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acute ischemic stroke treatment

Kelly M DeMars, Austin O McCrea, David M Siwarski, Brian D Sanz, Changjun Yang, Eduardo Candelario-Jalil
Ischemic stroke occurs when a clot forms in the brain vasculature that starves downstream tissue of oxygen and nutrients resulting in cell death. The tissue immediately downstream of the blockage, the core, dies within minutes, but the surrounding tissue, the penumbra is potentially salvageable. Prostaglandin E2 binds to four different G-protein coupled membrane receptors EP1-EP4 mediating different and sometimes opposing responses. Pharmacological activation of the EP4 receptor has already been established as neuroprotective in stroke, but the mechanism(s) of protection are not well-characterized...
2018: Frontiers in Neuroscience
Nobuyuki Sakai, Shinzo Ota, Yasushi Matsumoto, Rei Kondo, Tetsu Satow, Michiya Kubo, Tomoyuki Tsumoto, Yukiko Enomoto, Taketo Kataoka, Hirotoshi Imamura, Kenichi Todo, Mikito Hayakawa, Hiroshi Yamagami, Kazunori Toyoda, Yasushi Ito, Kenji Sugiu, Yuji Matsumaru, Shinichi Yoshimura
REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a...
March 9, 2018: Neurologia Medico-chirurgica
Kosuke Matsuzono, Masayuki Suzuki, Naoto Arai, Younhee Kim, Tadashi Ozawa, Takafumi Mashiko, Haruo Shimazaki, Reiji Koide, Shigeru Fujimoto
Some stroke patients with the acute aortic dissection receiving thrombolysis treatment resulted in fatalities. Thus, the concurrent acute aortic dissection is the contraindication for the intravenous recombinant tissue-type plasminogen activator. However, the safety and the effectiveness of the intravenous recombinant tissue-type plasminogen activator therapy are not known in patients with stroke some days after acute aortic dissection treatment. Here, we first report a case of a man with a cardioembolism due to the nonvalvular atrial fibrillation, who received the intravenous recombinant tissue-type plasminogen activator therapy 117 days after the traumatic Stanford type A acute aortic dissection operation...
March 7, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Mikiya Beppu, Yohei Mineharu, Hirotoshi Imamura, Hidemitsu Adachi, Chiaki Sakai, Shoichi Tani, Koichi Arimura, So Tokunaga, Nobuyuki Sakai
BACKGROUND AND PURPOSE: Although in-stent protrusion is a potential risk factor of thromboembolism following carotid artery stenting, the correlation between in-stent protrusion and postoperative ipsilateral stroke has not been well examined. MATERIALS AND METHODS: We retrospectively reviewed 342 consecutive carotid artery lesions in 319 patients who underwent carotid artery stenting between April 2008 and April 2015. After excluding cases with carotid artery dissection and acute occlusion, 301 lesions in total of 277 patients were included in the analysis...
March 7, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Paul Reidler, Kolja M Thierfelder, Matthias P Fabritius, Wieland H Sommer, Felix G Meinel, Franziska Dorn, Frank A Wollenweber, Marco Duering, Wolfgang G Kunz
BACKGROUND AND PURPOSE: Ipsilateral thalamic diaschisis (ITD) describes the reduction of thalamic function, metabolism, and perfusion resulting from a distant lesion of the ipsilateral hemisphere. Our aim was to evaluate the perfusion characteristics and clinical impact of ITD in acute middle cerebral artery stroke, which does not directly affect the thalamus. METHODS: One hundred twenty-four patients with middle cerebral artery infarction were selected from a prospectively acquired cohort of 1644 patients who underwent multiparametric computed tomography (CT), including CT perfusion for suspected stroke...
March 9, 2018: Stroke; a Journal of Cerebral Circulation
Anna Ver Hage, Mohamed Teleb, Evelyn Smith
BACKGROUND: Nurses play an integral role in triaging stroke patients. The purpose of this quality improvement initiative was to determine the efficacy of using an emergent large vessel occlusion (ELVO) screening protocol in the emergency department by nursing staff to improve identification of eligible patients as compared with current practice, improving time to endovascular treatment. METHODS: Retrospective chart review was used to identify 76 patients admitted to a large urban stroke center...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Yoav Eizenberg, Ehud Grossman, David Tanne, Silvia Koton
The impact of beta-blockers (BB) treatment on stroke outcome is unclear. We used data from a prospective national stroke registry to assess the associations between use of BB and poor outcome 3 months after stroke. Using the National Acute Stroke Israeli (NASIS) registry, we identified 1126 patients with ischemic stroke and intracerebral hemorrhage with pre-stroke hypertension treatment, who were followed for 3-months. Functional outcome and mortality at 3-month were compared by use of BB, adjusting for demographics and clinical factors...
March 9, 2018: Journal of Clinical Hypertension
Yu Wu, Yilun Zhou, Yuesong Pan, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Hao Li, S Claiborne Johnston, Xia Meng, Yilong Wang, Yongjun Wang
Clopidogrel resistance is prevalent in chronic kidney disease (CKD) patients. Genetic polymorphism is considered to be the most important factor that influences clopidogrel resistance. Limited data exist as to the role of pharmacogenetics in prognosis of stroke patients with impaired renal function on clopidogrel. We sought to explore whether decreased kidney function alters the association between CYP2C19 genetic variants and clinical outcome in patients with minor stroke or transient ischemic attack (TIA) receiving clopidogrel therapy...
March 8, 2018: Pharmacogenomics Journal
Committee Chinese Society For Integrated Chinese And Western Medicine First Aid Medicine Specialized, Bangjiang Fang, Zhijun Li, Yinping Li, Gang Wang
No abstract text is available yet for this article.
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Omid Nikoubashman, Kolja Schürmann, Ahmed E Othman, Jan-Philipp Bach, Martin Wiesmann, Arno Reich
Background and Purpose: With the advent of endovascular stroke treatment (EST) with mechanical thrombectomy, stroke treatment has also become more challenging. Purpose of this study was to investigate whether a fulltime neuroradiological on-site service and workflow optimization with a structured documentation of the interdisciplinary stroke workflow resulted in improved procedural times. Material and Methods: Procedural times of 322 consecutive patients, who received EST (1) before ( n = 96) and (2) after ( n = 126) establishing a 24-hour neuroradiological on-site service as well as (3) after implementation of a structured interdisciplinary workflow documentation ("Stroke Check") ( n = 100), were analysed...
2018: BioMed Research International
Carolina Soriano-Tárraga, Eva Giralt-Steinhauer, Marina Mola-Caminal, Angel Ois, Ana Rodríguez-Campello, Elisa Cuadrado-Godia, Israel Fernández-Cadenas, Natalia Cullell, Jaume Roquer, Jordi Jiménez-Conde
Age and stroke severity are the main mortality predictors after ischemic stroke. However, chronological age and biological age are not exactly concordant. Age-related changes in DNA methylation in multiple CpG sites across the genome can be used to estimate biological age, which is influenced by lifestyle, environmental factors, and genetic variation. We analyzed the impact of biological age on 3-month mortality in ischemic stroke. We assessed 594 patients with acute ischemic stroke in a cohort from Hospital del Mar (Barcelona) and validated the results in an independent cohort...
March 7, 2018: Scientific Reports
Jonathan T Caranfa, Elaine Nguyen, Rafay Ali, Iregi Francis, Albert Zichichi, Elliott Bosco, Craig I Coleman, William L Baker, Christine G Kohn
BACKGROUND: Randomized controlled trials (RCTs) have compared mechanical endovascular therapy (MET) in addition to intravenous tissue plasminogen activator (IVtPA) to IVtPA alone for the management of acute ischemic stroke (AIS). Direct comparative studies between individual METs are not available. In lieu of head-to-head randomized control trials, we performed an adjusted indirect treatment comparison (ITC) meta-analysis to assess the comparative efficacy and safety of different METs, Solitaire+IVtPA and Penumbra+IVtPA in AIS patients...
2018: PloS One
Emine Sekerdag, Ihsan Solaroglu, Yasemin Gursoy-Ozdemir
As a result of ischemia or hemorrhage, blood supply to neurons is disrupted which subsequently promotes a cascade of pathophysiological responses resulting in cell loss. Many mechanisms are involved solely or in combination in this disorder including excitotoxicity, mitochondrial death pathways, and the release of free radicals, protein misfolding, apoptosis, necrosis, autophagy and inflammation. Besides neuronal cell loss, damage to and loss of astrocytes as well as injury to white matter contributes also to cerebral injury...
March 1, 2018: Current Neuropharmacology
Marc-Antoine Labeyrie, Vittorio Civelli, Peggy Reiner, Armand Aymard, Jean-Pierre Saint-Maurice, Akli Zetchi, Emmanuel Houdart
OBJECTIVE: To identify the prevalence and therapeutic consequences of spontaneous intracranial artery dissection (IAD) at the acute phase of ischemic stroke. METHODS: We reviewed clinical and imaging data of consecutive patients attending our center for mechanical thrombectomy (MT) between January 2012 and November 2017. IAD was defined according to published criteria and our own angiographic criteria (no clot following MT, and normalization of the vessel caliber after stenting)...
March 6, 2018: Journal of Neurointerventional Surgery
Ruud C Van Kaam, Michel J A M van Putten, Sarah E Vermeer, Jeannette Hofmeijer
BACKGROUND: The noninjured, contralateral hemisphere is increasingly acknowledged in the process of recovery from acute ischemic stroke. We estimated the value of conventional electroencephalography (EEG) recordings for identifying contralateral hemisphere involvement in relation to functional recovery. METHODS: We analyzed 2-min epochs from 21 electrode EEG registrations of 18 patients with acute hemispheric ischemic stroke and compared with 18 age-matched controls...
March 6, 2018: Cerebrovascular Diseases
Jai Ho Choi, Sang Hyuk Im, Ki Jeong Lee, Ja Seong Koo, Bum Soo Kim, Yong Sam Shin
BACKGROUND: Whether intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) provides additional benefits remains controversial. We aimed to compare clinical and radiologic outcomes between IVT+MT and MT alone groups. METHODS: The clinical and radiological features of anterior circulation stroke patients due to large vessel occlusion (LVO) treated with MT within 8 hours from symptom onset were retrospectively reviewed from the prospectively collected database...
March 3, 2018: World Neurosurgery
Ning Ma, Zi-Ai Zhao, Nan-Nan Zhang, Hui-Sheng Chen
An urgent need exists to develop intra-arterial treatment for acute ischemic stroke in animal study. This study aimed to explore the beneficial effects of intra-arterial administration of human urinary kallidinogenase (HUK) on brain injury after permanent middle cerebral artery occlusion (pMCAO) in a rat model, and the potential underlying molecular mechanisms. Brain injury induced by pMCAO was evaluated through measuring neurological deficit scores, neuropathological changes, and inflammatory factors. Neurological deficits were observed 24 h after pMCAO and were alleviated by intra-arterial HUK treatment obviously...
March 3, 2018: Brain Research
Takuya Konno, Takeshi Miura, Andrea M Harriott, Naomi Mezaki, Emily S Edwards, Rosa Rademakers, Owen A Ross, James F Meschia, Takeshi Ikeuchi, Zbigniew K Wszolek
BACKGROUND AND PURPOSE: Mutations in colony stimulating factor 1 receptor (CSF1R) cause adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP). Patients with ALSP can be misdiagnosed as having acute ischemic stroke due to hyperintensity lesions on diffusion-weighted magnetic resonance imaging. Mutant CSF1R proteins identified in ALSP show a complete loss of autophosphorylation of CSF1R. METHODS: We conducted mutation screening of CSF1R in 123 patients with definite acute ischemic cerebrovascular syndrome and positive family history of stroke...
March 6, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Mayank Goyal, Bijoy K Menon, Alexis T Wilson, Mohammed A Almekhlafi, Ryan McTaggart, Mahesh Jayaraman, Andrew M Demchuk, Michael D Hill
Background and purpose Ischemic stroke patients must be transferred to comprehensive stroke centers for endovascular treatment, but this transfer can be interpreted post hoc as "futile" if patients do not ultimately undergo the procedure or have a poor outcome. We posit that transfer decisions must instead be evaluated in terms of appropriateness at the time of decision-making. Methods We propose a classification schema for Appropriateness of Transfer for Endovascular Thrombectomy based on patient, logistic, and center characteristics...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Aimen Moussaddy, Andrew M Demchuk, Michael D Hill
Acute stroke therapy has significantly evolved over the last two decades. The two main advances have been the approval of intravenous chemical thrombolysis in 1995, and the approval of intra-arterial mechanical thrombectomy in 2015. This has lead to significant improvement of functional outcomes in a disease known to be the first cause of disability worldwide. Subsequent studies have focused on identifying pre-treatment predictors of good treatment candidates, by developing biochemical and imaging biomarkers...
March 2, 2018: Neuropharmacology
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