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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/28424044/emergent-carotid-thromboendarterectomy-for-acute-symptomatic-occlusion-of-the-extracranial-internal-carotid-artery
#1
Igor Gunka, Dagmar Krajickova, Michal Lesko, Stanislav Jiska, Jan Raupach, Miroslav Lojik, Radovan Maly
BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28416406/acute-stroke-despite-dabigatran-anticoagulation-treated-with-idarucizumab-and-intravenous-tissue-plasminogen-activator
#2
David Bissig, Rashmi Manjunath, Brittany R Traylor, David P Richman, Kwan L Ng
Dabigatran is a direct thrombin inhibitor used to reduce the risk of stroke in patients with nonvalvular atrial fibrillation. For patients who present with an acute stroke despite dabigatran therapy, clinical data on the use of intravenous tissue plasminogen activator (IV-tPA) is limited. There is an anticipated increased risk of symptomatic intracranial hemorrhage (sICH) when using IV-tPA in patients on dabigatran therapy. In 2015, the humanized monoclonal antibody fragment idarucizumab was approved for rapid (minutes) reversal of anticoagulant effects of dabigatran...
April 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28411260/the-fast-ed-app-a-smartphone-platform-for-the-field-triage-of-patients-with-stroke
#3
Raul G Nogueira, Gisele S Silva, Fabricio O Lima, Yu-Chih Yeh, Carol Fleming, Daniel Branco, Arthur H Yancey, Jonathan J Ratcliff, Robert Keith Wages, Earnest Doss, Mehdi Bouslama, Jonathan A Grossberg, Diogo C Haussen, Teppei Sakano, Michael R Frankel
BACKGROUND AND PURPOSE: The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. METHODS: Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved...
April 14, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28411038/long-term-impact-of-implementation-of-a-stroke-protocol-on-door-to-needle-time-in-the-administration-of-intravenous-tissue-plasminogen-activator
#4
Machteld E Hillen, Wenzhuan He, Zaid Al-Qudah, Weizhen Wang, Andrea Hidalgo, Jessy Walia
BACKGROUND: This study aims to evaluate the effectiveness of implementing a stroke protocol (SP) in improving door-to-needle time (DTNT) and door-to-computed tomography (DTCT) time from 2010 to 2014. Published data from the Get With The Guidelines-Stroke (GWTGS) participating hospitals showed that median DTNT = 75 minutes with 26.6% of the patients achieving the recommended DTNT of 60 minutes or less. Implementation of an SP, which specifies the role of nurses, physicians, and technicians during acute stroke evaluation, can improve DTNT...
April 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28408066/derivation-and-validation-of-a-scoring-system-for-intravenous-tissue-plasminogen-activator-use-in-asian-patients
#5
Leonard L L Yeo, Shih-Chao Chien, Jr-Rung Lin, Chia-Wei Liow, Jiann-Der Lee, Tsung-I Peng, Teoh Hock Luen, Vijay Sharma, Bernard Chan, Tsong-Hai Lee
BACKGROUND AND PURPOSE: As Chinese Asian populations have an increased risk of intracerebral hemorrhage (ICH) after intravenous tissue plasminogen activator (IV tPA), we aimed to design a rapid, clinically applicable risk scoring system to predict ICH and functional outcomes after IV tPA treatment in Asian ischemic stroke patients. METHODS: From January 2009 to December 2012, consecutive acute ischemic stroke patients treated with IV tPA recruited from the Stroke Registry in Chang Gung Healthcare System (SRICHS) in Taiwan and the National University Hospital of Singapore (NUHS) acute stroke database were used to create and validate a scoring system...
April 10, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28400900/conjugate-eye-deviation-on-ct-associated-with-worse-outcomes-despite-iv-thrombolysis
#6
Nirav H Shah, Nirav Bhatt, Anita Tipirneni, Diego Condes, Priyank Khandelwal, Jose G Romano
INTRODUCTION: Rapid stroke management has significant implications in patient outcomes. Ipsilateral computed tomography conjugate eye deviation (CT-CED) has been associated with worse outcomes but has never been evaluated as predictive of vascular occlusion. To test the hypothesis that CT-CED is a marker for vascular occlusion, we evaluated patients treated with intravenous tissue plasminogen activator (IV tPA). METHODS: We performed a retrospective analysis of patients with acute ischemic stroke treated with IV tPA at a large tertiary care hospital over an 18-month period...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28400899/how-a-ct-direct-protocol-at-an-american-comprehensive-stroke-center-led-to-door-to-needle-times-less-than-30-minutes
#7
Lisa M Caputo, Judd Jensen, Michelle Whaley, Mark J Kozlowski, Christopher V Fanale, Jeffrey C Wagner, Alessandro Orlando, David Bar-Or
BACKGROUND AND PURPOSE: The safety and efficacy of intravenous tissue plasminogen activator (IV tPA) following acute ischemic stroke (AIS) is dependent on its timely administration. In 2014, our Comprehensive Stroke Center designed and implemented a computed tomography-Direct protocol to streamline the evaluation process of suspected patients with AIS, with the aim of reducing door-to-needle (DTN) times. The objectives of our study were to describe the protocol development and implementation process, and to compare DTN times and symptomatic intracranial hemorrhage (sICH) rates before and after protocol implementation...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28395923/correction-correction-to-clinical-policy-use-of-intravenous-tissue-plasminogen-activator-for-the-management-of-acute-ischemic-stroke-in-the-emergency-department-annals-of-emergency-medicine-66-2015-322-333-e31
#8
Michael D Brown, John H Burton, Devorah J Nazarian, Susan B Promes
Due to a miscommunication during the process of transferring this manuscript from our editorial team to Production, the Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee) were not properly indexed in PubMed. This has now been corrected online. The publisher would like to apologize for any inconvenience caused.
April 7, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28389607/nationwide-estimates-of-30-day-readmission-in-patients-with-ischemic-stroke
#9
Farhaan S Vahidy, John P Donnelly, Louise D McCullough, Jon E Tyson, Charles C Miller, Amelia K Boehme, Sean I Savitz, Karen C Albright
BACKGROUND AND PURPOSE: Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy. METHODS: We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations...
April 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28384594/vascular-closure-devices-in-stroke-patients-receiving-tissue-plasminogen-activator-a-retrospective-analysis-from-an-academic-tertiary-medical-center-and-a-teaching-community-hospital-stroke-database
#10
Mangaladevi S Patil, Mahesh V Jayaraman, Sun H Ahn
OBJECTIVES: To determine the safety and effectiveness of vascular closure devices in prevention of access site complications in acute stroke patient receiving intravenous (IV) and/or intra-arterial (IA) IV tissue plasminogen activator (tPA). PATIENTS AND METHODS: All patients with acute stroke onset treated with IV and/or IA tPA closed with vascular closure device and adult age (>18 years) were identified from an academic tertiary medical center and a teaching community hospital stroke database for 9 years (from March 2005 to June 2014)...
March 29, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28368084/neurovascular-ultrasound-in-emergency-settings-diagnostic-and-therapeutic-aspects
#11
REVIEW
T Santos, M Veloso, P Barros
INTRODUCTION: Neurovascular ultrasound is a non-invasive, portable and fast imaging method that, when performed by an experienced neurosonologist, offers reliable and reproducible information on the morphological and hemodynamic status of cervical and intracranial vessels. AIM: To review the available evidence regarding the use of this tool in the approach to acute stroke. DEVELOPMENT: Neurovascular ultrasound can be used in one of two ways: diagnostic and therapeutic...
April 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28366067/experimental-neuroprotection-in-ischemic-stroke-a-concise-review
#12
Gary B Rajah, Yuchuan Ding
Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. To date, intravenous tissue plasminogen activator and mechanical thrombectomy have been standards of care for AIS. There have been many advances in diagnostic imaging and endovascular devices for AIS; however, most neuroprotective therapies seem to remain largely in the preclinical phase. While many neuroprotective therapies have been identified in experimental models, none are currently used routinely to treat stroke patients...
April 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28356003/young-stroke-patients-treated-with-intravenous-thrombolysis-have-a-more-favorable-outcome-and-mortality-compared-with-older-patients
#13
Jijun Shi, Yongjun Cao, Shoujiang You, Zhichao Huang, Xia Zhang, Huihui Liu, Chun-Feng Liu
BACKGROUND: Previous clinical studies suggest that intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator benefits stroke patients, but the efficacy of IVT in young stroke patients is not well-studied in China. OBJECTIVE: We compared the safety and efficacy of IVT with recombinant tissue plasminogen activator between Chinese young stroke patients (18-50 years old) and older patients (51-80 years old). METHODS: We analyzed data from the Soochow Stroke Registry for 373 stroke patients (18-50 years, n=74 vs...
March 27, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28356002/prognostic-parameters-for-symptomatic-intracranial-hemorrhage-after-intravenous-thrombolysis-in-acute-ischemic-stroke-in-an-asian-population
#14
Thanin Lokeskrawee, Sombat Muengtaweepongsa, Jayanton Patumanond, Somsak Tiamkao, Thanoot Thamangraksat, Phanyarat Phankhian, Polchai Pleumpanupatand, Paworamon Sribussara, Teeraparp Kitjavijit, Anake Supap, Weerawan Rattanaphibool, Jariya Prisiri
Symptomatic intracranial hemorrhage (sICH) is a major complication after intravenous thrombolysis leading to severe disability and death. The incidence was higher in Asian than in westernized countries. Prognostic factors across ethnicities are presumably different. Studies in Asian populations are limited. Clinical data from January 2008 to September 2016 in one provincial and four regional hospitals in the northern part of Thailand were retrospectively reviewed. Patients were those with acute ischemic stroke, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed...
March 27, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28343220/hemorrhagic-transformations-after-thrombectomy-risk-factors-and-clinical-relevance
#15
Johannes Kaesmacher, Mirjam Kaesmacher, Christian Maegerlein, Claus Zimmer, Alexandra S Gersing, Silke Wunderlich, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Hemorrhagic transformation (HT) is a major complication of acute ischemic stroke, potentially associated with clinical deterioration. We attempted to identify risk factors and evaluated clinical relevance of minor and major HTs following endovascular thrombectomy (ET) in isolated middle cerebral artery (MCA) occlusions. METHODS: This is a retrospective single-center analysis of 409 patients with isolated MCA occlusion treated with ET. Patients' and procedural characteristics, severity of HT according to the European Cooperative Acute Stroke Study criteria, and clinical outcomes were analyzed...
March 25, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28341074/long-term-prognosis-in-ischemic-stroke-patients-treated-with-intravenous-thrombolytic-therapy
#16
Maja Stefanovic Budimkic, Tatjana Pekmezovic, Ljiljana Beslac-Bumbasirevic, Marko Ercegovac, Ivana Berisavac, Predrag Stanarcevic, Visnja Padjen, Dejana R Jovanović
BACKGROUND AND PURPOSE: It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke. METHODS: This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013...
January 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28304205/stenting-of-the-cervical-internal-carotid-artery-in-acute-stroke-management-the-karolinska-experience
#17
Anastasios Mpotsaris, Christoph Kabbasch, Jan Borggrefe, Vamsi Gontu, Michael Soderman
Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28298840/the-need-for-a-population-based-dose-optimization-study-for-recombinant-tissue-plasminogen-activator-in-acute-ischemic-stroke-a-study-from-a-tertiary-care-teaching-hospital-from-south-india
#18
Siju V Abraham, Fazil Thaha, S Vimal Krishnan, Athulya Shajan, Jayaraj Mymbilly Balakrishnan, Babu Urumese Palatty
CONTEXT: The guideline recommended dose of intravenous (i.v) recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke is 0.9 mg/kg in the European and American populations. In Asiatic population, some studies have shown that a lower dose of i.v rt-PA is equally efficacious. AIMS: To assess if there is a need for a dose optimization for i.v rt-PA study among Indians. SETTING AND DESIGN: A prospective, observational database of acute stroke cases that presented to a tertiary care institute over a period of 1 year was made...
January 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28298139/emergent-carotid-stenting-and-intra-arterial-abciximab-in-acute-ischemic-stroke-due-to-tandem-occlusion
#19
Fawaz Al-Mufti, Krishna Amuluru, Nathan W Manning, Imad Khan, Lissa Peeling, Chirag D Gandhi, Charles J Prestigiacomo, Galyna Pushchinska, David Fiorella, Henry H Woo
OBJECTIVE: Acute occlusions of the extracranial internal carotid artery (ICA) and a major intracranial artery respond poorly to intravenous tissue plasminogen activator (tPA) and present an endovascular challenge. The aim of our study was to retrospectively delineate the feasibility of the combined use of emergent carotid stenting and intra-arterial (IA) Abciximab with intracranial revascularization in the setting of acute ischemic stroke and carotid occlusions at our institution. METHODS: Eleven patients with complete cervical carotid occlusion with or without concomitant intracranial ICA and/or MCA occlusion were identified from a single center, retrospective review of patients admitted to the Stroke unit...
March 15, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28296671/the-use-of-thrombolytic-therapy-in-the-treatment-of-frostbite-injury
#20
Allyson Wexler, Sarah Zavala
Frostbite can lead to severe consequences including loss of digits and limbs. One of the mechanisms of frostbite includes vascular thrombosis. The use of tissue plasminogen activator (tPA) in frostbite has been shown to be effective in case reports and small prospective studies. A retrospective chart review was performed on all patients admitted for frostbite between January 2008 and April 2015, and six patients were identified as having received treatment with intravenous tPA. Patients received an initial bolus dose followed by a 6-hour infusion of tPA...
March 3, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
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