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Stroke, alteplase, brain

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https://www.readbyqxmd.com/read/29555402/safety-and-efficacy-of-intravenous-low-dose-alteplase-in-relative-contraindication-patients-with-acute-ischemic-stroke
#1
Tsuyoshi Ohta, Kenji Okada, Maki Fukuda, Noritaka Masahira, Toshiki Matsuoka, Takaya Tsuno, Mitsuhiro Takemura
OBJECT: The purpose of this study was to investigate the safety and efficacy of intravenous low-dose alteplase for acute ischemic stroke patients with relative contraindications. METHODS: The consecutive series of patients admitted within 4.5 hours of ischemic stroke onset between September 2012 and April 2017 were retrospectively evaluated. A good outcome at 90 days and symptomatic intracerebral hemorrhage were evaluated to determine the association with intravenous low-dose alteplase, especially in the presence of relative contraindications...
March 16, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29398533/cerebral-microbleeds-are-an-independent-predictor-of-hemorrhagic-transformation-following-intravenous-alteplase-administration-in-acute-ischemic-stroke
#2
Nandakumar Nagaraja, Nudrat Tasneem, Amir Shaban, Sudeepta Dandapat, Uzair Ahmed, Bruno Policeni, Heena Olalde, Hyungsub Shim, Edgar A Samaniego, Connie Pieper, Santiago Ortega-Gutierrez, Enrique C Leira, Harold P Adams
BACKGROUND AND PURPOSE: Intravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation. METHODS: Consecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation...
February 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29362281/-takotsubo-cardiomyopathy-and-neurogenic-pulmonary-edema-following-fibrinolytic-therapy-for-embolic-stroke-a-case-report
#3
Takehiro Kitagawa, Junkoh Yamamoto, Makoto Kureshima, Hitoshi Maeda, Shigeru Nishizawa
A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. The patient was treated with alteplase about 2.5 h after onset. Immediately after the intravenous alteplase administration, the hemiparesis improved. However, his respiratory condition unexpectedly worsened 10 h after onset. Chest radiography demonstrated an infiltrative shadow in both lung fields...
January 2018: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/29262432/spontaneous-intraventricular-hemorrhage-when-should-intraventricular-tpa-be-considered
#4
Peter A Abdelmalik, Wendy C Ziai
Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29191741/thrombolytic-therapy-of-acute-ischemic-stroke-during-early-pregnancy
#5
Anne Landais, Hugo Chaumont, Rachel Dellis
Thrombolytic treatment (recombinant tissue plasminogen activator [rt-PA]) has established efficacy in acute ischemic stroke, but pregnancy has been an exclusion criterion for all clinical trials that validated alteplase in acute stroke, so our knowledge about its use in this condition is limited. Herein we report the successful use of intravenous rt-PA thrombolysis, uncomplicated by neither hemorrhage development nor other complication in a woman who was 13 weeks pregnant with acute ischemic stroke. The brain magnetic resonance imaging diffusion-weighted sequences showed increased signal in the territory of the left middle cerebral artery...
February 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29097489/treatment-and-outcome-of-hemorrhagic-transformation-after-intravenous-alteplase-in-acute-ischemic-stroke-a-scientific-statement-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#6
REVIEW
Shadi Yaghi, Joshua Z Willey, Brett Cucchiara, Joshua N Goldstein, Nicole R Gonzales, Pooja Khatri, Louis J Kim, Stephan A Mayer, Kevin N Sheth, Lee H Schwamm
PURPOSE: Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. METHODS: A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH...
December 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29037436/which-imaging-before-reperfusion-strategy
#7
REVIEW
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28973174/low-dose-vs-standard-dose-alteplase-for-patients-with-acute-ischemic-stroke-secondary-analysis-of-the-enchanted-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Xia Wang, Thompson G Robinson, Tsong-Hai Lee, Qiang Li, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph Broderick, Andrew M Demchuk, Geoffrey Donnan, Jong S Kim, Pablo Lavados, Richard I Lindley, Sheila O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Vijay K Sharma, Nguyen H Thang, Ji-Guang Wang, Mark Woodward, Craig S Anderson, John Chalmers
Importance: A lower dose of intravenous alteplase appears to be a safer treatment option than the standard dose, reducing the risk of symptomatic intracerebral hemorrhage. There is uncertainty, however, over how this effect translates into an overall clinical benefit for patients with acute ischemic stroke (AIS). Objective: To assess whether older, Asian, or severely affected patients with AIS who are considered at high risk of thrombolysis may benefit more from low-dose rather than standard-dose alteplase treatment...
November 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28948451/a-diagnostic-approach-to-stroke-in-young-adults
#9
REVIEW
Christopher A Stack, John W Cole
Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28944741/the-application-of-nanoparticles-for-neuroprotection-in-acute-ischemic-stroke
#10
Lepei Chen, Xiaoling Gao
Stroke still represents one of the most common causes of death and disability worldwide. Acute ischemic stroke (AIS), caused by brain arterial occlusion resulting from a thrombus or embolus, is the most common form of stroke. However, current therapies in AIS are inadequate, and the only US FDA approved treatment is the thrombolytic drug Alteplase. Therefore, establishing effective therapeutic strategies for AIS is urgently needed. Using nanoparticle-based technologies to deliver neuroprotective agents to the ischemic area has attracted increasing attention of late...
October 2017: Therapeutic Delivery
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/28569122/rationale-and-design-of-combination-of-an-immune-modulator-fingolimod-with-alteplase-bridging-with-mechanical-thrombectomy-in-acute-ischemic-stroke-famtais-trial
#12
Sheng Zhang, Ying Zhou, Ruiting Zhang, Meixia Zhang, Bruce Campbell, Longting Lin, Fu-Dong Shi, Min Lou
Rationale In acute ischemic stroke patients with large vessel occlusion, although reperfusion within 6 h after stroke onset using combined intravenous alteplase and mechanical thrombectomy (bridging therapy) can improve functional outcome, still approximately 50% patients suffer disability which may result from reperfusion injury. Proof-of-concept clinical trials have indicated that the sphingosine-1-phosphate receptor modulator fingolimod may be efficacious in attenuating brain inflammation and improving clinical outcomes in acute ischemic stroke patients as a single therapy beyond 4...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27751554/safety-and-efficacy-of-minimally-invasive-surgery-plus-alteplase-in-intracerebral-haemorrhage-evacuation-mistie-a-randomised-controlled-open-label-phase-2-trial
#13
RANDOMIZED CONTROLLED TRIAL
Daniel F Hanley, Richard E Thompson, John Muschelli, Michael Rosenblum, Nichol McBee, Karen Lane, Amanda J Bistran-Hall, Steven W Mayo, Penelope Keyl, Dheeraj Gandhi, Tim C Morgan, Natalie Ullman, W Andrew Mould, J Ricardo Carhuapoma, Carlos Kase, Wendy Ziai, Carol B Thompson, Gayane Yenokyan, Emily Huang, William C Broaddus, R Scott Graham, E Francois Aldrich, Robert Dodd, Cristanne Wijman, Jean-Louis Caron, Judy Huang, Paul Camarata, A David Mendelow, Barbara Gregson, Scott Janis, Paul Vespa, Neil Martin, Issam Awad, Mario Zuccarello
BACKGROUND: Craniotomy, according to the results from trials, does not improve functional outcome after intracerebral haemorrhage. Whether minimally invasive catheter evacuation followed by thrombolysis for clot removal is safe and can achieve a good functional outcome is not known. We investigated the safety and efficacy of alteplase, a recombinant tissue plasminogen activator, in combination with minimally invasive surgery (MIS) in patients with intracerebral haemorrhage. METHODS: MISTIE was an open-label, phase 2 trial that was done in 26 hospitals in the USA, Canada, the UK, and Germany...
November 2016: Lancet Neurology
https://www.readbyqxmd.com/read/27637676/stroke
#14
REVIEW
Graeme J Hankey
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis...
February 11, 2017: Lancet
https://www.readbyqxmd.com/read/27559475/improving-door-to-needle-time-in-patients-for-thrombolysis
#15
Darren Fernandes, Udayaraj Umasankar
Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27306629/and-why-not-thrombolysis-in-the-ambulance-at-least-for-some
#16
REVIEW
Gilad Rosenberg, Israel Steiner
The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental...
July 12, 2016: Neurology
https://www.readbyqxmd.com/read/27180033/neuroprotection-in-acute-stroke-targeting-excitotoxicity-oxidative-and-nitrosative-stress-and-inflammation
#17
REVIEW
Ángel Chamorro, Ulrich Dirnagl, Xabier Urra, Anna M Planas
Treatments for acute ischaemic stroke continue to evolve after the superior value of endovascular thrombectomy was confirmed over systemic thrombolysis. Unfortunately, numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischaemic stroke, making the search for new treatments imperative. Increased awareness of the relevance of rigorous preclinical testing, and appropriate selection of study participants, might overcome the barriers to progress in stroke research. Relevant areas of interest include the search for safe and effective treatment strategies that combine neuroprotection reperfusion, better use of advanced brain imaging for patient selection, and wider implementation of prehospital conducted clinical trials...
July 2016: Lancet Neurology
https://www.readbyqxmd.com/read/27151226/cerebral-infarction-due-to-cardiac-myxoma-developed-with-the-loss-of-consciousness-immediately-after-defecation-a-case-report
#18
Toshimasa Ikeda, Masahiro Oomura, Chikako Sato, Chise Anan, Kentaro Yamada, Kaoru Kamimoto
A 74-year-old man lost consciousness immediately after defecation. The loss of consciousness lasted for several minutes, and he experienced difficulty in walking when he regained consciousness. He was transferred to our hospital via an ambulance. Upon neurological examination, nystagmus and ataxia in the left arm and leg were noted. An MRI of the brain revealed multiple acute infarcts mainly in the bilateral cerebellum. Intravenous thrombolytic therapy with alteplase was initiated 3 h and 20 min after the onset of symptoms, and an improvement in neurological symptoms was observed...
May 31, 2016: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/27023154/radiation-monitoring-results-from-the-first-year-of-operation-of-a-unique-ambulance-based-computed-tomography-unit-for-the-improved-diagnosis-and-treatment-of-stroke-patients
#19
Janet M Gutiérrez, Robert J Emery, Stephanie A Parker, Kamilah Jackson, James C Grotta
When a blood clot blocks the blood supply to the brain or when a blood vessel bursts, resulting in brain cell death, the medical condition is referred to as a "stroke." Stroke is a main cause of death worldwide and is a common cause of disability. A common form of stroke, called ischemic stroke, is when blood flow to the brain is decreased. Clinical research has revealed that treatment within the very first hours of symptom onset is key for ischemic stroke with recanalization of occluded arteries by thrombolysis with alteplase...
May 2016: Health Physics
https://www.readbyqxmd.com/read/26980937/spontaneous-splenic-rupture-following-intravenous-thrombolysis-with-alteplase-applied-as-stroke-therapy-case-report-and-review-of-literature
#20
Anka Aleksic-Shihabi, Eni Jadrijevic, Nina Milekic, Ana Repic Bulicic, Marina Titlic, Enra Suljic
INTRODUCTION: Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions. CASE REPORT: This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture.
February 2016: Medical Archives
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