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Thrombolytic therapy

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https://www.readbyqxmd.com/read/28644261/is-intravenous-thrombolysis-safe-and-effective-in-central-retinal-artery-occlusion-a-critically-appraised-topic
#1
Oana M Dumitrascu, Joanne F Shen, Madhavi Kurli, Maria I Aguilar, Lisa A Marks, Bart M Demaerschalk, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. OBJECTIVE: To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28642017/patterns-of-care-and-temporal-trends-in-ischemic-stroke-management-a-brazilian-perspective
#2
Monique Bueno Alves, Gisele Sampaio Silva, Renata Carolina Acri Miranda, Rodrigo Meireles Massaud, Andreia Maria Heins Vaccari, Miguel Cendoroglo-Neto, Solange Diccini
BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed...
June 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28641323/ischaemia-reperfusion-injury-and-hyperbaric-oxygen-pathways-a-review-of-cellular-mechanisms
#3
REVIEW
Ashish Francis, Richard Baynosa
Ischaemia-induced tissue injury has wide-ranging clinical implications including myocardial infarction, stroke, compartment syndrome, ischaemic renal failure and replantation and revascularization. However, the restoration of blood flow produces a 'second hit' phenomenon, the effect of which is greater than the initial ischaemic event and characterizes ischaemia-reperfusion (IR) injury. Some examples of potential settings of IR injury include: following thrombolytic therapy for stroke, invasive cardiovascular procedures, solid organ transplantation, and major trauma resuscitation...
June 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28631345/advantages-and-disadvantages-of-using-intravenous-tissue-plasminogen-activator-as-salvage-therapy-for-inoperable-heartware-thrombosis
#4
Robyn Basken, Charles M Bazzell, Richard Smith, Rajesh Janardhanan, Zain Khalpey
Device thrombosis is a devastating complication of left ventricular assist devices. The definitive treatment has been device exchange or explant. Evidence of increasing morbidity and mortality with device exchange has shifted strategies toward conservative management. In this report, we detail the use of thrombolytics as salvage therapy in a patient with an occlusive HeartWare ventricular assist device (HeartWare Inc., Framingham, MA) thrombus, resulting in long-term survival without further intervention.
June 19, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28623984/routine-extended-follow-up-surveillance-of-iliac-vein-stents-for-iliocaval-venous-obstruction-may-not-be-warranted
#5
Ryan Abdul-Haqq, Zdenek Novak, Benjamin J Pearce, Thomas C Matthews, Mark A Patterson, William D Jordan, Marc A Passman
OBJECTIVE: The purpose of this study was to evaluate outcomes of iliac vein stents placed for iliocaval venous obstruction (ICVO) and to determine if routine follow-up surveillance is warranted on the basis of timing of stent failure. METHODS: All patients who underwent iliac vein stenting from 2003 to 2015 were identified from a prospectively maintained registry. Demographics of the patients, venous risk factors, prior venous interventions, indications, imaging, anatomic location of the ICVO, operative findings, procedural success, complications, and clinical follow-up were recorded...
July 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28622743/endovascular-treatment-for-chronic-lower-extremity-ischaemia-with-sub-acute-deterioration
#6
Liangxi Yuan, Songlin Guo, Jian Dong, Jian Zhou, Qingsheng Lu, Junmin Bao, Zaiping Jing
OBJECTIVES: The purpose of this study is to report the efficacy of endovascular treatment for patients with sub-acute (14-day to 2-month) deterioration of chronic lower extremity ischaemia. MATERIALS AND METHODS: Between June 2013 and May 2015, 26 consecutive patients (22 men, 4 women; mean age, 68.6 years; range, 50-86 years) were treated for sub-acute deterioration of chronic lower extremity ischaemia in our hospital. All patients were treated with catheter-directed thrombolysis initially and then adjunctive percutaneous transluminal angioplasty and/or stenting was performed to correct underlying lesions...
July 2017: Diabetes & Vascular Disease Research
https://www.readbyqxmd.com/read/28616283/the-use-of-thrombolytics-in-the-management-of-complex-pleural-fluid-collections
#7
Jessica Heimes, Hannah Copeland, Aditya Lulla, Marjulin Duldulao, Khaled Bahjri, Salman Zaheer, Jason M Wallen
BACKGROUND: To determine the efficacy of thrombolytics for the management of complex pleural fluid collections. METHODS: We reviewed patients that received alteplase for persistent loculated pleural fluid collections after simple tube drainage between July 01, 2007 and November 01, 2012. Our alteplase protocol is 6 mg of alteplase in 50 mL of normal saline injected into the pleural chest tube. The chest tube is clamped for four hours and then opened. Normally this is repeated daily for 2 to 3 days (d)...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28610565/the-influence-of-dehydration-on-the-prognosis-of-acute-ischemic-stroke-for-patients-treated-with-tissue-plasminogen-activator
#8
Fei-Fan Wu, Yen-Chu Hung, Y H Tsai, Jen-Tsung Yang, Tsong-Hai Lee, Chia-Wei Liow, Jiann-Der Lee, Chung-Jen Lin, Tsung-I Peng, Leng-Chieh Lin
BACKGROUND: Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA). METHODS: Between 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio...
June 13, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28601092/ischemic-stroke-complicating-thrombolytic-therapy-with-tenecteplase-for-st-elevation-myocardial-infarction-two-case-reports
#9
Salim Arous, Meryem Haboub, Mohamed El Ghali Benouna, Tarik Bentaoune, Rachida Habbal
BACKGROUND: Hemorrhagic complications are quite common in the rare cases where thrombolysis is performed. Ischemic stroke in the aftermath of thrombolysis for a ST elevation myocardial infarction is a very rare and paradoxical complication. With these observations in mind we report two interesting cases of ischemic stroke which occurred after fibrinolytic therapy with tenecteplase for a ST elevation myocardial infarction. CASE PRESENTATION: The first case was a 56-year-old African man who presented with an acute infero-basal ST elevation myocardial infarction 6 hours after chest pain onset...
June 11, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28595202/vitamin-d-is-a-predictor-of-st-segment-resolution-and-infarct-size-following-thrombolysis-in-patients-with-acute-st-elevation-myocardial-infarction
#10
Ahmad Separham, Bahram Sohrabi, Leili Pourafkari, Nazli Sepasi, Samad Ghaffari, Naser Aslanabadi, Nader D Nader
OBJECTIVE: Vitamin D (VitD) insufficiency is linked to various chronic conditions, including cardiovascular disease. Aim of the present study was to examine role of serum VitD in resolution of ST segment elevation (STR) in response to thrombolytic therapy following acute ST elevation myocardial infarction (STEMI). METHODS: VitD was measured prospectively in all consecutive patients who were admitted with STEMI and received thrombolysis during the calendar year of 2014...
June 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28585904/egyptian-experience-in-increasing-utilization-of-reperfusion-therapies-in-acute-ischemic-stroke
#11
Magd Fouad Zakaria, Hany Aref, Azza Abd ElNasser, Nagia Fahmy, Mohamed Amir Tork, Mohamed Mahmoud Fouad, Ahmed ElBokl, Tamer Roushdy, Sara ElFaramawy, Mohammad Abdullah El-Shiekh, Ramez Reda Moustafa
Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28580536/annexin-a2-plus-low-dose-tissue-plasminogen-activator-combination-attenuates-cerebrovascular-dysfunction-after-focal-embolic-stroke-of-rats
#12
Xiang Fan, Yinghua Jiang, Zhanyang Yu, Qi Liu, Shuzhen Guo, Xiaochuan Sun, Klaus van Leyen, MingMing Ning, Xiumei Gao, Eng H Lo, Xiaoying Wang
Previous studies showed recombinant annexin A2 (rA2) in combination with low-dose tissue-type plasminogen activator (tPA) improved thrombolytic efficacy and long-term neurological outcomes after embolic focal ischemia in rats. The objective of this study was to investigate the effects and mechanisms of the combination in early BBB integrity and cerebrovascular patency in the rat focal embolic stroke model. Ischemic brain infarct volume and hemorrhagic transformation were quantified at 24 h after stroke. At an earlier time point, 16 h after stroke, BBB integrity was evaluated by IgG extravasation, and the involved mechanisms were assessed for tight junction ZO-1 and adhesion junction ve-cadherin protein expression, matrix metalloproteinase activation, extracellular matrix collagen IV and endothelial barrier antigen expression, and activation of microglia/macrophages and astrocytes...
June 4, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28578933/extracorporeal-membrane-oxygenation-pulmonary-embolectomy-and-right-ventricular-assist-device-for-massive-pulmonary-embolism
#13
Carly L Lodewyks, Joseph M Bednarczyk, Owen T Mooney, Rakesh C Arora, Rohit K Singal
Consensus regarding the management of massive pulmonary embolism (PE) and persistent shock after thrombolysis is lacking. A 30-year-old man collapsed with massive PE 3 days after an exploratory laparotomy for penetrating trauma, and he remained hypoxic and hypotensive despite thrombolytic therapy. Extracorporeal membrane oxygenation (ECMO) was instituted as a bridge to surgical embolectomy, and placement of a right ventricular assist device (RVAD) was used to facilitate separation from cardiopulmonary bypass...
March 31, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28572721/outcome-of-stroke-patients-receiving-different-doses-of-recombinant-tissue-plasminogen-activator
#14
Cheung-Ter Ong, Yi-Sin Wong, Chi-Shun Wu, Yu-Hsiang Su
BACKGROUND AND PURPOSE: Intravenous recombinant tissue plasminogen activator (tPA) at a dose of 0.9 mg/kg body weight is associated with a high hemorrhagic transformation (HT) rate. Low-dose tPA (0.6 mg/kg) may have a lower hemorrhage rate but the mortality and disability rates at 90 days cannot be confirmed as non-inferior to standard-dose tPA. Whether the doses 0.7 and 0.8 mg/kg have better efficacy and safety needs further investigation. Therefore, this study is to compare the efficacy and safety of each dose of tPA (0...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28567359/non-surgical-extraction-of-right-atrial-mass-by-angiovac-aspiration-device-under-fluoroscopic-and-transesophageal-echocardiographic-guidance
#15
Tariq H Enezate, Arun Kumar, Kul Aggarwal, Sudarshan Balla, Jad Omran
Right-sided cardiac masses are commonly encountered. We present a challenging case of a right atrial thrombus in a patient who had a high surgical risk for open removal. AngioVac aspiration device, under transesophageal echocardiography (TEE) and fluoroscopy guidance, was successfully used to remove the thrombus. The patient tolerated the procedure well and was discharged home. Our case confirms the safety and efficacy of this procedure for treatment of unwanted intracardiac and intravascular masses in patients who are not candidates for conventional therapies of surgery or thrombolytics...
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28566600/thrombolytic-therapy-and-aspiration-of-clots-were-effective-in-the-removal-of-a-transient-inferior-vena-cava-ivc-filter-that-captured-a-large-thrombus
#16
Norihito Takahashi, Kikuo Isoda, Masaru Hiki, Shinichiro Fujimoto, Hiroyuki Daida
A 37-year-old woman presented at 37 weeks of gestation with a history of heaviness in her left leg. Enhanced computed tomography revealed a left extensive ileofemoral thrombus, and we employed a transient inferior vena cava (IVC) filter (t-IVCF) before delivery. Although we attempted to remove the t-IVCF on the day after delivery, a large thrombus was captured in the filter. We therefore performed thrombolytic therapy for one week, but a few small clots remained within the t-IVCF. We were ultimately able to remove the t-IVCF under constant negative pressure by aspiration from a side-hole of the sheath...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28558773/magnetic-inductive-phase-shift-a-new-method-to-differentiate-hemorrhagic-stroke-from-ischemic-stroke-on-rabbit
#17
Qingguang Yan, Gui Jin, Ke Ma, Mingxin Qin, Wei Zhuang, Jian Sun
BACKGROUND: The major therapy for ischemic stroke is thrombolytic treatment, but severe consequences occur when this method is used to treat hemorrhagic stroke. Currently, computed tomography and magnetic resonance imaging are used to differentiate between two types of stroke, but these two methods are ineffective for pre-hospital care. METHODS: We developed a new brain diagnostic device for rabbits based on electromagnetic induction to non-invasively differentiate two types of stroke...
May 30, 2017: Biomedical Engineering Online
https://www.readbyqxmd.com/read/28553032/stroke-in-patients-with-chronic-kidney-disease%C3%A2-how-do-we-approach-and-manage-it
#18
REVIEW
S Nayak-Rao, M P Shenoy
Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit...
May 2017: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/28548010/initial-experience-with-the-6-f-and-8-f-indigo-thrombectomy-system-for-acute-renovisceral-occlusive-events
#19
Theodosios Bisdas, Konstantinos Stavroulakis, Efthymios Beropoulis, Arne Schwindt, Arne Stachmann, Martin Austermann, Giovanni Torsello
PURPOSE: To examine the safety and effectiveness of the new large-bore Indigo thrombectomy catheters to treat patients with acute renovisceral occlusion without the need of thrombolytic agents. METHODS: Between November 2015 and 2016, 7 consecutive patients (mean age 65±5 years; 5 men) with acute renovisceral artery occlusion were treated with the new large-bore (6-F and 8-F) vacuum-assisted thrombectomy catheters. The occluded vessels were 6 renal arteries and 3 superior mesenteric arteries (SMAs); 5 of the 9 thromboses were in bridging stent-grafts associated with branched endografts...
May 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28546045/intravenous-targeted-microbubbles-carrying-urokinase-versus-urokinase-alone-in-acute-peripheral-arterial-thrombosis-in-a-porcine-model
#20
Johanna H Nederhoed, Harm P Ebben, Jeroen Slikkerveer, Arjan Wj Hoksbergen, Otto Kamp, Geert-Jan Tangelder, Willem Wisselink, René Jp Musters, Kak K Yeung
PURPOSE: Standard therapy in acute peripheral arterial occlusion consists of intra-arterial catheter guided thrombolysis. As microbubbles may be used as a carrier for fibrinolytic agents and targeted to adhere to the thrombus, we can theoretically deliver the thrombolytic medication locally following simple intravenous injection. In this intervention-controlled feasibility study, we compared intravenously administered targeted microbubbles incorporating Urokinase and locally applied ultrasound, with intravenous Urokinase and ultrasound alone...
May 22, 2017: Annals of Vascular Surgery
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