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Alejandra Daruich, Jérôme Parcq, Kimberley Delaunay, Marie-Christine Naud, Quentin Le Rouzic, Emilie Picard, Patricia Crisanti, Denis Vivien, Marianne Berdugo, Francine Behar-Cohen
PURPOSE: Intravitreal recombinant tissue plasminogen activator (rtPA) is used off-label for the surgical management of submacular hemorrhage, a severe complication of neovascular age-related macular degeneration. rtPA is approved for coronary and cerebral thrombolysis. However, in ischemic stroke rtPA is known to increase excitotoxic neural cell death by interacting with the N-methyl-D-aspartate (NMDA) receptor. We therefore investigated the retinal toxicity of rtPA in healthy rats and in a model of NMDA-induced retinal excitotoxicity...
2016: Molecular Vision
Laurent Chazalviel, Benoit Haelewyn, Mickael Degoulet, Jean-Eric Blatteau, Nicolas Vallée, Jean-Jacques Risso, Stéphane Besnard, Jacques H Abraini
Recent data have shown that normobaric oxygen (NBO) increases the catalytic and thrombolytic efficiency of recombinant tissue plasminogen activator (rtPA) in vitro, and is as efficient as rtPA at restoring cerebral blood flow in rats subjected to thromboembolic brain ischemia. Therefore, in the present study, we studied the effects of hyperbaric oxygen (HBO) (i) on rtPA-induced thrombolysis in vitro and (ii) in rats subjected to thromboembolic middle cerebral artery occlusion-induced brain ischemia. HBO increases rtPA-induced thrombolysis in vitro to a greater extent than NBO; in addition, HBO treatment of 5-minute duration, but not of 25-minute duration, reduces brain damage and edema in vivo...
April 2016: Medical Gas Research
C Mouthon-Reignier, I Bonnaud, M Gaudron, S Vannier-Bernard, J-F Bodin, J-P Cottier, B De Toffol, S Debiais
INTRODUCTION: This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA. METHODS: This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data...
December 2016: Revue Neurologique
Eberhard Grambow, Christian Leppin, Katja Leppin, Günther Kundt, Ernst Klar, Marcus Frank, Brigitte Vollmar
The volatile transmitter hydrogen sulfide (H2S) is known for its various functions in vascular biology. This study evaluates the effect of the H2S-donor GYY4137 (GYY) on thrombus stability and microvascular thrombolysis. Human whole blood served for all in vitro studies and was analyzed in a resting state, after stimulation with thrombin-receptor activating peptide (TRAP) and after incubation with 10 or 30 mM GYY or its vehicle DMSO following TRAP-activation, respectively. As a marker for thrombus stability, platelet-leukocyte aggregation was assessed using flow cytometry after staining of human whole blood against CD62P and CD45, respectively...
November 7, 2016: Platelets
Didier Leys, Yannick Hommet, Clémence Jacquet, Solène Moulin, Igor Sibon, Jean-Louis Mas, Thierry Moulin, Maurice Giroud, Sharmila Sagnier, Charlotte Cordonnier, Elisabeth Medeiros de Bustos, Guillaume Turc, Thomas Ronzière, Yannick Bejot, Olivier Detante, Thavarak Ouk, Anne-Marie Mendyk, Pascal Favrole, Mathieu Zuber, Aude Triquenot-Bagan, Ozlem Ozkul-Wermester, Francisco Macian Montoro, Chantal Lamy, Anthony Faivre, Laurent Lebouvier, Camille Potey, Mathilde Poli, Hilde Hénon, Pauline Renou, Nelly Dequatre-Ponchelle, Marie Bodenant, Sabrina Debruxelles, Costanza Rossi, Régis Bordet, Denis Vivien
OBJECTIVE: To determine whether the ratio single chain (sc)/(sc + 2 chain [tc]) recombinant tissue plasminogen activator (rtPA) influences outcomes in patients with cerebral ischemia. METHODS: We prospectively included consecutive patients treated with IV rtPA for cerebral ischemia in 13 stroke centers and determined the sc/(sc + tc) ratio in the treatment administered to each patient. We evaluated the outcome with the modified Rankin Scale (mRS) at 3 months (prespecified analysis) and occurrence of epileptic seizures (post hoc analysis)...
December 6, 2016: Neurology
Naima Chtaou, Lamyae Rachdi, Aouatef El Midaoui, Zouhair Souirti, Nils Wahlgren, Mohammed Faouzi Belahsen
The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred. We report the case series of all patients who were treated with rt-PA at Stroke Unit of HASSAN II University hospital between 2010 and 2013. There were 52 patients treated with intravenous rtPA during the study period. The mean age was 63 years with the no gender predominance (sex ratio 1.02). Hypertension was the most common vascular risk factor (31%) and 17% of patients suffered from atrial fibrillation...
2016: Pan African Medical Journal
Vesna Malinova, Anna Schlegel, Veit Rohde, Dorothee Mielke
For the fibrinolytic therapy of intracerebral hematomas (ICH) using recombinant tissue plasminogen activator (rtPA), a catheter position in the core of the hematoma along the largest clot diameter was assumed to be optimal for an effective clot lysis. However, it never had been proven that core position indeed enhances clot lysis if compared with less optimal catheter positions. In this study, the impact of the catheter position on the effectiveness and on the time course of clot lysis was evaluated. We analyzed the catheter position using a relative error calculating the distance perpendicular to the catheter's center in relation to hematoma's diameter and evaluated the relative hematoma volume reduction (RVR)...
October 10, 2016: Neurosurgical Review
Klára Fekete, Sándor Márton, László Csiba, István Fekete
INTRODUCTION: Recombinant tissue plasminogen activator (rtPA) is an efficient therapy of acute ischemic stroke. The risk of a recurrent ischemic stroke is high. This prospective single center study aimed to assess whether or not the repeated rtPA treatment is beneficial for acute stroke patients. METHODS: All thrombolysed patients' data at the Department of Neurology, University of Debrecen have been recorded in the Debrecen Thrombolysis Database (DTD) since 2004...
September 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Basil Vasilios D Thanopoulos, Vlassis Ninios, Petros Dardas, Andreas Giannopoulos, Dan Deleanou, Silvia Iancovici
The standard technique of catheter closure of patent ductus arteriosus (PDA) may be associated with arterial complications particularly in small pediatric patients. The aim of this study was to evaluate whether catheter closure of PDA in small children using an exclusive venous approach is a safe and effective alternative to closure with the standard technique. One hundred-twelve patients, aged 2 to 24 months, were randomly assigned in a 1:1 ratio to catheter closure of PDA using the standard technique (group 1) and an exclusive venous approach (group 2), respectively...
August 23, 2016: American Journal of Cardiology
Maria Waizel, Margarita G Todorova, Sara Kazerounian, Annekatrin Rickmann, Björn R Blanke, Peter Szurman
BACKGROUND: The aim of this study was to compare the outcomes after subretinal recombinant tissue plasminogen activator (rtPA) treatment for subretinal hemorrhages (SRH), subpigment epithelial hemorrhages (SPH), and combined subretinal and subpigment epithelial hemorrhages (CH). METHODS: An observational analysis of patients treated with subretinal rtPA was performed. The primary endpoint was the assessment of visual improvement (best-corrected visual acuity, BCVA) after surgery...
2016: Ophthalmologica. Journal International D'ophtalmologie
Xiyang Yao, Dapeng Wang, Haiying Li, Haitao Shen, Zhang Shu, Gang Chen
OBJECTIVE: Erythropoietin (EPO) for treating acute ischemic stroke (AIS) has been investigated in many studies. However, the evidence was inconsistent. Thus, a systematic review and meta-analysis was performed to elucidate the role of EPO in treating patients with AIS. METHODS: Two electronic databases (PubMed and EMBASE) were used. 30-day NHISS measures primary outcome while all-cause mortality in the follow up and 90-day Barthel Index were regarded as secondary outcomes...
August 22, 2016: Current Drug Delivery
Johannes Kaesmacher, Justus F Kleine
BACKGROUND: Recent studies suggested that preinterventional intravenous (i. v.) recombinant tissue plasminogen activator (rtPA) as bridging therapy facilitates successful and fast vessel recanalization in endovascular stroke treatment (EST); however, data on this effect and the associated clinical value are discrepant. OBJECTIVE: This study examined if this discrepancy could be related to an effect-modifying variable, specifically to the exact occlusion site. METHODS: Retrospective analysis of 239 patients with acute occlusion of the middle cerebral artery (MCA) treated with up to date endovascular techniques...
August 19, 2016: Clinical Neuroradiology
Wing Mann Ho, Cesar Reis, Onat Akyol, Gokce Yilmaz Akyol, Richard Applegate 2nd, Gary Stier, Robert Martin, John H Zhang
Hemorrhagic transformation (HT) is a common and natural complication after acute ischemic stroke. The only FDA-approved treatment so far for acute ischemic stroke is rapid reperfusion with recombinant tissue plasminogen activator (rtPA). Although it has been shown to exaggerate the risk and severity of HT and to be associated with increased morbidity and mortality. Understanding HT is essential to restore cerebral blood flow to ischemic brain by reperfusion therapy without causing this complication and additional brain injury...
August 18, 2016: Current Drug Targets
Sang Hyun Shon, Sung Hyuk Heo, Bum Joon Kim, Hye-Yeon Choi, Youngnam Kwon, Sang Hun Yi, Ji Sung Lee, Young Seo Kim, Hyun Young Kim, Seong-Ho Koh, Dae-Il Chang
BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) is one of the most feared complications after administration of intravenous recombinant tissue plasminogen activator (IV rtPA). The aim of this study was to determine correlations between hemorrhage volume (HV) after IV rtPA treatment and risk factors for sICH. METHODS: We analyzed 318 patients from the stroke registries of 4 hospitals in Korea. We confirmed hemorrhage by computed tomography (CT) or magnetic resonance imaging within 36 hours...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Mostafa Almasi, Saeed Razmeh, Amir Hassan Habibi, Amir Hassan Rezaee
Recombinant tissue plasminogen activator (rTPA) is one of the main portions of acute ischemic stroke management, but unfortunately has some complications. Myocardial infarction (MI) is a hazardous complication of administration of intravenous rTPA that has been reported recently. A 78-year-old lady was admitted for elective coronary artery bypass graft surgery. On the second day of admission, she developed acute left hemiparesis and intravenous rTPA was administered within 120 minutes. Three hours later, she has had chest pain...
June 15, 2016: Neurology International
Maryam Abdoli Nasab, Mokhtar Jalali Javaran, Rosa M Cusido, Javier Palazon
Plants are low cost platforms for the production of recombinant proteins, but their complexity renders the purification of plant recombinant proteins more difficult than proteins expressed in yeast or bacteria. Plastid transformation enables high-level expression of foreign genes and the accumulation of recombinant proteins in plastid organelles. Histidine (His) tags are widely used for affinity purification of recombinant proteins in a nickel column. The human tissue-type plasminogen activator (tPA) is one of the most important pharmaceutical recombinant proteins involved in the breakdown of blood clots in different parts of the body...
June 25, 2016: Plant Physiology and Biochemistry: PPB
Mei-Xue Dong, Qing-Chuan Hu, Peng Shen, Jun-Xi Pan, You-Dong Wei, Yi-Yun Liu, Yi-Fei Ren, Zi-Hong Liang, Hai-Yang Wang, Li-Bo Zhao, Peng Xie
BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rtPA) is the only effective drug approved by US FDA to treat ischemic stroke, and it contains pleiotropic effects besides thrombolysis. We performed a meta-analysis to clarify effect of tissue plasminogen activator (tPA) on cerebral infarction besides its thrombolysis property in mechanical animal stroke. METHODS: Relevant studies were identified by two reviewers after searching online databases, including Pubmed, Embase, and ScienceDirect, from 1979 to 2016...
2016: PloS One
D G Romano, S Cioni, S Leonini, P Gennari, I M Vallone, A Zandonella, A Puliti, R Tassi, A Casasco, G Martini, S Bracco
BACKGROUND: For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation...
October 2016: Interventional Neuroradiology
Andrew D Barreto, Christopher V Fanale, Andrei V Alexandrov, Kevin C Gaffney, Farhaan S Vahidy, Claude B Nguyen, Amrou Sarraj, Mohammad Rahbar, James C Grotta, Sean I Savitz
OBJECTIVE: It is estimated that one of four ischemic strokes are noticed upon awakening and are not candidates for intravenous recombinant tissue plasminogen activator (rtPA) because their symptoms are >3 hours from last seen normal (LSN). We tested the safety of rtPA in a multicenter, single-arm, prospective, open-label study (NCT01183533) in patients with wake-up stroke (WUS). METHODS: We aimed to enroll 40 WUS patients with disabling deficits. Patients were 18 to 80 years of age, National Institutes of Health Stroke Scale (NIHSS) ≤25, and selected only on the appearance of noncontrast computed tomography (ie, over one-third middle cerebral artery territory hypodensity)...
August 2016: Annals of Neurology
Priyank Khandelwal, Dileep R Yavagal, Ralph L Sacco
Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone...
June 7, 2016: Journal of the American College of Cardiology
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