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acute ischemic stroke treatment

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https://www.readbyqxmd.com/read/28540400/imaging-of-cerebral-ischemic-edema-and-neuronal-death
#1
REVIEW
Rüdiger von Kummer, Imanuel Dzialowski
PURPOSE: In acute cerebral ischemia, the assessment of irreversible injury is crucial for treatment decisions and the patient's prognosis. There is still uncertainty how imaging can safely differentiate reversible from irreversible ischemic brain tissue in the acute phase of stroke. METHODS: We have searched PubMed and Google Scholar for experimental and clinical papers describing the pathology and pathophysiology of cerebral ischemia under controlled conditions...
May 24, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28536753/differentiation-of-clot-composition-using-conventional-and-dual-energy-computed-tomography
#2
Jan Borggrefe, Jonathan Kottlors, Mahmood Mirza, Victor-Frederic Neuhaus, Nuran Abdullayev, Volker Maus, Christoph Kabbasch, David Maintz, Anastasios Mpotsaris
BACKGROUND AND PURPOSE: In unenhanced computed tomography (CT) of acute ischemic stroke, the density of occluding clots is associated with the content of red blood cells and successful recanalization with stent thrombectomy. However, no CT marker for fibrin content is established. In order to improve clot diagnostics, we conducted an in vitro study to investigate thrombus composition of histologically defined ovine blood clots with unenhanced and contrast-enhanced CT using spectral detector CT (SDCT)...
May 23, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28536425/intravenous-thrombolysis-in-chinese-patients-with-different-subtype-of-mild-stroke-thrombolysis-in-patients-with-mild-stroke
#3
Weiqi Chen, Yuesong Pan, Xingquan Zhao, Liping Liu, Hao Li, Xiaoling Liao, Chunjuan Wang, Yilong Wang, Yongjun Wang
Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate whether patients with mild stroke or its specific etiologic subtype might benefit from rt-PA therapy. Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) and (2) the China National Stroke Registry (CNSR) database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale ≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype...
May 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28535100/the-national-institutes-of-health-stroke-scale-its-role-in-patients-with-posterior-circulation-stroke
#4
Antonio Siniscalchi, Roman Sztajzel, Giovanni Malferrari, Luca Gallelli
The National Institutes of Health Stroke Scale (NIHSS) is indispensable for both prognosis and treatment in patients with acute ischemic stroke. However, there is subtype of acute ischemic stroke (i.e., posterior circulation stroke) that is difficult to diagnose using the NIHSS. The authors report the limits of NIHSS in this stroke subtype, suggesting thereby the need to modify and render it more appropriate for the evaluation of the neurological signs occurring in posterior circulation stroke.
May 23, 2017: Hospital Topics
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#5
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28533683/new-standardized-nursing-cooperation-workflow-to-reduce-stroke-thrombolysis-delays-in-patients-with-acute-ischemic-stroke
#6
Yan Zhou, Zhuojun Xu, Jiali Liao, Fangming Feng, Lai Men, Li Xu, Yanan He, Gang Li
OBJECTIVE: We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. PATIENTS AND METHODS: AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28532498/the-golden-hour-of-acute-ischemic-stroke
#7
Rajiv Advani, Halvor Naess, Martin W Kurz
BACKGROUND: Acute Ischemic Stroke (AIS) treatment has been revolutionised in the last two decades with the increasing use of Intravenous Thrombolysis (IVT) and with the advent of Endovascular therapy (EVT). AIS treatment and outcome are time dependant and time saving measures are being implemented at every step of the treatment chain. These changes have resulted in lower treatment times in-hospital, but it is unclear if this translates into more patients being treated within 60 min of symptom onset - the Golden Hour...
May 22, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28531910/extracranial-carotid-disease-and-effect-of-intra-arterial-treatment-in-patients-with-proximal-anterior-circulation-stroke-in-mr-clean
#8
Olvert A Berkhemer, Jordi Borst, Manon Kappelhof, Albert J Yoo, Lucie A van den Berg, Puck S S Fransen, Debbie Beumer, Wouter J Schonewille, Paul J Nederkoorn, Marieke J H Wermer, Henk A Marquering, Hester F Lingsma, Yvo B W E M Roos, Robert J van Oostenbrugge, Diederik W J Dippel, Wim H van Zwam, Charles B L M Majoie, Bart J Emmer, Aad van der Lugt
Background: The presence of extracranial carotid disease (ECD) is associated with less favorable clinical outcomes a in patients with acute ischemic stroke caused by intracranial proximal occlusion. Acute intra-arterial treatment (IAT) in the setting of extracranial and intracranial lesions is considered challenging, and whether it yields improved outcomes remains uncertain. Objective: To examine whether the presence of ECD modified the effect of IAT for intracranial proximal anterior circulation occlusion...
May 23, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28530518/antiplatelet-therapy-and-clinical-outcomes-following-myocardial-infarction-among-patients-in-a-u-s-employer-based-insurance-database
#9
Mehul D Patel, David Wu, Monica Reed Chase, Panagiotis Mavros, Kim Heithoff, Mary E Hanson, Ross J Simpson
BACKGROUND: Estimates of residual cardiovascular risks among patients who have experienced a recent acute myocardial infarction (MI) are predominantly derived from secondary prevention trial populations, patient registries, and population-based cohorts. OBJECTIVE: To generate real-world evidence of antiplatelet treatment and recurrent events following MI in patients on antiplatelet treatment among commercial, employer-based insured patients in a large administrative database...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28524799/-y-stent-retriever-a-new-rescue-technique-for-refractory-large-vessel-occlusions
#10
Roberto Crosa, Alejandro M Spiotta, Matías Negrotto, Alejandra Jaume, Walter Casagrande
Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks...
May 19, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28523963/brain-hypoxia-mapping-in-acute-stroke-back-to-back-t2-mr-versus-18-f-fluoromisonidazole-pet-in-rodents
#11
Ulf Jensen-Kondering, Roido Mavanaki, Sohail Ejaz, Stephen J Sawiak, T Adrian Carpenter, Tim D Fryer, Franklin I Aigbirhio, David J Williamson, Jean-Claude Baron
Background Mapping the hypoxic brain in acute ischemic stroke has considerable potential for both diagnosis and treatment monitoring. PET using (18)F-fluoro-misonidazole (FMISO) is the reference method; however, it lacks clinical accessibility and involves radiation exposure. MR-based T2' mapping may identify tissue hypoxia and holds clinical potential. However, its validation against FMISO imaging is lacking. Here we implemented back-to-back FMISO-PET and T2' MR in rodents subjected to acute middle cerebral artery occlusion...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28522637/general-anesthesia-versus-conscious-sedation-for-endovascular-treatment-of-acute-ischemic-stroke-the-anstroke-trial-anesthesia-during-stroke
#12
Pia Löwhagen Hendén, Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, Sven-Erik Ricksten
BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28522232/efficacy-of-new-measures-saving-time-in-acute-stroke-management-a-quantified-analysis
#13
Ana María Iglesias Mohedano, Andrés García Pastor, Fernando Díaz Otero, Pilar Vázquez Alen, Marta Vales Montero, Elisa Luque Buzo, Nuria Redondo Ráfales, Beatriz Chavarria Cano, Yolanda Fernández Bullido, Jose Antonio Villanueva Osorio, Antonio Gil Núñez
BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014...
May 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28520753/comparative-accuracy-of-ct-perfusion-in-diagnosing-acute-ischemic-stroke-a-systematic-review-of-27-trials
#14
Jiantong Shen, Xianglian Li, Youping Li, Bing Wu
OBJECTIVE: To systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke. METHODS: We searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI...
2017: PloS One
https://www.readbyqxmd.com/read/28520657/ct-based-techniques-for-brain-perfusion
#15
Pradeep Krishnan, Amanda Murphy, Richard I Aviv
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology...
June 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28514408/-asymptomatic-atherosclerosis-of-the-brachiocephalic-arteries-current-approaches-to-diagnosis-and-treatment
#16
F Yu Kopylov, A A Bykova, D Yu Shchekochikhin, Kh E Elmanaa, A N Dzyundzya, Yu V Vasilevsky, S S Simakov
Acute cerebrovascular accident (ACVA) and transient ischemic attack are among the leading causes of morbidity, disability, and mortality in the Russian Federation and the world. Ischemic strokes account for 70-80% of all ACVAs, with 20-30% of them being associated with stenotic atherosclerosis of the brachiocephalic arteries (BCA). The paper describes modern views on the problem of asymptomatic BCA atherosclerosis and considers the possibilities of identifying risk groups among the patients with asymptomatic atherosclerosis of the BCA...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28514337/-sex-differences-in-acute-disturbances-of-cerebral-blood-circulation
#17
N A Pizov, N V Pizova
It is shown that in the development of stroke observed sex differences, which manifest themselves both clinically and by laboratory parameters. While men have a higher incidence of stroke for most of his life, a woman in a more advanced age have a higher risk for stroke. Sex differences in the development of stroke depend on several factors, including genetic and hormonal changes throughout life. Studies sex differences in the risk of stroke is only in the initial stage, but the first results show that there are differences in neuronal cell death in males and females after experimental ischemic stroke...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/28511475/colour-doppler-evaluation-of-extracranial-carotid-artery-in-patients-presenting-with-acute-ischemic-stroke-and-correlation-with-various-risk-factors
#18
Samrin Haq, Manoj Mathur, Jasvir Singh, Navkiran Kaur, Raminderpal Singh Sibia, Rajesh Badhan
INTRODUCTION: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28508117/single-center-experience-using-the-3max-reperfusion-catheter-for-the-treatment-of-acute-ischemic-stroke-with-distal-arterial-occlusions
#19
Kévin Premat, Bruno Bartolini, Flore Baronnet-Chauvet, Eimad Shotar, Vincent Degos, Paul Muresan, Federico Di Maria, Joseph Gabrieli, Charlotte Rosso, Silvia Pistocchi, Jacques Chiras, Nader Sourour, Sonia Alamowitch, Yves Samson, Frédéric Clarençon
PURPOSE: Most recent guidelines recommend the use of stent retriever devices in endovascular treatment of acute ischemic stroke with large vessel occlusion (LVO). Recently published data reported convincing results with thromboaspiration devices such as the Penumbra System (Penumbra, Alameda, CA, USA) combined with supple reperfusion catheters by using the ADAPT (A Direct Aspiration First-Pass Thrombectomy) technique. The aim of this study was to report our initial experience with the 3MAX (3...
May 15, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28506979/impact-of-ezetimibe-on-the-rate-of-cardiovascular-related-hospitalizations-and-associated-costs-among-patients-with-a-recent-acute-coronary-syndrome-results-from-the-improve-it-trial-improved-reduction-of-outcomes-vytorin-efficacy-international-trial
#20
Yashashwi Pokharel, Khaja Chinnakondepalli, Katherine Vilain, Kaijun Wang, Daniel B Mark, Glenn Davies, Michael A Blazing, Robert P Giugliano, Eugene Braunwald, Christopher P Cannon, David J Cohen, Elizabeth A Magnuson
BACKGROUND: Ezetimibe, when added to simvastatin therapy, reduces cardiovascular events after recent acute coronary syndrome. However, the impact of ezetimibe on cardiovascular-related hospitalizations and associated costs is unknown. METHODS AND RESULTS: We used patient-level data from the IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) to examine the impact of simvastatin-ezetimibe versus simvastatin-placebo on cardiovascular-related hospitalizations and related costs (excluding drug costs) over 7 years follow-up...
May 2017: Circulation. Cardiovascular Quality and Outcomes
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