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https://www.readbyqxmd.com/read/29145482/combination-of-ultrasound-and-rtpa-enhances-fibrinolysis-in-an-in-vitro-clot-system
#1
Julia Masomi-Bornwasser, Philipp Winter, Hendrik Müller-Werkmeister, Susanne Strand, Jochem König, Oliver Kempski, Florian Ringel, Sven R Kantelhardt, Naureen Keric
BACKGROUND: Catheter-based lysis with recombinant tissue plasminogen activator (rtPA) is a well-established therapy for spontaneous intracerebral hemorrhage (ICH). The effectiveness of this therapy can be increased with ultrasound, but the optimal conditions are not yet clearly established. Using a novel in vitro system of blood clots previously developed by our group, we investigated various parameters of intralesional sonothrombolysis using an endosonography catheter in combination with rtPA...
2017: PloS One
https://www.readbyqxmd.com/read/29137061/low-free-triiodothyronine-levels-predict-symptomatic-intracranial-hemorrhage-and-worse-short-term-outcome-of-thrombolysis-in-patients-with-acute-ischemia-stroke
#2
Mingjing Qiu, Min Fang, Xueyuan Liu
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29135819/prophylactic-rtpa-in-the-prevention-of-line-associated-thrombosis-and-infection-in-short-bowel-syndrome
#3
Lynn M Malec, James Cooper, Jeffrey Rudolph, Marian G Michaels, Margaret V Ragni
BACKGROUND: Central venous access devices (CVADs) are essential for total parenteral nutrition administration in patients with short bowel syndrome (SBS). However, they are fraught with complications including infection and venous thromboembolism (VTE), which increases associated morbidity and mortality in this population. There is evidence linking the development of CVAD-associated thrombosis and line-related infection. Thus, it has been postulated that prevention of catheter-related clot formation could minimize the risk of infection originating from the catheter...
November 10, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29116545/intravenous-thrombolysis-in-sle-related-stroke-a-case-report-and-literature-review
#4
Xiaodong Chen, Gelin Xu
Patients with systemic lupus erythematosus (SLE) bear an increased risk of ischemic stroke. However, evidences for treating acute stroke due to artery thrombosis in SLE patients are extremely limited. A 45-year-old woman experienced sudden left hemiplegia. She was transported to the emergency department of our hospital 2 hours after the initial symptom. According to the medical records, the patient was diagnosed with SLE at the age of 28. CT scanned 150 min after the initial symptom showed no evidence of acute changes or hemorrhage...
November 7, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/29102234/acute-treatment-of-stroke-due-to-spontaneous-calcified-cerebral-emboli-causing-large-vessel-occlusion
#5
REVIEW
Muhammad Faraz Raghib, Johannes Sebastian Mutzenbach, Cornelia Rösler, Ferdinand Otto, Mark Mc Coy, Erasmia Müller-Thies-Broussalis, Slaven Pikija
INTRODUCTION: Calcified cerebral emboli (CCE) are rarely responsible for large vessel occlusion (LVO) in acute anterior stroke, and therefore therapeutic experience is scarce. We sought to expand current knowledge upon therapeutic options with three new cases and a review of current literature. METHODS: Systematic search of patients with acute anterior stroke due to LVO in one comprehensive stroke center throughout a 4 year period. Literature search for reported cases of CCE...
October 25, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29100857/safe-readministration-of-intravenous-thrombolysis-in-recurrent-basilar-thrombosis
#6
Alina Khan, Ahmed Itrat
We report a patient who had recurrence of stroke in the basilar artery territory because of repeat thrombosis, and was administered intravenous recombinant tissue plasminogen activator (IV-rtPA) twice within a span of 3 weeks without any adverse events, with radiological evidence of successful thrombolysis. Because of minor and improving stroke symptoms with IV-rtPA, endovascular therapy was not performed and there was radiological evidence of recanalization with IV-rtPA alone. This report adds to the very limited literature on the topic demonstrating safe and successful use of repeat IV thrombolysis following a previous recent stroke...
October 31, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29027122/hi1a-as-a-novel-neuroprotective-agent-for-ischemic-stroke-by-inhibition-of-acid-sensing-ion-channel-1a
#7
Yandong Ren, Chengchong Li, Jinlong Chang, Rui Wang, Yuhua Wang, Xiang-Ping Chu
Strokes are the second-leading cause of death worldwide, and the cellular and molecular mechanisms underlying stroke-induced brain damage are still uncertain. The present therapy for acute ischemic stroke is limited to thrombolysis with the recombinant tissue plasminogen activator (rtPA). However, rtPA has a narrow therapeutic timeframe of 3-4.5 h, and only approximately 5% of stroke patients can benefit from rtPA treatment. Neuroprotective agents, such as N-methyl-D-aspartate receptor antagonists, have shown great promise in preclinical studies...
October 13, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28988732/rupture-of-an-occult-intracranial-mycotic-aneurysm-after-intravenous-thrombolysis-with-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke
#8
Jared Glenn, Margaret Strecker-McGraw, Ian McGraw, Karim Jabbar, Nathan A James, C Keith Stone
BACKGROUND: The treatment of acute ischemic stroke with recombinant tissue plasminogen activator (rtPA) has become the mainstay of treatment, but its use carries a risk of subsequent intracranial hemorrhage (ICH). Guidelines have been developed to aid in the selection of the appropriate candidates to treat with rtPA to reduce this risk. We present a case of a stroke patient who was an appropriate candidate and was treated with rtPA who experienced a fatal subarachnoid hemorrhage due to a ruptured mycotic aneurysm (MA)...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28987516/cannabis-can-augment-thrombolytic-properties-of-rtpa-case-report-of-an-intracranial-hemorrhage-in-a-heavy-cannabis-user
#9
Amar Shere, Hemant Goyal
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke...
September 28, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28986280/recombinant-tissue-plasminogen-activator-induces-long-term-anxiety-like-behaviors-via-the-erk1-2-gad1-gaba-cascade-in-the-hippocampus-of-a-rat-model
#10
Mei-Xue Dong, Chen-Meng Li, Peng Shen, Qing-Chuan Hu, You-Dong Wei, Yi-Fei Ren, Jia Yu, Si-Wen Gui, Yi-Yun Liu, Jun-Xi Pan, Peng Xie
OBJECTIVES: Recombinant tissue plasminogen activator (rtPA) is widely used for patients with thromboembolic disease, and increasing evidence indicates that it can directly induce neurotoxicity independent of its thrombolysis property. Here, we aimed to confirm the long-term effect of rtPA on animal's behavior, and investigate the underlying pathogenesis. METHODS AND RESULTS: Male Sprague-Dawley rats randomly received a dose of rtPA (10 mg/kg) or sterile saline...
October 3, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28985592/pharmacological-thrombolysis-for-acute-ischemic-stroke-treatment-gender-differences-in-clinical-risk-factors
#11
Michael J Colello, Lauren E Ivey, Jordan Gainey, Rakiya V Faulkner, Ashleigh Johnson, Leanne Brechtel, Lee Madeline, Thomas I Nathaniel
BACKGROUND: In a stroke population, women have a worse outcome than men when untreated. In contrast, there is no significant difference in treated patients. In this study, we determined whether clinical variables represent a promising approach to assist in the evaluation of gender differences in a stroke population. METHODS: We analyzed data from ischemic stroke patients' ≥18 years-old from the stroke registry on rtPA administration and identified gender differences in clinical factors within inclusion and exclusion criteria in a stroke population that received rtPA...
October 3, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28963363/a-population-based-incidence-of-m2-strokes-indicates-potential-expansion-of-large-vessel-occlusions-amenable-to-endovascular-therapy
#12
Ansaar T Rai, Jennifer R Domico, Chelsea Buseman, Abdul R Tarabishy, Daniel Fulks, Noelle Lucke-Wold, SoHyun Boo, Jeffrey S Carpenter
BACKGROUND: M2 occlusions may result in poor outcomes and potentially benefit from endovascular therapy. Data on the rate of M2 strokes is lacking. METHODOLOGY: Patients with acute ischemic stroke discharged over a period of 3 years from a tertiary level hospital in the 'stroke belt' were evaluated for M2 occlusions on baseline vascular imaging. Regional and national incidence was calculated from discharge and multicounty data. RESULTS: There were 2739 ICD-9 based AIS discharges...
September 28, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28939303/early-partial-recanalization-after-intravenous-thrombolysis-leads-to-prediction-of-favorable-outcome-in-cases-of-acute-ischemic-stroke-with-major-vessel-occlusion
#13
Jun Young Chang, Hyun Park, Se Young Jang, Seunguk Jung, Hee-Joon Bae, O-Ki Kwon, Moon-Ku Han
We investigated the association between early recanalization degree after intravenous thrombolysis (IVT), occurrence of hemorrhagic transformation, and functional outcome. We also evaluated whether recombinant tissue plasminogen activator (rTPA) dosing error could influence the outcome. Patients with ischemic stroke with major vessel occlusion (n=256) who underwent IVT were included. Recanalization status (no recanalization, partial recanalization, and complete recanalization) was confirmed by subsequent magnetic resonance or conventional angiography...
December 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28923530/transfer-of-stroke-patients-impairs-eligibility-for-endovascular-stroke-treatment
#14
Omid Nikoubashman, Franziska Pauli, Kolja Schürmann, Ahmed E Othman, Jan-Philipp Bach, Martin Wiesmann, Arno Reich
BACKGROUND: Many patients who are potentially eligible for endovascular stroke treatment (EST) receive intravenous rtPA in the closest stroke unit before being transferred to tertiary centres for EST. It has been shown that clinical outcome of transferred and EST-treated patients is comparable to that of patients with direct access to EST. We analysed clinical outcome of patients, who were transferred and eventually not treated due to clinical and/or radiological deterioration. METHODS: We retrospectively analysed our prospectively maintained stroke registry for patients who were transferred for stroke therapy...
September 18, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28922363/predictors-of-post-thrombolysis-symptomatic-intracranial-hemorrhage-in-chinese-patients-with-acute-ischemic-stroke
#15
Mingyong Liu, Yuesong Pan, Lichun Zhou, Yongjun Wang
BACKGROUND AND PURPOSE: Predictors of symptomatic intracranial hemorrhage (sICH) in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator remain unclear. METHODS: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study were assessed to explore risk factors for symptomatic intracranial hemorrhage after intravenous thrombolysis. Three candidate sICH definitions were analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/28882130/the-hemorrhagic-transformation-index-score-a-prediction-tool-in-middle-cerebral-artery-ischemic-stroke
#16
Mikhail N Kalinin, Dina R Khasanova, Murat M Ibatullin
BACKGROUND: We aimed to develop a tool, the hemorrhagic transformation (HT) index (HTI), to predict any HT within 14 days after middle cerebral artery (MCA) stroke onset regardless of the intravenous recombinant tissue plasminogen activator (IV rtPA) use. That is especially important in the light of missing evidence-based data concerning the timing of anticoagulant resumption after stroke in patients with atrial fibrillation (AF). METHODS: We retrospectively analyzed 783 consecutive MCA stroke patients...
September 7, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28879581/activation-of-blood-coagulation-and-thrombin-generation-in-acute-ischemic-stroke-treated-with-rtpa
#17
Sarah Goldman, Shannon M Prior, Jan P Bembenek, Maciej Niewada, Elżbieta Broniatowska, Anna Członkowska, Saulius Butenas, Anetta Undas
The impact of thrombolysis with recombinant tissue plasminogen activator (rtPA) on blood coagulation in acute ischemic stroke (AIS) patients is not completely understood. We studied the effect of thrombolysis on the thrombin generation (TG) profile as well as coagulant activity of activated factors IX (FIXa), XI (FXIa) and tissue factor (TF) in AIS patients. In a case-control study, TG parameters as well as FIXa, FXIa and TF levels were assessed in 95 AIS patients, including individuals receiving rtPA treatment within 4...
October 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28797689/can-the-benefits-of-rtpa-treatment-for-stroke-be-improved
#18
REVIEW
D Vivien
Tissue-type plasminogen activator (tPA) is a serine protease well known to promote fibrinolysis. This is why: its recombinant form (rtPA) can be used, either alone or combined with thrombectomy, to promote recanalization/reperfusion following ischemic stroke. However, its overall benefits are counteracted by some of its side-effects, including incomplete lysis of clots, an increased risk of hemorrhagic transformation and the possibility of neurotoxicity. Nevertheless, better understanding of the mechanisms by which tPA influences brain function and promotes its alteration may help in the design of new strategies to improve stroke therapy...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28759998/pharmacist-participation-in-acute-ischemic-stroke-decreases-door-to-needle-time-to-recombinant-tissue-plasminogen-activator
#19
Megan A Rech, Stephanie Bennett, Elisabeth Donahey
BACKGROUND: Pharmacists are an important member of the stroke team and aid in obtaining medication and medical history, providing education, managing blood pressure, reviewing exclusion criteria for recombinant tissue plasminogen activator (rtPA), and facilitating reconstitution and administration of rtPA. OBJECTIVE: To determine if pharmacist presence at bedside during acute ischemic stroke resulted in a reduction in door-to-needle (DTN) times. METHODS: This was a retrospective cohort study between January 1, 2011 and December 31, 2015 of patients who received rtPA for acute ischemic stroke in either the emergency department or hospital...
December 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28741405/optimized-tpa-a-non-neurotoxic-fibrinolytic-agent-for-the-drainage-of-intracerebral-hemorrhages
#20
Romain Goulay, Mikaël Naveau, Thomas Gaberel, Denis Vivien, Jérôme Parcq
Intracerebral hemorrhage (ICH) is the most severe form of stroke. Catheter-delivered thrombolysis with recombinant tissue-type plasminogen activator (rtPA) for the drainage of ICH is currently under evaluation in a phase III clinical trial (MISTIE III). However, in a pig model of ICH, in situ fibrinolysis with rtPA was reported to increase peri-lesional edema by promoting N-methyl-D-aspartate (NMDA)-dependent excitotoxicity. In the present study, we engineered a non-neurotoxic tPA variant, OptPA, and investigated its safety and efficacy for in situ fibrinolysis in a rat model of ICH...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
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