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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/28730951/penumbra-and-re-canalization-acute-computed-tomography-in-ischemic-stroke-evaluation-practise-study-protocol
#1
Salwa El-Tawil, Joanna Wardlaw, Ian Ford, Grant Mair, Tom Robinson, Lalit Kalra, Keith W Muir
Rationale Multimodal imaging, including computed tomography angiography and computed tomography perfusion imaging, yields additional information on intracranial vessels and brain perfusion and can differentiate between ischemic core and penumbra which may affect patient selection for intravenous thrombolysis. Hypothesis The use of multimodal imaging will increase the number of patients receiving intravenous thrombolysis and lead to better treatment outcomes. Sample size 400 patients. Methods and design PRACTISE is a prospective, multicenter, randomized, controlled trial in which patients presenting within 4...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28730949/eric-acute-stroke-recanalization-a-study-using-predictive-analytics-to-assess-a-new-device-for-mechanical-thrombectomy
#2
Susanne Siemonsen, Nils D Forkert, Martina Bernhardt, Götz Thomalla, Martin Bendszus, Jens Fiehler
Aim and hypothesis Using a new study design, we investigate whether next-generation mechanical thrombectomy devices improve clinical outcomes in ischemic stroke patients. We hypothesize that this new methodology is superior to intravenous tissue plasminogen activator therapy alone. Methods and design ERic Acute StrokE Recanalization is an investigator-initiated prospective single-arm, multicenter, controlled, open label study to compare the safety and effectiveness of a new recanalization device and distal access catheter in acute ischemic stroke patients with symptoms attributable to acute ischemic stroke and vessel occlusion of the internal cerebral artery or middle cerebral artery...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28721332/to-stent-or-not-to-stent-a-tale-of-two-occlusions
#3
Ali S Haider, Lyndon K Lee, Tijani Osumah, Saira Alli, Umair Khan, Steven Vayalumkal, Aida Kafai Golahmadi, Richa Thakur, Phu Nguyen, Kennith F Layton
Stenting and balloon angioplasty, along with mechanical thrombectomy, have gained notability as adjunctive treatment options to intravenous tissue plasminogen activator (IV-tPA) for tandem internal carotid artery (ICA) and middle cerebral artery (MCA) occlusions (TIM occlusions). Acute ischemic strokes (AISs) secondary to TIM occlusions are associated with poor patient outcomes primarily due to low recanalization rates following intravenous thrombolysis, consequently prompting the need for more invasive recanalization efforts...
June 17, 2017: Curēus
https://www.readbyqxmd.com/read/28720659/microbleeds-cerebral-hemorrhage-and-functional-outcome-after-stroke-thrombolysis-individual-patient-data-meta-analysis
#4
Andreas Charidimou, Guillaume Turc, Catherine Oppenheim, Shenqiang Yan, Jan F Scheitz, Hebun Erdur, Pascal P Klinger-Gratz, Marwan El-Koussy, Wakoh Takahashi, Yusuke Moriya, Duncan Wilson, Chelsea S Kidwell, Jeffrey L Saver, Asma Sallem, Solene Moulin, Myriam Edjlali-Goujon, Vincent Thijs, Zoe Fox, Ashkan Shoamanesh, Gregory W Albers, Heinrich P Mattle, Oscar R Benavente, H Rolf Jäger, Gareth Ambler, Junya Aoki, Jean-Claude Baron, Kazumi Kimura, Wataru Kakuda, Shunya Takizawa, Simon Jung, Christian H Nolte, Min Lou, Charlotte Cordonnier, David J Werring
BACKGROUND AND PURPOSE: We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. METHODS: We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator...
July 18, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28706119/disparities-and-trends-in-door-to-needle-time-the-fl-pr-cresd-study-florida-puerto-rico-collaboration-to-reduce-stroke-disparities
#5
Sofia A Oluwole, Kefeng Wang, Chuanhui Dong, Maria A Ciliberti-Vargas, Carolina M Gutierrez, Li Yi, Jose G Romano, Enmanuel Perez, Brittany Ann Tyson, Maranatha Ayodele, Negar Asdaghi, Hannah Gardener, David Z Rose, Enid J Garcia, Juan Carlos Zevallos, Dianne Foster, Mary Robichaux, Salina P Waddy, Ralph L Sacco, Tatjana Rundek
BACKGROUND AND PURPOSE: In the United States, about half of acute ischemic stroke patients treated with tPA (tissue-type plasminogen activator) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (door-to-needle time [DTNT] ≤60) and 45 minutes (DTNT ≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT ≤60 and DTNT ≤45. METHODS: Among 65 654 acute ischemic stroke admissions in the National Institute of Neurological Disorders and Stroke-funded FL-PR CReSD study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) from 2010 to 2015, we included 6181 intravenous tPA-treated cases (9...
July 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28705890/mechanical-thrombectomy-of-m1-and-m2-middle-cerebral-artery-occlusions
#6
Hisham Salahuddin, Guru Ramaiah, Diana E Slawski, Julie Shawver, Mark Buehler, Syed F Zaidi, Mouhammad Jumaa
BACKGROUND: Over half of patients who receive intravenous tissue plasminogen activator for middle cerebral artery division (MCA-M2) occlusion do not recanalize, leaving a large percentage of patients who may need mechanical thrombectomy (MT). However, the outcomes of MT for M2 occlusion have not been well characterized. OBJECTIVE: To determine if MT of M2 occlusion is as safe and efficacious as current standard-of-care MT for M1 occlusions. METHODS: With institutional review board approval, we retrospectively reviewed records of 212 patients undergoing MT for isolated MCA M1 or M2 occlusions during a 36-month period (Sept 2013 to Sept 2016) at two centres...
July 13, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28702878/recent-trends-in-clot-retrieval-devices-a-review
#7
REVIEW
Aamir Hameed, Haroon Zafar, Darren Mylotte, Faisal Sharif
Stroke is the second leading cause of death worldwide and in Europe. Even with gold standard medical management of acute ischemic stroke, which is intravenous (IV) thrombolysis by administration of recombinant tissue plasminogen activator (rt-PA), the mortality rate remains the same. Intra-arterial (IA) thrombolysis therapy also did not achieve significant results and was not approved by the US Food and Drug Administration (FDA) because of limited sample size. This encouraged scientists and engineers to develop endovascular clot retrieval devices for the mechanical recanalization of the occluded arteries in stroke patients...
July 12, 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28702117/balloon-angioplasty-for-intracranial-atherosclerotic-disease-a-multicenter-study
#8
Lakshmi Sudha Prasanna Karanam, Mukesh Sharma, Anand Alurkar, Sridhar Reddy Baddam, Vijaya Pamidimukkala, Raghavasarma Polavarapu
AIM: To evaluate the role and efficacy of the balloon angioplasty in intracranial atherosclerotic disease (ICAD) in patients who presented with acute stroke due to vessel occlusion and in patients with symptomatic disease despite optimum medical management. METHODS: From 2013 to 2016, a total of 39 patients (24 males and 15 females with a mean age of 64.5 years) underwent balloon angioplasty over a period of 2 years and 8 months in three different institutions in India...
June 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/28700732/tissue-plasminogen-activator-mediates-deleterious-complement-cascade-activation-in-stroke
#9
Xue-Jun Zhao, Timothy M Larkin, Molly A Lauver, Saif Ahmad, Andrew F Ducruet
The use of intravenous tissue plasminogen activator (tPA) in the treatment of ischemic stroke is limited by its propensity to exacerbate brain edema and hemorrhage. The mechanisms underlying these deleterious effects of tPA remain incompletely understood. The purpose of this study was to delineate a pathway of tPA-mediated complement cascade activation in stroke and to determine whether complement inhibition ameliorates the adverse effects of post-ischemic tPA administration. We found that tPA promotes C3 cleavage both in vitro and in ischemic brain through a plasmin-mediated extrinsic pathway...
2017: PloS One
https://www.readbyqxmd.com/read/28692682/low-thrombin-generation-predicts-poor-prognosis-in-ischemic-stroke-patients-after-thrombolysis
#10
Renáta Hudák, Edina G Székely, Katalin R Kovács, Attila Nagy, Gergely Hofgárt, Ervin Berényi, László Csiba, János Kappelmayer, Zsuzsa Bagoly
Thrombolysis by intravenous recombinant tissue plasminogen activator (rt-PA) is an effective therapy in acute ischemic stroke (AIS). Thrombin generation test (TGT) is a global hemostasis test providing information about the speed and amount of generated thrombin in plasma. Here we aimed to find out whether results of this test before the initiation of thrombolysis might predict outcomes. Study population included 120 consecutive AIS patients, all within 4.5 hours of their symptom onset, who underwent thrombolysis by rt-PA...
2017: PloS One
https://www.readbyqxmd.com/read/28691864/outcomes-following-telestroke-assisted-thrombolysis-for-stroke-in-ontario-canada
#11
Joan Porter, Ruth E Hall, Moira K Kapral, Jiming Fang, Ferhana Khan, Frank L Silver
Introduction Since 2002, the Ontario Telestroke Program has provided hospitals in under-served regions of the province the opportunity to offer intravenous thrombolysis with tissue plasminogen activator (IV tPA) to eligible patients. The purpose of this study was to determine whether telestroke-assisted IV tPA patients had similar risks of 7- and 90-day mortality, symptomatic intracerebral haemorrhage (sICH), and poor functional outcome compared to patients who received IV tPA with on-site expertise. Methods Data from two audits of patients with acute ischaemic stroke hospitalized in Ontario, Canada in 2010 and 2012 were analysed...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/28690532/safe-intravenous-thrombolysis-after-traumatic-cardiopulmonary-resuscitation-with-rib-fractures-a-case-report
#12
Andrea Dressing, Zina Graeter, Juergen Bardutzky
We report a case of successful intravenous thrombolysis for a distal middle cerebral artery occlusion shortly after traumatic cardiopulmonary resuscitation due to an episode of ventricular tachycardia. A high prevalence of fatal cardiac arrhythmias in acute stroke patients raises the question of safety when administrating thrombolytic therapy after traumatic cardiopulmonary resuscitation; guidelines do not provide a satisfactory statement about this. Our case suggests that intravenous tissue-type plasminogen activator for acute ischemic stroke can be administered after a thorough risk-to-benefit evaluation without major adverse effects in patients after traumatic cardiopulmonary resuscitation, as bleeding complications seem rare and can be monitored and treated...
May 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28689999/real-world-outcomes-of-acute-ischemic-stroke-treatment-with-intravenous-recombinant-tissue-plasminogen-activator
#13
Keith A Betts, Dana Hurley, Jinlin Song, Gautam Sajeev, Jenny Guo, Ella Xiaoyan Du, Marco Paschoalin, Eric Q Wu
BACKGROUND AND PURPOSE: In clinical trials, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) reduces the likelihood of disability if given within 3 hours of acute ischemic stroke. This study compared real-world outcomes between patients treated and patients not treated with IV rt-PA. METHODS: In this retrospective study, United States-based neurologists randomly selected eligible acute ischemic stroke patients from their charts who were and were not treated with IV rt-PA...
July 6, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28679847/safety-outcomes-after-thrombolysis-for-acute-ischemic-stroke-in-patients-with-recent-stroke
#14
Alexander E Merkler, Setareh Salehi Omran, Gino Gialdini, Michael P Lerario, Shadi Yaghi, Mitchell S V Elkind, Babak B Navi
BACKGROUND AND PURPOSE: It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes. METHODS: Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality...
July 5, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28678211/incidence-and-impact-of-stroke-during-hajj-results-of-2015-hajj-stroke-registry
#15
Mohammed A Almekhlafi, Maher A Alhazmi, Sarah S Alsulami, Soha A Almorsy
OBJECTIVE: To investigate the incidence of stroke among pilgrims and describe factors associated with presentation and management during Hajj. Physical stress, age and vascular risk factors render pilgrims at a high risk of stroke. METHODS: This is a prospective registry of all acute stroke patients admitted to 6 hospitals during the 2015 Hajj season from 9 September to 4 November. Participating hospitals were King Abdullah Medical City (KAMC), Al-Noor, King Abdulaziz hospital, King Faisal hospital, Hira, and Mena general hospitals; all in Makkah city...
July 2017: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
https://www.readbyqxmd.com/read/28673809/intravenous-thrombolysis-for-acute-ischemic-stroke-in-patients-with-cervicocephalic-dolichoarteriopathy
#16
Rahsan Gocmen, Ethem Murat Arsava, Kader Karli Oguz, Mehmet Akif Topcuoglu
BACKGROUND AND PURPOSE: Cervicocephalic dolichoarteriopathy is not rare in patients with acute stroke. Results of intravenous (IV) tissue plasminogen activator (tPA) treatment have not been documented in this specific population. METHODS: One hundred (58 females, age: 69 ± 13 years) consecutive patients treated with IV tPA for acute anterior circulation stroke were analyzed. Smoker's criteria were used to score basilar artery dolichoarteriopathy and combined criteria of Weibel-Fields and Metz for cervical carotid artery dolichoarteriopathy...
June 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28663010/intravenous-fibrinolysis-in-ischemic-stroke-of-large-vessel-after-reversing-effect-of-dabigatran-with-idarucizumab
#17
Gary Alvarez Bravo, Emilio Orts Castro, Guilherme Carvalho Monteiro, Ignacio López Zuazo
Currently the use of idarucizumab to reverse the effect of dabigatran emerges as a possibility of treatment for those patients who present with an ischemic stroke despite taking this anticoagulant. We present our experience regarding the use of intravenous tissue plasminogen activator in a patient with ischemic stroke due to complete occlusion of the left middle cerebral artery after blocking the effect of dabigatran with idarucizumab and whose result was an almost total improvement of the neurologic deficit...
June 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28662192/the-risk-of-intravenous-thrombolysis-induced-intracranial-hemorrhage-in-taiwanese-patients-with-unruptured-intracranial-aneurysm
#18
Wei Ting Chiu, Chien Tai Hong, Nai Fang Chi, Chaur Jong Hu, Han Hwa Hu, Lung Chan
BACKGROUND: The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk...
2017: PloS One
https://www.readbyqxmd.com/read/28652060/reliability-and-utility-of-the-alberta-stroke-program-early-computed-tomography-score-in-hyperacute-stroke
#19
Jillian Naylor, Leonid Churilov, Neil Rane, Ziyuan Chen, Bruce C V Campbell, Bernard Yan
GOAL: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (NCCT) is dependent on the visibility of early ischemic change. The goal of our study was to evaluate whether time from ischemic stroke onset to initial NCCT influences the inter-rater variability and prognostic accuracy of ASPECTS for a 3-month functional outcome. MATERIALS AND METHODS: Ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA) from 2007 to 2014 at the Royal Melbourne Hospital were included...
June 23, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28650062/safety-and-outcome-of-rtpa-in-acute-ischemic-stroke-in-patients-with-active-cancer-case-control-study
#20
T Geraldes, L Pereira, C Guarda, M Grunho, A C Ribeiro, J Coimbra, I Mendes, M Rodrigues
INTRODUCTION: Cancer patients have increased stroke risk from direct and indirect malignancy effects. Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is standard medical treatment for acute ischemic stroke (AIS). AIM: To review rtPA use in AIS patients with active cancer. SUBJECTS AND METHODS: Retrospective observational case-control study evaluating patients with AIS and cancer admitted to our stroke unit between January/2010 and June/2015...
July 1, 2017: Revista de Neurologia
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