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Thrombolysis, stroke, ischemia

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https://www.readbyqxmd.com/read/28986149/factors-associated-with-early-dramatic-recovery-following-successful-recanalization-of-occluded-artery-by-endovascular-treatment-in-anterior-circulation-stroke
#1
Dae-Hyun Kim, Hyun-Wook Nah, Hyun-Seok Park, Jae-Hyung Choi, Myung-Jin Kang, Jae-Kwan Cha
Endovascular treatment (EVT) significantly increases the recanalization rate and improves functional outcomes in acute ischemic stroke. However, despite successful recanalization by EVT, some stroke patients demonstrate no early dramatic recovery (EDR). We assessed factors associated with EDR following recanalization by EVT. We included subjects with anterior circulation stroke treated with EVT who met the following criteria: Thrombolysis in Cerebral Ischemia scores (TICI) 2b-3 after EVT, lesion volume <70mL as seen on the pre-treatment diffusion-weighted imaging (DWI) scan and a baseline NIHSS score ≥6...
October 3, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28981224/-endovascular-treatment-of-ischemic-strokes-outcomes-and-practical-issues
#2
N Ligot, B Lubicz, G Naeije
Ischemic stroke is a leading cause of disability and death due to brain arterial occlusion and subsequent ischemia. Acute treatment aims to recanalize the occluded artery as soon as possible. Treatment to achieve recanalization of the occluded artery has evolved during the last couple of years. First therapeutic improvement : intra-veinous thrombolysis (IV rt-PA) was the first validated treatment to achieve reduction in ischemic stroke morbi-mortality. However, rt-PA is efficient in the first hours of stroke onset and for small calibers occluded vessels...
2017: Revue Médicale de Bruxelles
https://www.readbyqxmd.com/read/28931617/normobaric-hyperoxia-reduces-blood-occludin-fragments-in-rats-and-patients-with-acute-ischemic-stroke
#3
Shuhai Shi, Zhifeng Qi, Qingfeng Ma, Rong Pan, Graham S Timmins, Yongmei Zhao, Wenjuan Shi, Yunzhou Zhang, Xunming Ji, Ke Jian Liu
BACKGROUND AND PURPOSE: Damage of the blood-brain barrier (BBB) increases the incidence of neurovascular complications, especially for cerebral hemorrhage after tPA (tissue-type plasminogen activator) therapy. Currently, there is no effective method to evaluate the extent of BBB damage to guide tPA use. Herein, we investigated whether blood levels of tight junction proteins could serve as biomarker of BBB damages in acute ischemic stroke (AIS) in both rats and patients. We examined whether this biomarker could reflect the extent of BBB permeability during cerebral ischemia/reperfusion and the effects of normobaric hyperoxia (NBO) on BBB damage...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28890041/successful-endovascular-thrombectomy-90h-after-stroke-onset
#4
Rusiru Gunawardena, Andrew Cheung, Paul Spira, Jianna He, Jason Wenderoth, Albert H Y Chiu
Endovascular thrombectomy (EVT) has extended the conventionally accepted time window of treatment, from 4.5h (ECASS III trial) for intravenous thrombolysis, to 7.3h for EVT (HERMES collaboration). More recent evidence suggests EVT times could be extended to 24h in carefully selected patients (DAWN trial). Some patients present after these time windows with large areas of ischemia but little established infarction on imaging. They represent a major dilemma with much to gain from EVT but at theoretically higher risk of a poor outcome...
September 7, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28887393/white-matter-hyperintensity-volume-and-outcome-of-mechanical-thrombectomy-with-stentriever-in-acute-ischemic-stroke
#5
Kunakorn Atchaneeyasakul, Thabele Leslie-Mazwi, Kathleen Donahue, Anne-Katrin Giese, Natalia S Rost
BACKGROUND AND PURPOSE: Finding of white matter hyperintensity (WMH) has been associated with an increased risk of parenchymal hematoma and poor clinical outcomes after mechanical thrombectomy using old-generation endovascular devices. Currently, no data exist with regard to the risk of mechanical thrombectomy using stentriever devices in patients with significant WMH. We hypothesized that WMH volume will not affect the hemorrhagic and clinical outcome in patients with acute ischemic stroke undergoing thrombectomy using new-generation devices...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28887094/salvianolic-acids-for-injection-safi-promotes-functional-recovery-and-neurogenesis-via-sonic-hedgehog-pathway-after-stroke-in-mice
#6
Ye Zhang, Xiangjian Zhang, Lili Cui, Rong Chen, Cong Zhang, Yaoru Li, Tingting He, Xingyuan Zhu, Zuyuan Shen, Lipeng Dong, Jingru Zhao, Ya Wen, Xiufen Zheng, Pan Li
There is a pressing need of developing approaches for delayed post-stroke therapy for patients who fail to receive thrombolysis within the narrow time window. Neuroprotection of Salvianolic Acids for Injection (SAFI) for cerebral ischemia-reperfusion injury in acute phase has been well documented. The current study was to determine the influence of SAFI at the subacute phase after stroke in mice, and to elucidate the underlying mechanisms. Adult male C57BL/6 mice were subjected to permanent occlusion of the distal middle cerebral artery (dMCAO), followed by daily intraperitoneal injection of SAFI 24 h after stroke for 14 days...
September 5, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28855859/%C3%AE-2-adrenergic-receptor-mediated-hif-1%C3%AE-upregulation-mediates-blood-brain-barrier-damage-in-acute-cerebral-ischemia
#7
Yanyun Sun, Xi Chen, Xinyu Zhang, Xianzhi Shen, Mengwei Wang, Xiaona Wang, Wen-Cao Liu, Chun-Feng Liu, Jie Liu, Wenlan Liu, Xinchun Jin
Disruption of the blood brain barrier (BBB) within the thrombolytic time window is an antecedent event to intracerebral hemorrhage in ischemic stroke. Our recent studies showed that 2-h cerebral ischemia induced BBB damage in non-infarcted area and secreted matrix metalloproteinase-2 (MMP-2) accounted for this disruption. However, the factors that affect MMP-2 secretion and regulate BBB damage remains unknown. Since hypoxia-inducible factor-1 alpha (HIF-1α) was discovered as a mater regulator in hypoxia, we sought to investigate the roles of HIF-1α in BBB damage as well as the factors regulating HIF-1α expression in the ischemic brain...
2017: Frontiers in Molecular Neuroscience
https://www.readbyqxmd.com/read/28822510/high-versus-low-dose-statin-therapy-in-indian-patients-with-acute-st-segment-elevation-myocardial-infarction-undergoing-thrombolysis
#8
K Priti, Anand Agrawal, Bhanwar L Ranwa
OBJECTIVES: This study sought to compare high dose versus low dose statin therapy in Indian patients with ST-segment elevation myocardial infarction (STEMI) undergoing thrombolysis. BACKGROUND: Randomized trials have demonstrated that statin treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, randomized studies of statin therapy in Indian patients with STEMI are scarce. METHODS: Of 1859 patients with acute STEMI, 1027 eligible patients were randomized to 80-mg (n=512) or 10-mg (n=515) atorvastatin...
July 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28783210/monocyte-count-at-onset-predicts-poststroke-outcomes-during-a-90-day-follow-up
#9
Luca Liberale, Fabrizio Montecucco, Aldo Bonaventura, Ilaria Casetta, Silva Seraceni, Alessandro Trentini, Marina Padroni, Franco Dallegri, Enrico Fainardi, Federico Carbone
BACKGROUND: Acute ischaemic stroke (AIS) triggers both systemic and neurovascular inflammation, influencing poststroke recovery. In smokers with AIS, inflammation might be further upregulated, increasing ischaemia/reperfusion injury. Here, the predictive value of leucocyte and adhesion molecules levels on poststroke outcomes was investigated. MATERIALS AND METHODS: A total of 89 patients with AIS (n = 30 smokers and n = 59 nonsmokers) were recruited and evaluated 1, 7 and 90 days after the onset to assess stroke severity by the National Institute of Health Stroke Scale (NIHSS) score as well as clinical recovery at 90 days by the modified Rankin Scale (mRS)...
August 7, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28712001/in-hospital-ischaemic-stroke-treated-with-intravenous-thrombolysis-or-mechanical-thrombectomy
#10
François Caparros, Marc Ferrigno, Amélie Decourcelle, Anais Hochart, Solène Moulin, Nelly Dequatre, Marie Bodenant, Hilde Hénon, Charlotte Cordonnier, Didier Leys
Patients with in-hospital strokes (IHS) may be eligible for recanalization therapies. The objective of this study is to compare outcomes in patients with IHS and community-onset strokes (COS) treated by recanalization therapy. We analysed data prospectively collected in consecutive patients treated by thrombolysis, thrombectomy, or both for cerebral ischemia at the Lille University Hospital. We compared four outcomes measures at 3 months in patients with IHS and COS: (1) modified Rankin scale (mRS) 0-1, (2) mRS 0-2, (3) death, and (4) symptomatic intracranial haemorrhage (ECASS 2 definition)...
August 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28710023/transient-brain-hypothermia-reduces-the-reperfusion-injury-of-delayed-tissue-plasminogen-activator-and-extends-its-therapeutic-time-window-in-a-focal-embolic-stroke-model
#11
Mohammadreza Zarisfi, Fatemeh Allahtavakoli, Mahsa Hassanipour, Mohammad Khaksari, Hossain Rezazadeh, Mohammad Allahtavakoli, Mohammad Mohsen Taghavi
It has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether shortIt has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether short-term and mild local brain cooling can prevent hyperemia and/or adverse effects of delayed tPA in rat embolic stroke model...
July 11, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28700732/tissue-plasminogen-activator-mediates-deleterious-complement-cascade-activation-in-stroke
#12
Xue-Jun Zhao, Timothy M Larkin, Molly A Lauver, Saif Ahmad, Andrew F Ducruet
The use of intravenous tissue plasminogen activator (tPA) in the treatment of ischemic stroke is limited by its propensity to exacerbate brain edema and hemorrhage. The mechanisms underlying these deleterious effects of tPA remain incompletely understood. The purpose of this study was to delineate a pathway of tPA-mediated complement cascade activation in stroke and to determine whether complement inhibition ameliorates the adverse effects of post-ischemic tPA administration. We found that tPA promotes C3 cleavage both in vitro and in ischemic brain through a plasmin-mediated extrinsic pathway...
2017: PloS One
https://www.readbyqxmd.com/read/28685662/simultaneous-functional-photoacoustic-microscopy-and-electrocorticography-reveal-the-impact-of-rtpa-on-dynamic-neurovascular-functions-after-cerebral-ischemia
#13
Aishwarya Bandla, Lun-De Liao, Su Jing Chan, Ji Min Ling, Yu-Hang Liu, Yen-Yu Ian Shih, Han-Chi Pan, Peter Tsun-Hon Wong, Hsin-Yi Lai, Nicolas Kon Kam King, You-Yin Chen, Wai Hoe Ng, Nitish V Thakor
The advance of thrombolytic therapy has been hampered by the lack of optimization of the therapy during the hyperacute phase of focal ischemia. Here, we investigate neurovascular dynamics using a custom-designed hybrid electrocorticography (ECoG)-functional photoacoustic microscopy (fPAM) imaging system during the hyperacute phase (first 6 h) of photothrombotic ischemia (PTI) in male Wistar rats following recombinant tissue plasminogen activator (rtPA)-mediated thrombolysis. We reported, for the first time, the changes in neural activity and cerebral hemodynamic responses following rtPA infusion at different time points post PTI...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28674513/isolated-striatocapsular-infarcts-after-endovascular-treatment-of-acute-proximal-middle-cerebral-artery-occlusions-prevalence-enabling-factors-and-clinical-outcome
#14
Johannes Kaesmacher, Thomas Huber, Manuel Lehm, Claus Zimmer, Kathleen Bernkopf, Silke Wunderlich, Tobias Boeckh-Behrens, Nathan W Manning, Justus F Kleine
BACKGROUND: Striatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28649936/berlin-prehospital-or-usual-delivery-of-acute-stroke-care-study-protocol
#15
Martin Ebinger, Peter Harmel, Christian H Nolte, Ulrike Grittner, Bob Siegerink, Heinrich J Audebert
Rationale Prehospital stroke care in specialized ambulances increases thrombolysis rates, reduces alarm-to-treatment times, and improves the prehospital triage. Preliminary analyses suggest cost-effectiveness. However, scientific proof of better functional outcome compared to usual care is still lacking. Aim To prove better functional outcomes after deployment of the Stroke Emergency Mobile compared to regular ambulances. Sample size estimates A sample size of 686 patients will be required in each arm (Stroke Emergency Mobile group vs...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28640874/risk-factors-are-different-for-deep-and-lobar-remote-hemorrhages-after-intravenous-thrombolysis
#16
Luis Prats-Sanchez, Alejandro Martínez-Domeño, Pol Camps-Renom, Raquel Delgado-Mederos, Daniel Guisado-Alonso, Rebeca Marín, Laura Dorado, Salvatore Rudilosso, Alejandra Gómez-González, Francisco Purroy, Manuel Gómez-Choco, David Cánovas, Dolores Cocho, Moises Garces, Sonia Abilleira, Joan Martí-Fàbregas
BACKGROUND AND PURPOSE: Remote parenchymal haemorrhage (rPH) after intravenous thrombolysis is defined as hemorrhages that appear in brain regions without visible ischemic damage, remote from the area of ischemia causing the initial stroke symptom. The pathophysiology of rPH is not clear and may be explained by different underlying mechanisms. We hypothesized that rPH may have different risk factors according to the bleeding location. We report the variables that we found associated with deep and lobar rPH after intravenous thrombolysis...
2017: PloS One
https://www.readbyqxmd.com/read/28596447/impact-of-thrombus-length-on-outcomes-after-intra-arterial-aspiration-thrombectomy-in-the-therapy-trial
#17
RANDOMIZED CONTROLLED TRIAL
Albert J Yoo, Pooja Khatri, J Mocco, Osama O Zaidat, Rishi Gupta, Donald Frei, Demetrius Lopes, Harish Shownkeen, Olvert A Berkhemer, Denise Meyer, Susana S Hak, Sophia S Kuo, Hope Buell, Arani Bose, Siu Po Sit, Rüdiger von Kummer
BACKGROUND AND PURPOSE: Increasing thrombus length (TL) impedes recanalization after intravenous (IV) thrombolysis. We sought to determine whether the clinical benefit of aspiration thrombectomy relative to IV r-tPA (recombinant tissue-type plasminogen activator) may be greater at longer TL. METHODS: THERAPY was a randomized trial of aspiration thrombectomy plus IV r-tPA versus IV r-tPA alone in large-vessel stroke patients with prospective TL measurement ≥8 mm...
July 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28592694/opening-a-new-time-window-for-treatment-of-stroke-by-targeting-hdac2
#18
Yu-Hui Lin, Jian Dong, Ying Tang, Huan-Yu Ni, Yu Zhang, Ping Su, Hai-Ying Liang, Meng-Cheng Yao, Hong-Jin Yuan, Dong-Liang Wang, Lei Chang, Hai-Yin Wu, Chun-Xia Luo, Dong-Ya Zhu
Narrow therapeutic window limits treatments with thrombolysis and neuroprotection for most stroke patients. Widening therapeutic window remains a critical challenge. Understanding the key mechanisms underlying the pathophysiological events in the peri-infarct area where secondary injury coexists with neuroplasticity over days to weeks may offer an opportunity for expanding the therapeutic window. Here we show that ischemia-induced histone deacetylase 2 (HDAC2) upregulation from 5 to 7 d after stroke plays a crucial role...
July 12, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28522637/general-anesthesia-versus-conscious-sedation-for-endovascular-treatment-of-acute-ischemic-stroke-the-anstroke-trial-anesthesia-during-stroke
#19
RANDOMIZED CONTROLLED TRIAL
Pia Löwhagen Hendén, Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, Sven-Erik Ricksten
BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28496428/effect-of-cyclosporine-on-lesion-growth-and-infarct-size-within-the-white-and-gray-matter
#20
Elodie Ong, Nathan Mewton, Julien Bouvier, Fabien Chauveau, Thomas Ritzenthaler, Laura Mechtouff, Laurent Derex, Marielle Buisson, Yves Berthezène, Michel Ovize, Norbert Nighoghossian, Tae-Hee Cho
BACKGROUND: In a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis. MATERIALS AND METHODS: We analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month...
2017: Frontiers in Neurology
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