without-improving-tissue-type-plasminogen-activator-induced-brain-haemorrhage-towards-pre-clinical-simulation-of-symptomatic-ich
#3
Be'eri Niego, Brad R S Broughton, Heidi Ho, Christopher G Sobey, Robert L Medcalf
BACKGROUND: Symptomatic intracerebral haemorrhage (sICH) following tissue-type plasminogen activator (rt-PA) administration is the most feared and lethal complication of thrombolytic therapy for ischaemic stroke, creating a significant obstacle for a broader uptake of this beneficial treatment. rt-PA also undermines cerebral vasculature stability in a multimodal process which involves engagement with LDL receptor-related protein 1 (LRP-1), potentially underlying the development of sICH...
November 21, 2017: Fluids and Barriers of the CNS
https://www.readbyqxmd.com/read/29154937/effect-of-human-recombinant-prourokinase-rhpro-uk-on-thromboembolic-stroke-in-rats
#4
Chun-Hua Hao, Wen-Xia Ding, Qian Sun, Xin-Xin Li, Wei-Ting Wang, Zhuan-You Zhao, Li-da Tang
We evaluated the efficacy and safety of human recombinant prourokinase ( rhpro-UK) on thromboembolic stroke in rats. 60 rats with thromboembolic stroke were divided into 6 groups(n=10). The model group was given saline, the reagent groups were given rhpro-UK (5, 10, 20×10(4) U/kg), and positive control groups were given urokinase (UK) 10×10(4) U/kg and recombinant tissue plasminogen activator (rt-PA) 9mg/kg through intravenous infusion at 1.5h after embolism. And other 10 rats without occluded by autologous blood clots as the sham group were given saline...
November 15, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/29153122/age-specific-cost-effectiveness-of-using-intravenous-recombinant-tissue-plasminogen-activator-for-treating-acute-ischemic-stroke
#5
Heesoo Joo, Guijing Wang, Mary G George
INTRODUCTION: Studies have demonstrated that intravenous recombinant tissue plasminogen activator (IV rtPA) is a cost-effective treatment for acute ischemic stroke. Age-specific cost effectiveness has not been well examined. This study estimated age-specific incremental cost-effectiveness ratios (ICERs) of IV rtPA treatment versus no IV rtPA. METHODS: A Markov model was developed to examine the economic impact of IV rtPA over a 20-year time horizon on four age groups (18-44, 45-64, 65-80, and ≥81 years) from the U...
December 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29146873/mobile-interventional-stroke-teams-lead-to-faster-treatment-times-for-thrombectomy-in-large-vessel-occlusion
#6
Daniel Wei, Thomas J Oxley, Dominic A Nistal, Justin R Mascitelli, Natalie Wilson, Laura Stein, John Liang, Lena M Turkheimer, Jacob R Morey, Claire Schwegel, Ahmed J Awad, Hazem Shoirah, Christopher P Kellner, Reade A De Leacy, Stephan A Mayer, Stanley Tuhrim, Srinivasan Paramasivam, J Mocco, Johanna T Fifi
BACKGROUND AND PURPOSE: Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model...
November 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29146829/is-bridging-therapy-still-required-in-stroke-due-to-carotid-artery-terminus-occlusions
#7
Romain Bourcier, Pierre-Louis Alexandre, François Eugène, Béatrice Delasalle-Guyomarch, Benoit Guillon, Basile Kerleroux, Suzana Saleme, Gaultier Marnat, Samy Boucebci, Mahmood Mirza, Jean-Christophe Ferré, Chrysanthi Papagiannaki, Hubert Desal
INTRODUCTION: Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. OBJECTIVE: To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT)...
November 16, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29146434/cerebral-hyperperfusion-syndrome-after-endovascular-reperfusion-therapy-in-a-patient-with-acute-internal-carotid-artery-and-middle-cerebral-artery-occlusions
#8
Tetsuya Hashimoto, Shoji Matsumoto, Mitsushige Ando, Hideo Chihara, Atsushi Tsujimoto, Taketo Hatano
BACKGROUND: Cerebral hyperperfusion syndrome (CHS) is known to be a rare but devastating complication of carotid artery revascularization. Because patients with acute ischemic stroke due to acute major cerebral and/or cervical artery occlusion treated with endovascular reperfusion therapy may have impaired autoregulation in the cerebral vasculature, these patients may also develop CHS. Despite the growing number of endovascular reperfusion procedures for acute ischemic stroke, this complication has only rarely been reported...
November 13, 2017: World Neurosurgery
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
#9
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/29116527/worse-outcome-in-stroke-patients-treated-with-rt-pa-without-early-reperfusion-associated-factors
#10
Ramón Iglesias-Rey, Manuel Rodríguez-Yáñez, Emilio Rodríguez-Castro, José Manuel Pumar, Susana Arias, María Santamaría, Iria López-Dequidt, Pablo Hervella, Clara Correa-Paz, Tomás Sobrino, Denis Vivien, Francisco Campos, Mar Castellanos, José Castillo
Based on preclinical studies suggesting that recombinant tissue plasminogen activator (rt-PA) may promote ischemic brain injuries, we investigated in patients the possible risk of worse clinical outcome after rt-PA treatment as a result of its inability to resolve cerebral ischemia. Here, we designed a cohort study using a retrospective analysis of patients who received treatment with intravenous (4.5-h window) or intraarterial rt-PA, without or with thrombectomy. Controls were consecutive patients who did not receive recanalization treatment, who met all inclusion criteria...
November 7, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/29114975/real-world-evidence-for-off-label-intravenous-thrombolysis-in-acute-ischemic-stroke
#11
Georgios Tsivgoulis, Vasileios-Arsenios Lioutas
The most feared complication of intravenous tissue-plasminogen-activator (tPA) delivery in patients with acute ischemic stroke (AIS) is symptomatic intracerebral hemorrhage (sICH) which has been the driver behind most of the exclusion criteria in all randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of intravenous thrombolysis (IVT) for AIS(1) . This article is protected by copyright. All rights reserved.
November 8, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29111341/low-dose-tissue-plasminogen-activator-in-acute-ischemic-stroke-a-systematic-review-and-meta-analysis
#12
Ji-Wei Cheng, Xiao-Jing Zhang, Li-Shan Cheng, Guo-Yi Li, Li-Jun Zhang, Kang-Xiang Ji, Qing Zhao, Yu Bai
BACKGROUND: Intravenous thrombolysis using tissue plasminogen activator (tPA) improves significantly the neurologic function in patients with acute ischemic stroke (AIS). However, it brings financial burden to patients and is associated with symptomatic intracranial hemorrhage (SICH). Whether low-dose tPA can effectively reduce SICH and has the same efficacy as standard-dose tPA is still controversial. METHODS: We searched for English clinical trials published before March, 2017on the comparison of the efficacy and safety between low and standard dose of tPA in the treatment of AIS using MEDLINE, Embase, and Cochrane Library...
October 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29105528/cost-effectiveness-analysis-of-tissue-plasminogen-activator-in-acute-ischemic-stroke-in-iran
#13
Asrin Amiri, Reza Goudarzi, Mohammadreza Amiresmaili, Farhad Iranmanesh
AIMS: Tissue plasminogen activator (tPA) is used to treat acute ischemic stroke up to 4.5 hours after symptom onset. Its cost-effectiveness in developing countries is not specified yet. This study aimed to study cost-effectiveness of tPA in Iran. METHODS: This is a cost-effectiveness analysis from the perspective of the third party payer to compare IV tPA with no tPA of ischemic stroke. A Markov model with a lifetime horizon was used to analyze the costs and outcomes...
November 5, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/29102234/acute-treatment-of-stroke-due-to-spontaneous-calcified-cerebral-emboli-causing-large-vessel-occlusion
#14
REVIEW
Muhammad Faraz Raghib, Johannes Sebastian Mutzenbach, Cornelia Rösler, Ferdinand Otto, Mark Mc Coy, Erasmia Müller-Thies-Broussalis, Slaven Pikija
INTRODUCTION: Calcified cerebral emboli (CCE) are rarely responsible for large vessel occlusion (LVO) in acute anterior stroke, and therefore therapeutic experience is scarce. We sought to expand current knowledge upon therapeutic options with three new cases and a review of current literature. METHODS: Systematic search of patients with acute anterior stroke due to LVO in one comprehensive stroke center throughout a 4 year period. Literature search for reported cases of CCE...
October 25, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29100857/safe-readministration-of-intravenous-thrombolysis-in-recurrent-basilar-thrombosis
#15
Alina Khan, Ahmed Itrat
We report a patient who had recurrence of stroke in the basilar artery territory because of repeat thrombosis, and was administered intravenous recombinant tissue plasminogen activator (IV-rtPA) twice within a span of 3 weeks without any adverse events, with radiological evidence of successful thrombolysis. Because of minor and improving stroke symptoms with IV-rtPA, endovascular therapy was not performed and there was radiological evidence of recanalization with IV-rtPA alone. This report adds to the very limited literature on the topic demonstrating safe and successful use of repeat IV thrombolysis following a previous recent stroke...
October 31, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29095323/thrombolytic-therapy-in-acute-ischemic-stroke-in-patients-not-fulfilling-conventional-criteria
#16
Man Sum Chi, Lok Yiu Chan
INTRODUCTION: There are many exclusion criteria in early randomized control trials for intravenous recombinant tissue plasminogen activator use in acute ischemic stroke, thus, many patients were not eligible for the treatment. OBJECTIVE: This study aimed to compare the safety and short-term treatment outcome between those who fulfilled the criteria and those who did not. METHODS: All acute ischemic stroke patients treated with intravenous thrombolysis from 2004 to 2015 in Tuen Mun hospital were recruited...
November 2017: Neurologist
https://www.readbyqxmd.com/read/29092734/predictors-of-functional-outcome-and-hemorrhagic-complications-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-retrospective-analysis%C3%A2
#17
Qinqin Zhao, Wenya Shan, Li Liu, Xuchun Fu, Ping Liu, Yunzhen Hu
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) within 4.5 hours is an effective and routine therapy for acute ischemic stroke (AIS). The purpose of the study was to identify predictors of functional outcome at 3 months and hemorrhagic complications after IVT. A total of 123 AIS patients treated with intravenous alteplase within 4.5 hours after stroke were enrolled. Baseline clinical characteristics, medication and disease history, radiographic and laboratory data were collected...
October 26, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29077175/the-important-role-of-manual-aspiration-through-the-guiding-catheter-during-repeated-solitaire-mechanical-thrombectomy-in-acute-ischemic-stroke
#18
R Xu, X-K Zhao, M-L Wang, X Liu, D Xi
OBJECTIVE: Acute ischemic stroke (AIS) is an important global health problem. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the standard treatment. However, only a small number of patients benefit from it because of strict application restrictions. Increasing evidence has demonstrated that mechanical thrombectomy is an effective and safe therapy for AIS. PATIENTS AND METHODS: We present 14 cases of successful recanalization with Solitaire devices for AIS patients after stroke onset...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29033031/the-next-challenges-for-optimal-reperfusion-in-the-era-of-mechanical-thrombectomy
#19
REVIEW
M Mazighi
The therapeutic management of acute ischemic stroke has changed tremendously over the past few years. Mechanical thrombectomy in addition to intravenous tissue plasminogen activator (t-PA) is currently the standard of care for patients experiencing acute ischemic stroke as a consequence of large vessel occlusion of the anterior circulation. Yet, despite strong evidence supporting such a therapeutic approach, several issues remain a source of debate, such as the need for intravenous t-PA, the optimal target for blood pressure levels and the opportunity for additional antithrombotic therapies to improve reperfusion...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28994833/the-efficacy-and-safety-of-endovascular-recanalization-of-occluded-large-cerebral-arteries-during-the-subacute-phase-of-cerebral-infarction-a-case-series-report
#20
Kangning Chen, Xianhua Hou, Zhenhua Zhou, Guangjian Li, Qu Liu, Li Gui, Jun Hu, Shugui Shi
BACKGROUND: Intravenous tissue plasminogen activator with or without mechanical thrombectomy during the acute phase are approved therapies for ischaemic stroke. Due to the short treatment time window (<6 hours) and often treatment failure, these patients would still have an intracranial arterial occlusion (IAO). It is unclear whether these patients can benefit from subsequent interventional recanalizationof their occluded artery in the subacute phase. In this retrospective study, we have examined the efficacy and safety in patients who have received either percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) for IAO in the subacute phase of their stroke...
September 2017: Stroke and Vascular Neurology
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