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acute ischemic stroke treatment

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https://www.readbyqxmd.com/read/28650062/safety-and-outcome-of-rtpa-in-acute-ischemic-stroke-in-patients-with-active-cancer-case-control-study
#1
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
https://www.readbyqxmd.com/read/28649948/endovascular-thrombectomy-in-patients-with-acute-ischemic-stroke-and-atrial-fibrillation-a-mr-clean-subgroup-analysis
#2
Alis Heshmatollah, Puck S S Fransen, Olvert A Berkhemer, Debbie Beumer, Aad van der Lugt, Charles B L M Majoie, Robert J Oostenbrugge, Wim H van Zwam, Peter J Koudstaal, Yvo B W E M Roos, Diederik W J Dippel
AIMS: Endovascular thrombectomy (EVT) improves outcome after acute ischemic stroke (AIS) caused by an intracranial occlusion. The aim of the present study is to determine if atrial fibrillation (AF) modifies the effect of EVT. METHODS AND RESULTS: MRCLEAN was a randomized clinical trial of EVT plus usual care vs. usual care alone for patients with an intracranial occlusion. The primary outcome was the modified Rankin scale (mRS) score at 90 days. The primary effect parameter was the adjusted common odds ratio (acOR), estimated with ordinal logistic regression and adjusted for age and stroke severity at baseline...
June 27, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28647417/recurrent-thromboembolic-events-after-ischemic-stroke-in-patients-with-primary-brain-tumors
#3
Neal S Parikh, Jaclyn E Burch, Hooman Kamel, Lisa M DeAngelis, Babak B Navi
BACKGROUND: Stroke mechanisms and the risk of recurrent thromboembolism are incompletely understood in patients with primary brain tumors. We sought to better delineate these important clinical features. METHODS: We performed a retrospective cohort study of adults with primary brain tumors diagnosed with magnetic resonance imaging-confirmed acute ischemic stroke at the Memorial Sloan Kettering Cancer Center from 2005 to 2015. Study neurologists collected data on patients' cancer history, stroke risk factors, treatments, and outcomes...
June 21, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#4
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g. premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646445/update-on-neurocritical-care-of-stroke
#5
Jason Siegel, Michael A Pizzi, J Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L Brown, David Hodge, W David Freeman
PURPOSE OF REVIEW: This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. RECENT FINDINGS: New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations...
August 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28645938/practice-patterns-for-acute-ischemic-stroke-workup-a-longitudinal-population-based-study
#6
Matthew C Loftspring, Brett M Kissela, Matthew L Flaherty, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Dawn O Kleindorfer, Daniel Woo, Opeolu Adeoye, Simona Ferioli, Joseph P Broderick, Pooja Khatri
BACKGROUND: We examined practice patterns of inpatient testing to identify stroke etiologies and treatable risk factors for acute ischemic stroke recurrence. METHODS AND RESULTS: We identified stroke cases and related diagnostic testing from four 1-year study periods (July 1993 to June 1994, 1999, 2005, and 2010) of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients aged ≥18 years were included. We focused on evaluation of extracranial arteries for carotid stenosis and assessment of atrial fibrillation because randomized controlled trials supported treatment of these conditions for stroke prevention across all 4 study periods...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28645780/salvia-miltiorrhiza-bunge-danshen-extract-attenuates-permanent-cerebral-ischemia-through-inhibiting-platelet-activation-in-rats
#7
Yu-Xiang Fei, Si-Qi Wang, Li-Jian Yang, Yan-Ying Qiu, Yi-Ze Li, Wen-Yuan Liu, Tao Xi, Wei-Rong Fang, Yun-Man Li
ETHNOPHARMACOLOGICAL RELEVANCE: Danshen is a crude herbal drug isolated from dried roots of Salvia miltiorrhiza Bunge. This plant is widely used in oriental medicine for the treatment of cardiovascular and cerebrovascular diseases. The supercritical CO2 extract from Danshen (SCED) (57.85%, 5.67% and 4.55% for tanshinone IIA, tanshinone I and cryptotanshinone respectively) was studied in this article, whose potential molecular mechanism remains unclear, especially in anti-thrombosis. AIM OF THE STUDY: The present study was designed to observe the protective effect of SCED on ischemic stroke in rats and to explore the underlying anti-thrombosis mechanism...
June 20, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28645588/long-term-outcomes-of-mechanical-thrombectomy-for-the-treatment-of-acute-ischemic-stroke
#8
David McCarthy, Christian Theodotou, Samir Sur, Brian Snelling, Stephanie Chen, Eric C Peterson, Robert M Starke
No abstract text is available yet for this article.
June 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28644924/intravenous-thrombolysis-for-acute-ischemic-stroke-a-bridge-between-two-centuries
#9
Georgios Tsivgoulis, Odysseas Kargiotis, Andrei Alexandrov
Intravenous tissue-plasminogen activator (tPA) remains the only approved systemic reperfusion therapy suitable for most patients presenting timely with acute ischemic stroke. Accumulating real-word experience for over 20 years regarding tPA safety and effectiveness lead to re-appraisal of original contraindications for intravenous thrombolysis (IVT). Areas covered: This narrative review focuses on fast yet appropriate selection of patients for safe administration of tPA per recently expanded indications. Novel strategies for rapid patient assessment will be discussed...
June 23, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/28644260/intravenous-alteplase-for-acute-stroke-and-pulmonary-embolism-in-a-patient-with-recent-abdominoplasty
#10
Michael E Christiansen, Gyanendra Kumar, Raman C Mahabir, Richard A Helmers, Bernard R Bendok, Cumara B O'Carroll
INTRODUCTION: Major surgery in the past 14 days is a relative contraindication to treatment of acute stroke with intravenous (IV) alteplase. The 2016 American Heart Association/American Stroke Association scientific statement discussing inclusion and exclusion criteria for alteplase in acute stroke allows for provider judgment citing a lack of evidence to support surgery as an absolute contraindication. CASE REPORT: A 59-year-old woman presented with acute left hemiparesis, dysarthria, and acute respiratory failure...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28644251/risk-factors-etiological-classification-topographical-location-and-outcome-in-medullary-infarctions
#11
Elif Gökçal, Gözde Baran, Elvin Niftaliyev, Vildan Güzel, Talip Asil
An understanding of the etiological mechanisms is important for therapeutic decisions and prognostic evaluation of patients with ischemic stroke. The object of this study was to evaluate the risk factors, etiological subtypes, and topography of lesion in patients with medullary infarctions (MIs). Besides, we also investigated early neurological deterioration, new vascular events, and functional outcome of all patients at 3-month follow-up. We analyzed our database consisting of patients who were diagnosed with acute MI and who were admitted within 24 hours of onset...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28636854/cluster-randomized-crossover-trial-of-head-positioning-in-acute-stroke
#12
Craig S Anderson, Hisatomi Arima, Pablo Lavados, Laurent Billot, Maree L Hackett, Verónica V Olavarría, Paula Muñoz Venturelli, Alejandro Brunser, Bin Peng, Liying Cui, Lily Song, Kris Rogers, Sandy Middleton, Joyce Y Lim, Denise Forshaw, C Elizabeth Lightbody, Mark Woodward, Octavio Pontes-Neto, H Asita De Silva, Ruey-Tay Lin, Tsong-Hai Lee, Jeyaraj D Pandian, Gillian E Mead, Thompson Robinson, Caroline Watkins
BACKGROUND: The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. We wanted to determine whether outcomes in patients with acute ischemic stroke could be improved by positioning the patient to be lying flat (i.e., fully supine with the back horizontal and the face upwards) during treatment to increase cerebral perfusion. METHODS: In a pragmatic, cluster-randomized, crossover trial conducted in nine countries, we assigned 11,093 patients with acute stroke (85% of the strokes were ischemic) to receive care in either a lying-flat position or a sitting-up position with the head elevated to at least 30 degrees, according to the randomization assignment of the hospital to which they were admitted; the designated position was initiated soon after hospital admission and was maintained for 24 hours...
June 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28634365/different-levels-of-blood-pressure-different-benefit-from-dual-antiplatelet-therapy-in-minor-stroke-or-tia-patients
#13
Jie Xu, Yongli Tao, Hao Li, Hongqiu Gu, Xuewei Xie, Xia Meng, Yuming Xu, Yilong Wang, Yongjun Wang
The study aimed to evaluate whether the benefits of dual antiplatelet therapy would be influenced by blood pressure (BP) levels, among acute minor stroke or transient ischemic attack (TIA). In CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling cerebrovascular Events) trail, Patients were stratified by systolic BP (SBP) and diastolic BP (DBP) level measured on admission, respectively, using the supine position BP within 24 hours after symptoms onset. The primary efficacy outcome was stroke recurrence, bleeding was the safety outcome...
June 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28626055/ischemic-stroke-what-does-the-histological-composition-tell-us-about-the-origin-of-the-thrombus
#14
Peter B Sporns, Uta Hanning, Wolfram Schwindt, Aglaé Velasco, Jens Minnerup, Tarek Zoubi, Walter Heindel, Astrid Jeibmann, Thomas Ulrich Niederstadt
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke...
June 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28626054/prediction-of-recurrent-stroke-or-transient-ischemic-attack-after-noncardiogenic-posterior-circulation-ischemic-stroke
#15
Changqing Zhang, Yilong Wang, Xingquan Zhao, Liping Liu, ChunXue Wang, Yuehua Pu, Xinying Zou, Yuesong Pan, Ka Sing Wong, Yongjun Wang
BACKGROUND AND PURPOSE: Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes. METHODS: We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms <7 days...
June 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28623119/the-cost-effectiveness-of-a-stroke-unit-in-providing-enhanced-patient-outcomes-in-an-australian-teaching-hospital
#16
Shaun Zhai, Fergus Gardiner, Teresa Neeman, Brett Jones, Yash Gawarikar
BACKGROUND: Stroke is one of the leading causes of disability and mortality. Patients who receive organized inpatient care in a stroke unit (SU) have better clinical outcomes. However, evidence on the cost analysis of an SU is lacking. The objective of this study was to assess the performance and analyze the cost-effectiveness of an SU. METHODS: A retrospective observational study was conducted comparing the acute stroke patient care in a 6-month period before and after the establishment of an acute SU at Calvary Hospital in 2013-2014...
June 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28619102/dl-3-n-butylphthalide-protects-the-heart-against-ischemic-injury-and-h9c2-cardiomyoblasts-against-oxidative-stress-involvement-of-mitochondrial-function-and-biogenesis
#17
Xiaochao Tian, Weiliang He, Rong Yang, Yingping Liu
BACKGROUND: Myocardial infarction (MI) is an acute and fatal condition that threatens human health. Dl-3-n-butylphthalide (NBP) has been used for the treatment of acute ischemic stroke. Mitochondria may play a protective role in MI injury. However, there are few reports on the cardioprotective effect of NBP or the potential mitochondrial mechanism for the NBP-induced protection against cardiac ischemia injury. We investigated the therapeutic effects of NBP in an in vivo MI model and an in vitro oxidative stress model, as well as the potential mitochondrial mechanism...
June 15, 2017: Journal of Biomedical Science
https://www.readbyqxmd.com/read/28616930/-a-study-of-etiology-classification-of-minor-stroke-based-on-toast-and-asco-systems
#18
Jie Zhou, Yang Zhang, Yi-Jia Guo, Li He
OBJECTIVES: To investigate the differences in the etiology between minor stroke and non-minor stroke based on TOAST and ASCO systems, and to guide the early intervention for minor stroke. METHODS: We retrospectively analyzed the patients with acute ischemic stroke admitted to our department from July 2012 to July 2014. We sub-typed minor stroke patients and non-minor stroke patients in etiology using Trial of Org 10172 in Acute Stroke Treatment (TOAST) and ASCO (A for atherosclerosis, S for small vessel disease, C for Cardiac source, O for other cause) systems respectively to investigate the difference of etiology between the two groups...
May 2017: Sichuan da Xue Xue Bao. Yi Xue Ban, Journal of Sichuan University. Medical Science Edition
https://www.readbyqxmd.com/read/28614434/post-stroke-psychosis-how-long-should-we-treat
#19
Maria do Céu Ferreira, Célia Machado, Beatriz Santos, Álvaro Machado
Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone)...
June 12, 2017: Trends in Psychiatry and Psychotherapy
https://www.readbyqxmd.com/read/28612680/benefits-of-stroke-treatment-delivered-using-a-mobile-stroke-unit-trial
#20
Jose-Miguel Yamal, Suja S Rajan, Stephanie A Parker, Asha P Jacob, Michael O Gonzalez, Nicole R Gonzales, Ritvij Bowry, Andrew D Barreto, Tzu-Ching Wu, David R Lairson, David Persse, Barbara C Tilley, David Chiu, Jose I Suarez, William J Jones, Andrei Alexandrov, James C Grotta
Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
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