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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/27904545/treatment-of-recurrent-prosthetic-mitral-valve-thrombosis-with-reteplase-a-report-of-four-cases
#1
Neda Behzadnia, Babak Sharif Kashani, Arda Kiani, Atefe Abedini, Seyed Reza Seyedi, Hossein Zargham Ahmadi, Farah Naghash Zadeh, Atefeh Fakharian
Thrombosis is a life threatening complications of prosthetic mitral valves and is associated with high morbidity and mortality. Even in presence of systemic anticoagulation prosthetic valve thrombosis has an incidence of 0.5% to 8%. Recurrent prosthetic valve thrombosis and the resulting thrombotic occlusion require re-establishment of blood flow across the valve. While surgical repair is considered the classic first line treatment option for prosthetic valve thrombosis, intravenous thrombolysis has emerged as an acceptable alternative for the first episode of prosthetic valve thrombosis...
2016: Tanaffos
https://www.readbyqxmd.com/read/27899742/acute-endovascular-treatment-delivery-to-ischemic-stroke-patients-transferred-within-a-telestroke-network-a-retrospective-observational-study
#2
Jessica Barlinn, Johannes Gerber, Kristian Barlinn, Lars-Peder Pallesen, Timo Siepmann, Charlotte Zerna, Claudia Wojciechowski, Volker Puetz, Rüdiger von Kummer, Heinz Reichmann, Jennifer Linn, Ulf Bodechtel
BACKGROUND: Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. AIM: We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. METHODS: Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center...
November 29, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#3
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27879449/ethnic-comparison-of-clinical-characteristics-and-ischemic-stroke-subtypes-among-young-adult-patients-with-stroke-in-hawaii
#4
Kazuma Nakagawa, Cherisse S Ito, Sage L King
BACKGROUND AND PURPOSE: Native Hawaiians and other Pacific Islanders (NHOPI) with ischemic stroke have younger age of stroke onset compared with whites. However, ethnic differences in stroke subtypes in this population have been inadequately studied. METHODS: Consecutive young adult patients (aged ≤55 years) who were hospitalized for ischemic stroke between 2006 and 2012 at a tertiary center in Honolulu were studied. Clinical characteristics and stroke subtypes based on pathophysiological TOAST classification (Trial of Org 10172) of NHOPI and Asians were compared with whites...
November 22, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27879445/agreement-among-stroke-faculty-and-fellows-in-treating-ischemic-stroke-patients-with-tissue-type-plasminogen-activator-and-thrombectomy
#5
Ahmad-Riad Ramadan, Mary Carter Denny, Farhaan Vahidy, Jose-Miguel Yamal, Tzu-Ching Wu, Amrou Sarraj, Sean Savitz, James Grotta
BACKGROUND AND PURPOSE: The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT). METHODS: Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients. RESULTS: In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0...
November 22, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27864581/prognostic-value-of-diffusion-weighted-imaging-dwi-apparent-diffusion-coefficient-adc-in-patients-with-hyperacute-cerebral-infarction-receiving-rt-pa-intravenous-thrombolytic-therapy
#6
Hai-Jing Sui, Cheng-Gong Yan, Zhen-Guo Zhao, Qing-Ke Bai
BACKGROUND The aim of this study was to investigate the potential value of apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in the prognosis of patients with hyperacute cerebral infarction (HCI) receiving intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). MATERIAL AND METHODS From June 2012 to June 2015, 58 cases of HCI (<6 h) undergoing rt-PA intravenous thrombolytic therapy (thrombolysis group) and 70 cases of HCI (<6 h) undergoing conventional antiplatelet and anticoagulant therapy (control group) in the same period were collected...
November 19, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27863833/rapid-systematic-review-intra-arterial-thrombectomy-clot-retrieval-for-selected-patients-with-acute-ischemic-stroke
#7
William J Meurer, Bradley E Barth, Gary Gaddis, Gary M Vilke, Samuel H F Lam
BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have "large vessel" strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA)...
November 15, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27862464/randomized-assessment-of-imatinib-in-patients-with-acute-ischaemic-stroke-treated-with-intravenous-thrombolysis
#8
N Wahlgren, M Thorén, B Höjeberg, T-B Käll, A-C Laska, C Sjöstrand, J Höijer, H Almqvist, S Holmin, A Lilja, L Fredriksson, D Lawrence, U Eriksson, N Ahmed
BACKGROUND: Imatinib, a tyrosine kinase inhibitor, has been shown to restore blood-brain barrier integrity and reduce infarct size, haemorrhagic transformation and cerebral oedema in stroke models treated with tissue plasminogen activator. We evaluated the safety of imatinib, based on clinical and neuroradiological data, and its potential influence on neurological and functional outcomes. METHODS: A phase II randomized trial was performed in patients with acute ischaemic stroke treated with intravenous thrombolysis...
November 14, 2016: Journal of Internal Medicine
https://www.readbyqxmd.com/read/27847771/emergent-double-barrel-bypass-shortly-after-intravenous-administration-of-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke
#9
Joon-Ho Choi, Hyun-Seok Park
Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27844035/intravenous-thrombolysis-in-acute-ischemic-stroke-after-dabigatran-reversal-with-idarucizumab-a-case-report
#10
Johannes Sebastian Mutzenbach, Slaven Pikija, Ferdinand Otto, Ursula Halwachs, Friedrich Weymayr, Johann Sellner
Much excitement has been generated with the approval of idarucizumab, a humanized monoclonal antigen-binding antibody fragment that is capable of reversing the anticoagulant activity of dabigatran. Here, we describe our initial experience of using tissue plasminogen activator (tPA) in an acute posterior circulation ischemic stroke after dabigatran reversal with idarucizumab. Both treatments were well tolerated and no hemorrhagic or procoagulatory complications were observed. We propose that the option of dabigatran reversal needs to be considered for contemporary treatment concepts of acute ischemic stroke...
November 2016: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/27834751/stroke-thrombolysis-in-a-centralized-and-a-decentralized-system-helsinki-and-telemedical-project-for-integrative-stroke-care-network
#11
Gordian J Hubert, Atte Meretoja, Heinrich J Audebert, Turgut Tatlisumak, Florian Zeman, Sandra Boy, Roman L Haberl, Markku Kaste, Peter Müller-Barna
BACKGROUND AND PURPOSE: Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. METHODS: We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1...
November 10, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27834750/baseline-predictors-of-poor-outcome-in-patients-too-good-to-treat-with-intravenous-thrombolysis
#12
Syed F Ali, Khawja Siddiqui, Hakan Ay, Scott Silverman, Aneesh Singhal, Anand Viswanathan, Natalia Rost, Michael Lev, Lee H Schwamm
BACKGROUND AND PURPOSE: Several studies have reported poor outcomes in patients too good to treat with intravenous thrombolysis because of mild or rapidly improving symptoms. We sought to determine baseline clinical and imaging predictors of poor outcome in these patients. METHODS: Among 3950 consecutive stroke admissions (2009-2015) in our local Get With the Guidelines-Stroke database, 632 patients presented ≤4.5 hours and did not receive tissue-type plasminogen activator, with 380 of 632 (60...
November 10, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27834742/results-of-the-ictus-2-trial-intravascular-cooling-in-the-treatment-of-stroke-2
#13
Patrick Lyden, Thomas Hemmen, James Grotta, Karen Rapp, Karin Ernstrom, Teresa Rzesiewicz, Stephanie Parker, Mauricio Concha, Syed Hussain, Sachin Agarwal, Brett Meyer, Julie Jurf, Irfan Altafullah, Rema Raman
BACKGROUND AND PURPOSE: Therapeutic hypothermia is a potent neuroprotectant approved for cerebral protection after neonatal hypoxia-ischemia and cardiac arrest. Therapeutic hypothermia for acute ischemic stroke is safe and feasible in pilot trials. We designed a study protocol to provide safer, faster therapeutic hypothermia in stroke patients. METHODS: Safety procedures and 4°C saline infusions for faster cooling were added to the ICTuS trial (Intravascular Cooling in the Treatment of Stroke) protocol...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27822079/intravenous-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke-a-feasibility-and-safety-study
#14
Elyar Sadeghi-Hokmabadi, Mehdi Farhoudi, Aliakbar Taheraghdam, Mazyar Hashemilar, Daryous Savadi-Osguei, Reza Rikhtegar, Kaveh Mehrvar, Ehsan Sharifipour, Parisa Youhanaee, Reshad Mirnour
BACKGROUND: In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. METHODS: In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded...
2016: International Journal of General Medicine
https://www.readbyqxmd.com/read/27816339/management-of-acute-cerebral-ischaemia
#15
Solène Moulin, Didier Leys
Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12,000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented...
November 2, 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27815374/treatment-with-tpa-in-the-golden-hour-and-the-shape-of-the-4-5-hour-time-benefit-curve-in-the-national-us-get-with-the-guidelines-stroke-population
#16
Joon-Tae Kim, Gregg C Fonarow, Eric E Smith, Mathew J Reeves, Digvijaya D Navalkele, James C Grotta, Maria V Grau-Sepulveda, Adrian F Hernandez, Eric D Peterson, Lee H Schwamm, Jeffrey L Saver
BACKGROUND: -Earlier tissue plasminogen activator (tPA) treatment improves ischemic stroke outcome, but aspects of the time-benefit relationship still not well delineated are: 1) the degree of additional benefit accrued with treatment in the first 60 minutes after onset, and 2) the shape of the time-benefit curve through 4.5 hours. METHODS: -We analyzed acute ischemic stroke patients treated with intravenous tPA within 4.5 hours of onset from the Get With The Guidelines-Stroke US national program...
November 4, 2016: Circulation
https://www.readbyqxmd.com/read/27789665/review-of-the-enchanted-trial-enhanced-control-of-hypertension-and-thrombolysis-stroke-study-how-low-can-we-go-with-intravenous-tissue-type-plasminogen-activator-dose-and-blood-pressure-level
#17
Daniel Strbian, Gustavo Saposnik
No abstract text is available yet for this article.
October 27, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27781043/treatment-strategies-for-acute-ischemic-stroke-caused-by-carotid-artery-occlusion
#18
REVIEW
Wei Li, Qin Yin, Gelin Xu, Xinfeng Liu
Background: Acute ischemic stroke caused by internal carotid artery (ICA) occlusion usually has a poor prognosis, especially the T occlusion cases without functional collaterals. The efficacy of intravenous (IV) or intra-arterial (IA) thrombolysis with recombinant tissue plasminogen activator (rt-PA) remains ambiguous in these patients. Eendovascular recanalization of the occluded carotid has been attempted in recent years as a potential strategy. However, the different etiologies of ICA occlusion pose a significant challenge to neurointerventionists...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27781037/rescue-thrombectomy-in-large-vessel-occlusion-strokes-leads-to-better-outcomes-than-intravenous-thrombolysis-alone-a-real-world-applicability-of-the-recent-trials
#19
Raul G Nogueira, Osama O Zaidat, Alicia C Castonguay, Diogo C Haussen, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Tim W Malisch, Franklin A Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael T Froehler, Aamir Badruddin, Thanh N Nguyen, M Asif Taqi, Michael G Abraham, Vallabh Janardhan, Albert J Yoo, Hashem Shaltoni, Alex Abou-Chebl, Peng R Chen, Gavin W Britz, Roberta Novakovic, Ashish Nanda, Ritesh Kaushal, Mohammad A Issa, Michael R Frankel, Rishi Gupta
BACKGROUND: The Interventional Management of Stroke III (IMS-III) trial demonstrated no benefit for intravenous recombinant tissue plasminogen activator (IV rt-PA) followed by endovascular therapy versus IV rt-PA alone. However, IMS-III mostly included earlier generation devices. The recent thrombectomy trials have incorporated the stent-retriever technology, but their generalizability remains unknown. METHODS: The North American Solitaire Acute Stroke (NASA) registry recruited patients treated with the Solitaire FR™ device between March 2012 and February 2013...
September 2016: Interventional Neurology
https://www.readbyqxmd.com/read/27769189/the-collateral-circulation-determines-cortical-infarct-volume-in-anterior-circulation-ischemic-stroke
#20
Estelle Seyman, Hilla Shaim, Shani Shenhar-Tsarfaty, Tali Jonash-Kimchi, Natan M Bornstein, Hen Hallevi
BACKGROUND: Acute ischemic stroke (AIS) is a common neurological event that causes varying degrees of disability. AIS outcome varies considerably, from complete recovery to complete loss of tissue and function. This diversity is partly explained by the compensatory ability of the collateral circulation and the ensuing cerebral flow grade. The collateral flow to the anterior circulation largely supplies the cortical areas. The deep brain tissue is supplied by penetrating arteries and has little or no collateral supply...
October 21, 2016: BMC Neurology
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