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acute ischemic stroke treatment

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https://www.readbyqxmd.com/read/29792090/procedural-and-clinical-outcomes-of-endovascular-recanalization-therapy-in-patients-with-cancer-related-stroke
#1
Seunguk Jung, Cheolkyu Jung, Jae Hyoung Kim, Byung Se Choi, Yun Jung Bae, Leonard Sunwoo, Ho Geol Woo, Jun Young Chang, Beom Joon Kim, Moon-Ku Han, Hee-Joon Bae
Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed...
January 1, 2018: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29791947/global-burden-of-stroke
#2
Mira Katan, Andreas Luft
Stroke is the second leading cause of death and a major cause of disability worldwide. Its incidence is increasing because the population ages. In addition, more young people are affected by stroke in low- and middle-income countries. Ischemic stroke is more frequent but hemorrhagic stroke is responsible for more deaths and disability-adjusted life-years lost. Incidence and mortality of stroke differ between countries, geographical regions, and ethnic groups. In high-income countries mainly, improvements in prevention, acute treatment, and neurorehabilitation have led to a substantial decrease in the burden of stroke over the past 30 years...
April 2018: Seminars in Neurology
https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#3
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat
BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2 ) to the fraction of inspired oxygen (Fio2 ) of less than 50 mm Hg for more than 3 hours; a Pao2 :Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29791706/use-of-a-noblestitch%C3%A2-el-device-for-pfo-closure
#4
Emanuela de Cillis, Tommaso Acquaviva, Pasquale D'Alessandro, Alessandro Santo Bortone
Cryptogenic stroke is the final diagnosis in almost 40% of ischemic acute cerebrovascular events. There is currently no definitive clinical evidence that percutaneous closure of patent foramen ovale (PFO) can prevent the recurrence of stroke or transient ischemic attack (TIA). Identification of the causes of neurologic ischemic syndromes is essential for any strategy intended to prevent the catastrophic consequences of cerebral infarction. Since the initial reports of an unexpectedly high prevalence of PFO in younger patients with cryptogenic stroke in 1988, there has been growing interest and experience in diagnosing and treating these patients, both medically and/or with percutaneous closure, in particular for the potential to eliminate paradoxical embolism via PFO, which is a likely mechanism for stroke in these patients...
June 1, 2018: Surgical Technology International
https://www.readbyqxmd.com/read/29791600/unilateral-spatial-neglect-in-the-acute-phase-of-ischemic-stroke-can-predict-long-term-disability-and-functional-capacity
#5
Gustavo José Luvizutto, Augusta Fabiana Moliga, Gabriela Rizzo Soares Rizzatti, Marcelo Ortolani Fogaroli, Eduardo de Moura Neto, Hélio Rubens de Carvalho Nunes, Luiz Antônio de Lima Resende, Rodrigo Bazan
OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received...
May 21, 2018: Clinics
https://www.readbyqxmd.com/read/29790969/microcatheter-first-pass-effect-predicts-acute-intracranial-artery-atherosclerotic-disease-related-occlusion
#6
Ting-Yu Yi, Wen-Huo Chen, Yan-Min Wu, Mei-Fang Zhang, A-Lai Zhan, Yue-Hong Chen, Zong-Zhong Wu, Yan-Chuan Shi, Bai-Ling Chen
BACKGROUND: The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally...
May 22, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29789872/endovascular-thrombectomy-for-large-vessel-occlusion-strokes-with-preexisting-intracranial-aneurysms
#7
Tengfei Zhou, Tianxiao Li, Liangfu Zhu, Ziliang Wang, Weixing Bai, Jiangyu Xue, Guang Feng
OBJECTIVE: This study aimed to investigate the safety of endovascular thrombectomy in acute ischemic stroke with preexisting intracranial aneurysms. METHODS: Patients with acute ischemic stroke due to large-artery occlusion combined with intracranial aneurysms, who received endovascular treatment, were analyzed retrospectively, and the procedure-related data were recorded. RESULTS: Among the 124 patients who suffered acute large-artery occlusion and received endovascular recanalization therapy, intracranial aneurysms were found in seven patients (5...
May 22, 2018: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/29787393/recanalization-of-chronic-occlusion-of-the-middle-cerebral-artery-with-tissue-plasminogen-activator-treatment-a-case-report
#8
Seung Jae Lee, Jin Sung Cheong, Han Uk Ryu, Hyun Goo Kang
OBJECTIVES: Patients with chronic proximal middle cerebral artery (MCA) occlusion do not present with severe symptoms, but early recanalization of acute occlusion is associated with high morbidity and mortality. Tissue plasminogen activator (tPA) is a recombinant thrombolytic agent approved for treating ischemic stroke, although only a few cases of tPA administration in chronic MCA occlusion have yielded positive results. METHODS: A 71-year-old patient had a history of right MCA territorial infarction with the occlusion occurring 12 years ago (November 2005)...
May 21, 2018: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/29785465/causes-and-treatment-of-acute-ischemic-stroke-during-pregnancy
#9
REVIEW
Ina Terón, Melissa S Eng, Jeffrey M Katz
PURPOSE OF REVIEW: Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state...
May 21, 2018: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/29781051/prehospital-prediction-of-large-vessel-occlusion-in-suspected-stroke-patients
#10
REVIEW
Kevin J Keenan, Charles Kircher, Jason T McMullan
PURPOSE OF REVIEW: Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29779882/antithrombotic-therapy-strategy-for-cancer-associated-ischemic-stroke-a-case-series-of-26-patients
#11
Hiroyuki Naito, Tomohisa Nezu, Naohisa Hosomi, Shiro Aoki, Hiroki Ueno, Kazuhide Ochi, Hirofumi Maruyama
BACKGROUND: The risk of complications from thromboembolism is increased for patients with malignancy. Cancer-associated stroke is also a serious issue with regard to the management of patients with cancer because stroke incidence often causes disabilities that affect daily life and cancer treatment strategy. METHODS: Between March 2011 and September 2017, 328 patients with acute ischemic stroke were registered to our hospital. RESULTS: Of these patients, 26 (7...
May 17, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29778315/the-risk-of-hemorrhagic-transformation-after-thrombolysis-for-acute-ischemic-stroke-in-chinese-versus-north-americans-a-comparative-study
#12
Xiaomeng Xu, Deren Wang, Fang Wang, Casey Norton, Xinfeng Liu, Magdy Selim
BACKGROUND: There is a widespread belief that Asians are more susceptible to hemorrhagic transformation (HT) after receiving recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke (AIS). However, this has not been examined in clinical practice. This study aims to compare the incidence of symptomatic hemorrhagic transformation (SHT) among thrombolysis-treated AIS patients in China and in the United States. METHODS: We compared 212 consecutive patients receiving thrombolysis within 4...
May 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29776790/-modern-treatment-of-mesenteric-ischemia
#13
Alexandre Nuzzo, Audrey Huguet, Olivier Corcos
Acute mesenteric ischemia is a highly morbid affliction which requires urgent care. Acute mesenteric ischemia consists in an ischemia injury of the small bowel, secondary to vascular insufficiency, either occlusive (thrombosis, embolism, arterial, venous) or non-occlusive (low flow or vasospasm). Given that the superior mesenteric artery supplies the small bowel as well as the right part of the colon, any ischemic process involving the right colon should be considered an acute mesenteric ischemia until proven otherwise...
May 15, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29773949/effect-of-dual-antiplatelet-on-recurrent-stroke-in-minor-stroke-or-tia-depends-on-bodyweight
#14
Yan Ma, Ying Liu, Jie Xu, Yilong Wang, Yongjun Wang, Fenghe Du
Objective: To assess whether bodyweight influences the efficacy and safety of dual antiplatelet therapy (DAT) in male patients with minor stroke or transient ischemic attack patients. Materials and methods: All 3,420 male participants coming from the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial were divided into 3 groups based on bodyweight (<65 kg, 65-75 kg, and ≥75 kg). The stroke outcomes included stroke recurrence, combined vascular events, and bleeding events during 90 days of follow-up...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29773716/thrombectomy-6-24-hours-after-stroke-in-trial-ineligible-patients
#15
Shashvat M Desai, Marcelo Rocha, Bradley J Molyneaux, Matthew Starr, Cynthia L Kenmuir, Bradley A Gross, Brian Thomas Jankowitz, Tudor G Jovin, Ashutosh P Jadhav
BACKGROUND AND PURPOSE: The DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials. METHODS: A retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6-24 hour time window...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29773569/mobile-stroke-unit-reduces-time-to-image-acquisition-and-reporting
#16
E M Nyberg, J R Cox, R G Kowalski, D V Duarte, B Schimpf, W J Jones
Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy...
May 17, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29772576/wake-up-stroke-versus-stroke-with-known-onset-time-clinical-and-multimodality-ct-imaging-characteristics
#17
Jan W Dankbaar, Henri P Bienfait, Coen van den Berg, Edwin Bennink, Alexander D Horsch, Tom van Seeters, Irene C van der Schaaf, L Jaap Kappelle, Birgitta K Velthuis
BACKGROUND: Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. METHODS: All patients were selected from a large prospective cohort study (Dutch acute stroke study)...
May 17, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29769288/targeted-complement-inhibition-salvages-stressed-neurons-and-inhibits-neuroinflammation-after-stroke-in-mice
#18
Ali Alawieh, E Farris Langley, Stephen Tomlinson
Ischemic stroke results from the interruption of blood flow to the brain resulting in long-term motor and cognitive neurological deficits, and it is a leading cause of death and disability. Current interventions focus on the restoration of blood flow to limit neuronal death, but these treatments have a therapeutic window of only a few hours and do not address post-stroke cerebral inflammation. The complement system, a component of the innate immune system, is activated by natural immunoglobulin M (IgM) antibodies that recognize neoepitopes expressed in the brain after ischemic stroke...
May 16, 2018: Science Translational Medicine
https://www.readbyqxmd.com/read/29766805/a-novel-neuroimaging-model-to-predict-early-neurological-deterioration-after-acute-ischemic-stroke
#19
Yen-Chu Huang, Yuan-Hsiung Tsai, Jiann-Der Lee, Jen-Tsung Yang, Yi-Ting Pan
OBJECTIVE: In acute ischemic stroke, early neurological deterioration (END) may occur in up to one-third of patients. However, there is still no satisfying or comprehensive predictive model for all the stroke subtypes. We propose a practical model to predict END using magnetic resonance imaging (MRI). METHOD: Patients with anterior circulation infarct were recruited and they underwent an MRI within 24 hours of stroke onset. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 72 hours of stroke onset...
May 16, 2018: Current Neurovascular Research
https://www.readbyqxmd.com/read/29766750/clopidogrel-and-aspirin-in-acute-ischemic-stroke-and-high-risk-tia
#20
S Claiborne Johnston, J Donald Easton, Mary Farrant, William Barsan, Robin A Conwit, Jordan J Elm, Anthony S Kim, Anne S Lindblad, Yuko Y Palesch
Background Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population. Methods In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone...
May 16, 2018: New England Journal of Medicine
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