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Valerie Jeanneret, Juan P Ospina, Ariel Diaz, Luis G Manrique, Paola Merino, Laura Gutierrez, Enrique Torre, Fang Wu, Lihong Cheng, Manuel Yepes
Cerebral ischemia causes the presynaptic release of tissue-type plasminogen activator (tPA). The postsynaptic density (PSD) is a postsynaptic structure that provides a matrix where signaling transduction of excitatory synapses takes place. The postsynaptic density protein-95 (PSD-95) is the most abundant scaffolding protein in the postsynaptic density (PSD), where it modulates the postsynaptic response to the presynaptic release of glutamate by regulating the anchoring of glutamate receptors to the PSD. We found that tPA induces the local translation of PSD-95 mRNA and the subsequent recruitment of PSD-95 protein to the PSD, via plasminogen-independent activation of TrkB receptors...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
William J Meurer, Bradley Barth, Michael Abraham, Jerome Hoffman, Gary M Vilke, Gerard DeMers
BACKGROUND: Stroke treatment is a continuum that begins with the rapid identification of symptoms and treatment with transition to successful rehabilitation. Therapies for acute ischemic stroke (AIS) may vary based on anatomic location, interval from symptom onset, and coexisting health conditions. Successful therapy requires a seamless systematic approach with coordination from prehospital environment through acute management at medical facilities to disposition and long-term care of the patient...
March 12, 2018: Journal of Emergency Medicine
Raquel Delgado-Mederos, Clara Gregori-Pla, Peyman Zirak, Igor Blanco, Lavinia Dinia, Rebeca Marín, Turgut Durduran, Joan Martí-Fàbregas
In this pilot study, we have evaluated bedside diffuse optical monitoring combining diffuse correlation spectroscopy and near-infrared diffuse optical spectroscopy to assess the effect of thrombolysis with an intravenous recombinant tissue plasminogen activator (rtPA) on cerebral hemodynamics in an acute ischemic stroke. Frontal lobes of five patients with an acute middle cerebral artery occlusion were measured bilaterally during rtPA treatment. Both ipsilesional and contralesional hemispheres showed significant increases in cerebral blood flow, total hemoglobin concentration and oxy-hemoglobin concentration during the first 2...
March 1, 2018: Biomedical Optics Express
Elias Atallah, Kimon Bekelis, Hassan Saad, Nohra Chalouhi, Sophia Dang, Jonathan Li, Ayan Kumar, Justin Turpin, Randa Barsoom, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana Labella, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVES: Neurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its proven efficacy, neurovascular surgeons(NS) are playing an increasingly important role in the management and overall care of AIS. We assessed outcomes of AIS patients managed by NS, who have been traditionally managed by neurologists...
February 23, 2018: Clinical Neurology and Neurosurgery
Mark Flower, James Harvey, Jonathan Hunter
An 84-year-old male Jehovah's Witness presented to the emergency department 1 hour after onset of left facial droop and left upper limb weakness. Thrombolytic stroke treatment was commenced as per local thrombolytic protocol with intravenous recombinant tissue plasminogen activator (rtPA) at 2 hours and 25 min following onset of symptoms. Almost immediately after rtPA infusion the patient reported chest pain and had ECG changes consistent with a diagnosis of anterior ST elevation myocardial infarction...
March 5, 2018: BMJ Case Reports
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
Xian-Ru Lee, Gui-Ling Xiang
OBJECTIVES: Edaravone, a free radical scavenger, alleviates blood-brain barrier disruption in conjunction with suppression of the inflammatory reaction in acute cerebral infarction. Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established therapy for acute cerebral infarction patients. The purpose of this study was to assess the effects of edaravone on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of iv-rt-PA. PATIENTS AND METHODS: We conducted a retrospective cohort study using the database of Ningbo First Hospital...
February 24, 2018: Clinical Neurology and Neurosurgery
Taylor Wapshott, Brice Blum, Williams Kelsey, Thomas I Nathaniel
Background: Many studies have reported that women who survive stroke have less favorable outcomes than men in the use of rtPA, while others reported worse outcomes in men than women. The gender difference in the exclusion criteria in a diabetic stroke population is not fully understood. This issue was investigated in this study. Method: In a diabetic stroke population from a stroke registry of data collected between January 2010 to June 30, 2016, the gender difference was determined using demographics and clinical factors...
December 2017: Journal of Vascular and Interventional Neurology
Felipe De Los Rios La Rosa, Amy K Starosciak, Brian Wolf
No abstract text is available yet for this article.
December 2017: Neurology. Clinical Practice
Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach
BACKGROUND AND PURPOSE: Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine. METHODS: Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines...
January 8, 2018: Clinical Neuroradiology
Yunn-Hwa Ma, Chao-Wei Huang, Chih-Jen Wen, Yi-Ching Lu, Shiaw-Pyng Wey, Tze-Chein Wun
Without conjunctive administration of an anticoagulant, endothelial injury-induced thrombosis is resistant to thrombolysis and prone to re-thrombosis. We hypothesized that co-delivery of recombinant tissue plasminogen activator (rtPA) with annexin V-containing anticoagulants that specifically target the injured endothelium may passivate the thrombogenic elements of the vascular injury site and enhance rtPA-induced thrombolysis. In this study, the effects of conjunctive administration of Kinexins (Kunitz inhibitor-annexin V fusion proteins) with rtPA on thrombolysis were determined in vitro and in vivo...
January 2018: Thrombosis and Haemostasis
Radouane Ghebouli, Stephane Loyau, Murielle Maire, Pierre Saboural, Jean-Philippe Collet, Martine Jandrot-Perrus, Didier Letourneur, Frédéric Chaubet, Jean-Baptiste Michel
Acute ischaemic stroke, myocardial infarction and pulmonary embolism are the main causes of mortality and morbidity worldwide. Thrombolysis by intravenous injection of recombinant tissue plasminogen activator (rtPA) remains the most common non-interventional treatment to recanalize occluded vessels. However, this procedure is limited by significant drawbacks, including high doses and bleeding complications. Recent studies showed that fucoidan targets the intraluminal thrombus in vivo. We have developed a chimaera covalently linking fucoidan, able to target platelets within the thrombus, to dilysine, able to non-covalently bind rtPA...
January 2018: Thrombosis and Haemostasis
Jennifer E Fugate, Waleed Brinjikji, Harry Cloft, David F Kallmes, Alejandro A Rabinstein
BACKGROUND: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. METHODS: Retrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010-November 2014...
December 19, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
Johann Otto Pelz, Dominik Michalski, Dorothee Saur
No abstract text is available yet for this article.
September 2017: ENeurologicalSci
Zhiliang Guo, Shuhong Yu, Xin Chen, Ping Zheng, Ting Hu, Zhenhui Duan, Xiaoyun Liu, Qian Liu, Ruidong Ye, Wusheng Zhu, Xinfeng Liu
BACKGROUND: Inflammation and neutrophils play pivotal roles in hemorrhagic transformation (HT) after recombinant tissue plasminogen activator (rtPA) treatment in stroke; however, the contribution of Nod-like receptor protein 3 (NLRP3), a key component of the innate immune system, is not yet known. This study aimed to explore the role of NLRP3 in the delayed rtPA-induced HT and its association with the neutrophil recruitment. METHODS: Rats were subjected to thromboembolic focal cerebral ischemia and delayed rtPA treatment at 4 h after ischemia to mimic HT...
December 16, 2017: Brain Research Bulletin
Anna Starostka-Tatar, Beata Łabuz-Roszak, Michał Skrzypek, Mariusz Gąsior, Marek Gierlotka
Stroke was already diagnosed in the ancient times. For hundreds of years the treatment of this disease has changed radically. According to the current WHO definition, stroke is a clinical syndrome caused by focal or generalized brain injury that lasts more than 24 hours or leads to death and has no other cause than vascular. Stroke constitutes a big social and economic problem, as it can lead to death or disability. In the highly developed countries stroke is the third most common cause of adult deaths, the second leading cause of dementia, and the most common cause of disability...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Beata Łabuz-Roszak, Anna Starostka-Tatar, Anetta Lasek-Bal, Marek Gierlotka, Mariusz Gąsior, Michał Skrzypek
BACKGROUND: The available data on diagnostics and treatment of ischemic stroke (IS) in Poland come mainly from non-representative cohorts or are outdated. OBJECTIVE: Therefore, the current study was done to access the most recent data on IS in the industrial region that covers 12% of the country's population. MATERIALS & METHODS: Analysis of the data from stroke questionnaires, obligatory for all patients hospitalized due to acute stroke and administered by the National Health Fund (the only public health insurer in Poland) between 2009 and 2015 (n=81,193)...
November 14, 2017: Neurologia i Neurochirurgia Polska
Adam J Dixon, John Marschner Robert Rickel, Brian D Shin, Alexander L Klibanov, John A Hossack
Therapeutic approaches that enhance thrombolysis by combining recombinant tissue plasminogen activator (rtPA), ultrasound, and/or microbubbles (MBs) are known as sonothrombolysis techniques. To date, sonothrombolysis approaches have primarily utilized commercially available MB formulations (or derivatives thereof) with diameters in the range 1-4 µm and circulation lifetimes between 5 and 15 min. The present study evaluated the in vitro sonothrombolysis efficacy of large diameter MBs (dMB  ≥ 10 µm) with much shorter lifetimes that were produced on demand and in close proximity to the blood clot using a flow-focusing microfluidic device...
February 2018: Annals of Biomedical Engineering
Luana Antunes Maranha Gatto, Gelson Luis Koppe, Zeferino Demartini, Viviane de Hiroki Flumignan Zétola
OBJECTIVE: Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. OBJECTIVE: To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. METHODS: An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. RESULTS: 456 physicians from different specialties answered the questions...
October 2017: Arquivos de Neuro-psiquiatria
Heesoo Joo, Guijing Wang, Mary G George
INTRODUCTION: Studies have demonstrated that intravenous recombinant tissue plasminogen activator (IV rtPA) is a cost-effective treatment for acute ischemic stroke. Age-specific cost effectiveness has not been well examined. This study estimated age-specific incremental cost-effectiveness ratios (ICERs) of IV rtPA treatment versus no IV rtPA. METHODS: A Markov model was developed to examine the economic impact of IV rtPA over a 20-year time horizon on four age groups (18-44, 45-64, 65-80, and ≥81 years) from the U...
December 2017: American Journal of Preventive Medicine
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