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acute ischemic stroke treatment

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https://www.readbyqxmd.com/read/28936196/anti-inflammatory-targets-for-the-treatment-of-reperfusion-injury-in-stroke
#1
REVIEW
Atsushi Mizuma, Midori A Yenari
While the mainstay of acute stroke treatment includes revascularization via recombinant tissue plasminogen activator or mechanical thrombectomy, only a minority of stroke patients are eligible for treatment, as delayed treatment can lead to worsened outcome. This worsened outcome at the experimental level has been attributed to an entity known as reperfusion injury (R/I). R/I is occurred when revascularization is delayed after critical brain and vascular injury has occurred, so that when oxygenated blood is restored, ischemic damage is increased, rather than decreased...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28935626/wide-variability-in-prethrombectomy-workflow-practices-in-the-united-states-a-multicenter-survey
#2
A P Kansagra, G C Meyers, M S Kruzich, D T Cross, C J Moran
BACKGROUND AND PURPOSE: Clinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion depend on the speed and quality of workflows leading to mechanical thrombectomy. In the absence of universally accepted best practices for workflow, developing stroke hospitals can benefit from improved awareness of real-world workflows in effect at experienced centers. To this end, we surveyed prethrombectomy workflow practices at stroke centers throughout the United States...
September 21, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28935502/outcomes-of-nonagenarians-with-acute-ischemic-stroke-treated-with-intravenous-thrombolytics
#3
Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, Catharina J M Klijn, Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli
BACKGROUND: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established. MATERIALS AND METHODS: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28935501/safety-and-time-course-of-drip-and-ship-in-treatment-of-acute-ischemic-stroke
#4
Hideyuki Ishihara, Fumiaki Oka, Takayuki Oku, Mizuya Shinoyama, Eiichi Suehiro, Kazutaka Sugimoto, Michiyasu Suzuki
BACKGROUND: The drip-and-ship approach allows intravenous tissue plasminogen activator therapy and adjuvant endovascular treatment in acute ischemic stroke, even in rural areas. Here, we examined the safety and time course of the drip-and-ship approach. METHODS: Fifty consecutive cases treated with the drip-and-ship approach (drip-and-ship group) in June 2009 to March 2016 were retrospectively examined. Changes in mean blood pressure, systemic complications, and neurological complications were compared according to method of transportation...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28935027/sex-differences-in-the-impact-of-acute-stroke-treatment-in-a-population-based-study-a-sex-specific-propensity-score-approach
#5
Lynda D Lisabeth, Jonggyu Baek, Lewis B Morgenstern, Mathew J Reeves, Devin L Brown, Darin B Zahuranec, Melinda A Smith, Brisa N Sánchez
PURPOSE: We investigated whether sex modifies the association of acute stroke treatment on functional outcome using propensity score (PS) methods to minimize confounding and to explore the differential effects of confounders by sex. METHODS: We included tissue plasminogen activator (tPA) treated (n = 84) and nontreated ischemic stroke cases (n = 143) from a population-based stroke study (2008-2013). The PS model that estimated the probability of receiving tPA included interactions between sex and treatment predictors...
August 2017: Annals of Epidemiology
https://www.readbyqxmd.com/read/28933065/cerebrovascular-disease-consequences-of-obesity-induced-endothelial-dysfunction
#6
Liliana Letra, Cristina Sena
Despite the well-known global impact of overweight and obesity in the incidence of cerebrovascular disease, many aspects of this association are still inconsistently defined. In this chapter we aim to present a critical review on the links between obesity and both ischemic and hemorrhagic stroke and discuss its influence on functional outcomes, survival, and current treatments to acute and chronic stroke. The role of cerebrovascular endothelial function and respective modulation is also described as well as its laboratory and clinical assessment...
2017: Advances in Neurobiology
https://www.readbyqxmd.com/read/28931621/minimal-clinically-important-difference-for-safe-and-simple-novel-acute-ischemic-stroke-therapies
#7
Jessica S Cranston, Brett D Kaplan, Jeffrey L Saver
BACKGROUND AND PURPOSE: Determining the minimal clinically important difference (MCID) is essential for evaluating novel therapies. For acute ischemic stroke, expert surveys have yielded MCIDs that are substantially higher than the MCIDs observed in actual expert behavior in guideline writing and clinical practice, potentially because of anchoring bias. METHODS: We administered a structured, internet-based survey to a cross-section of academic stroke neurologists in the United States...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28931617/normobaric-hyperoxia-reduces-blood-occludin-fragments-in-rats-and-patients-with-acute-ischemic-stroke
#8
Shuhai Shi, Zhifeng Qi, Qingfeng Ma, Rong Pan, Graham S Timmins, Yongmei Zhao, Wenjuan Shi, Yunzhou Zhang, Xunming Ji, Ke Jian Liu
BACKGROUND AND PURPOSE: Damage of the blood-brain barrier (BBB) increases the incidence of neurovascular complications, especially for cerebral hemorrhage after tPA (tissue-type plasminogen activator) therapy. Currently, there is no effective method to evaluate the extent of BBB damage to guide tPA use. Herein, we investigated whether blood levels of tight junction proteins could serve as biomarker of BBB damages in acute ischemic stroke (AIS) in both rats and patients. We examined whether this biomarker could reflect the extent of BBB permeability during cerebral ischemia/reperfusion and the effects of normobaric hyperoxia (NBO) on BBB damage...
September 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28929836/the-relationship-between-blood-flow-impairment-and-oxygen-depletion-in-acute-ischemic-stroke-imaged-with-magnetic-resonance-imaging
#9
Alexander Seiler, Nicholas P Blockley, Ralf Deichmann, Ulrike Nöth, Oliver C Singer, Michael A Chappell, Johannes C Klein, Marlies Wagner
Oxygenation-sensitive spin relaxation time T2' and relaxation rate R2' (1/T2') are presumed to be markers of the cerebral oxygen extraction fraction (OEF) in acute ischemic stroke. In this study, we investigate the relationship of T2'/R2' with dynamic susceptibility contrast-based relative cerebral blood flow (rCBF) in acute ischemic stroke to assess their plausibility as surrogate markers of the ischemic penumbra. Twenty-one consecutive patients with internal carotid artery and/or middle cerebral artery occlusion were studied at 3...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28929697/-effects-of-berberine-on-serum-inflammatory-factors-and-carotid-atherosclerotic-plaques-in-patients-with-acute-cerebral-ischemic-stroke
#10
Ying Li, Pei Wang, Mei-Jing Chai, Fan Yang, Hong-Shan Li, Jing Zhao, Huan Wang, Dan-Dan Lu
This study aims to analyze the effect of berberine on serum inflammatory factors and carotid atherosclerotic plaques in ppatients with acute cerebral ischemic stroke(AIS). In the study, 120 patients with AIS were randomly divided into berberine group(n=60) and general group (n=60). The 60 cases in the general group were provided with general therapy according to the latest guidelines of diagnosis and treatment of AIS. The berberine group received berberine 300 mg(tid) in addition to the therapy of the general group...
November 2016: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
https://www.readbyqxmd.com/read/28917378/chinese-herbal-medicine-dengzhan-xixin-injection-for-acute-ischemic-stroke-a-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#11
REVIEW
Jin-Gen Li, Li-Qiong Wang, Xiao-Ying Yang, Zhuo Chen, Lily Y W Lai, Hao Xu, Jian-Ping Liu
OBJECTIVE: To evaluate the effectiveness and safety of Chinese herbal medicine Dengzhan Xixin (Erigeron breviscapus) injection for acute ischemic stroke. DESIGN: Systematic review and meta-analysis (CRD42016038413, http://www.crd.york.ac.uk/PROSPERO). METHODS: Six electronic databases were searched from inception to March 2016 for randomised controlled trials (RCTs) of Dengzhan Xixin (DZXX) injection for acute ischemic stroke. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool...
October 2017: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/28916672/effects-of-statin-intensity-and-adherence-on-the-long-term-prognosis-after-acute-ischemic-stroke
#12
Jinkwon Kim, Hye Sun Lee, Chung Mo Nam, Ji Hoe Heo
BACKGROUND AND PURPOSE: Statin is an established treatment for secondary prevention after ischemic stroke. However, the effects of statin intensity and adherence on the long-term prognosis after acute stroke are not well known. METHODS: This retrospective cohort study using a nationwide health insurance claim data in South Korea included patients admitted with acute ischemic stroke between 2002 and 2012. Statin adherence and intensity were determined from the prescription data for a period of 1 year after the index stroke...
September 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28913720/emergency-neurological-life-support-acute-ischemic-stroke
#13
Hartmut Gross, Noah Grose
Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including both intravenous thrombolysis and endovascular approaches to thrombus removal. Extensive study has demonstrated that rapid, protocolized, assessment and treatment is essential to improving neurological outcome. For this reason, acute ischemic stroke was chosen as an emergency neurological life support protocol. The protocol focuses on the first hour of medical care following the acute onset of a neurological deficit...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28911996/accessibility-to-tertiary-stroke-centers-in-hokkaido-japan-use-of-novel-metrics-to-assess-acute-stroke-care-quality
#14
Kensuke Fujiwara, Toshiya Osanai, Eiichi Kobayashi, Takumi Tanikawa, Ken Kazumata, Kikutaro Tokairin, Kiyohiro Houkin, Katsuhiko Ogasawara
BACKGROUND: Both the accessibility and availability of stroke specialists are major determinants of patient outcomes following acute ischemic stroke (AIS). The purpose of this study was to implement novel metrics to assess the accessibility of tertiary stroke centers as well as to evaluate regional disparities in stroke specialists. METHODS: Using network analysis in a geographic information system, we calculated areas within 30- and 60-minute travel times to facilities providing intravenous recombinant tissue-type plasminogen activator and mechanical thrombectomy...
September 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28910463/use-of-acetylsalicylic-acid-in-the-prehospital-setting-for-suspected-acute-ischemic-stroke
#15
John M Levri, Armando Ocon, Paul Schunk, Cord W Cunningham
Acute ischemic stroke (AIS) treatment guidelines include various recommendations for treatment once the patient arrives at the hospital. Prehospital care recommendations, however, are limited to expeditious transport to a qualified hospital and supportive care. The literature has insufficiently considered prehospital antiplatelet therapy. An otherwise healthy 30-year-old black man presented with headache for about 3 hours, left-sided facial and upper extremity numbness, slurred speech, miosis, lacrimation, and general fatigue and malaise...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28904450/acute-ischemic-stroke-treatment-using-mechanical-thrombectomy-a-study-of-137-patients
#16
Rakeshsingh K Singh, Vishal Annaji Chafale, Rakesh Shyam Lalla, Keyurkumar Chandrakantbhai Panchal, Anil Pandurang Karapurkar, Satish Vasant Khadilkar, Pawan K Ojha, Yogesh Godge, Rakesh K Singh, Rajesh Benny
BACKGROUND: Mechanical thrombectomy (MT) is the most effective treatment in large vessel occlusion (LVO). We have analyzed our initial experience of MT of 137 patients in anterior circulation (AC) and posterior circulation (PC) LVO using Solitaire stent retriever device. METHODS: Retrospective cohort analysis of 112 AC and 25 PC acute ischemic strokes was done considering various baseline characteristics, risk factors, National Institute of Health Stroke Scale (NIHSS) change, revascularization rate, complications, and functional outcome at 3 months using modified Rankin score...
July 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28904228/anesthesia-related-outcomes-for-endovascular-stroke-revascularization-a-systematic-review-and-meta-analysis
#17
Waleed Brinjikji, Jeffrey Pasternak, Mohammad H Murad, Harry J Cloft, Tasha L Welch, David F Kallmes, Alejandro A Rabinstein
BACKGROUND AND PURPOSE: There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group). METHODS: A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed...
September 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28899946/secondary-prevention-treatment-after-acute-stroke-in-older-south-asian-chinese-and-other-canadians-a-retrospective-data-analysis
#18
Nadia A Khan, Finlay A McAlister, Louise Pilote, Anita Palepu, Hude Quan, Michael D Hill, Jiming Fang, Moira K Kapral
BACKGROUND: Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke. METHODS: Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009)...
September 11, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28899866/subacute-endovascular-recanalization-of-symptomatic-cerebral-artery-occlusion-a-propensity-score-matched-analysis
#19
Sang Hun Lee, Dae Chul Suh, Su Hee Cho, Jae Jon Sheen, Deok Hee Lee, Jong S Kim
BACKGROUND: The interval between the onset of cerebral vessel occlusion and recanalization has been shown to be an independent predictor of poor outcomes. However, endovascular recanalization of symptomatic cerebral vessel occlusion in the subacute period has not been well documented. We investigated the safety and efficacy of subacute recanalization of occluded cerebral vessels in patients with ischemic stroke or transient ischemic attacks (TIAs). METHODS: Between 2014 and 2015, 98 patients were admitted to the emergency room for ischemic stroke or TIA with a small infarct core, which was defined as modest early ischemic change on non-contrast CT or overt diffusion-perfusion mismatch...
September 12, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28898204/beneficial-effect-of-beraprost-sodium-plus-aspirin-in-the-treatment-of-acute-ischemic-stroke
#20
Siqia Chen, Sisi Xie, Wenzhen He, Duncan Wei, Shunxian Li, Wenjie Chen
BACKGROUND To investigate the combination of beraprost sodium (BPS) and aspirin in the treatment of acute ischemic stroke (AIS). MATERIAL AND METHODS 308 patients with acute cerebral infarction were randomly divided into two groups: experimental group (n=154), treated with BPS (40 μg, tid) and aspirin (100 mg, qd); control group (n=154), treated with 100 mg of aspirin, qd). The antiplatelet therapy remained unchangeable until six months after hospital discharge. RESULTS Initially, no significant differences were found between the two groups...
September 12, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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