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Thrombolysis, stroke, ischemia

Marina Padroni, Sandra Boned, Marc Ribó, Marian Muchada, David Rodriguez-Luna, Pilar Coscojuela, Alejandro Tomasello, Jordi Cabero, Jorge Pagola, Noelia Rodriguez-Villatoro, Jesus M Juega, Estela Sanjuan, Carlos A Molina, Marta Rubiera
: The Alberta Stroke Program Early CT Score (ASPECTS) is a useful scoring system for assessing early ischemic signs on noncontrast computed tomography (CT). Cerebral blood volume (CBV) on CT perfusion defines the core lesion assumed to be irreversibly damaged. We aim to explore the advantages of CBV_ASPECTS over CT_ASPECTS in the prediction of final infarct volume according to time. METHODS: Consecutive patients with anterior circulation stroke who underwent endovascular reperfusion according to initial CT_ASPECTS ≥7 were studied...
September 2016: Interventional Neurology
Marc P Bonaca, Mark A Creager, Jeffrey Olin, Benjamin M Scirica, Ian C Gilchrist, Sabina A Murphy, Erica L Goodrich, Eugene Braunwald, David A Morrow
OBJECTIVES: The aim of this study was to determine whether the reduction in peripheral revascularization with vorapaxar in patients with peripheral artery disease (PAD) is directionally consistent across indications, including acute limb ischemia, progressively disabling symptoms, or both. BACKGROUND: The protease-activated receptor-1 antagonist vorapaxar reduces peripheral revascularization in patients with PAD. METHODS: The TRA 2°P-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50) trial randomized 26,449 patients with histories of myocardial infarction, stroke, or symptomatic PAD to vorapaxar or placebo on a background of standard therapy...
October 24, 2016: JACC. Cardiovascular Interventions
P Sobrino-Garcia, A Garcia-Pastor, A Garcia-Arratibel, R Dominguez-Rubio, P M Rodriguez-Cruz, A M Iglesias-Mohedano, F Diaz-Otero, P Vazquez-Alen, Y Fernandez-Bullido, J A Villanueva-Osorio, A Gil-Nunez
AIM: To describe the information provided by transcranial color-coded duplex (TCCD) sonography for therapeutic decision-making in patients with acute ischemic stroke and to analyze the relationship between TCCD findings and the severity and prognosis of stroke. PATIENTS AND METHODS: TCCD performed within the six first hours after an acute ischemic stroke were analyzed in our institution. The presence of an arterial occlusion and its location were collected using TIBI (Thrombolysis in Brain Ischemia) and COGIF (Consensus on Grading Intracranial Flow Obstruction) criteria...
October 16, 2016: Revista de Neurologia
Kang-Ho Choi, Man-Seok Park, Joon-Tae Kim, Hyung-Seok Kim, Ja-Hae Kim, Tai-Seung Nam, Seong-Min Choi, Seung-Han Lee, Byeong-Chae Kim, Myeong-Kyu Kim, Ki-Hyun Cho
BACKGROUND: Alpha-lipoic acid (aLA) is a strong antioxidant commonly used for treating diabetic polyneuropathy. Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on patients with stroke remain unknown. We investigated whether patients treated with aLA have better functional outcomes after acute ischemic stroke (AIS) and reperfusion therapy than patients not receiving aLA. METHODS: In this retrospective study of 172 prospectively registered patients with diabetes and AIS treated with tissue plasminogen activator (tPA), we investigated the relationship between aLA use and functional outcome both after 3 months and after 1 year...
2016: PloS One
Alain Yelnik, Cedric Andriantsifanetra, Peggy Reinert, Mathilde Evrard, Hélène Marneff, Marie Wanepain, Margaux Barbie, Johann Beaudreuil, Jean Pascal Devailly, Eric Vicaut
OBJECTIVE: Active and intensive physical therapy (PT) facilitates motor recovery when provided at a subacute stage after stroke. The efficiency of very early intensive PT (within the 2 first weeks) has been much less investigated. Early intensive rehabilitation might be beneficial for neural plasticity but also detrimental by worsening the cerebral ischemia. The AVERT study (Bernhardt 2015) showed negative effect of high dose of very early mobilisation. MATERIAL/PATIENTS AND METHODS: Patients have been recruited in this multicentre randomized controlled trial (9 stroke units with PRM teams) to compare "soft" (20 min/day apart from respiratory needs) versus "intensive" PT (idem+45 minutes of intensive exercises/day), initiated within the 72 first hours after a first hemispheric stroke...
September 2016: Annals of Physical and Rehabilitation Medicine
Philippe Garrigue, Guillaume Hache, Youssef Bennis, Pauline Brige, Jimmy Stalin, Lionel Pellegrini, Lionel Velly, Francesca Orlandi, Elena Castaldi, Françoise Dignat-George, Florence Sabatier, Benjamin Guillet
BACKGROUND: endothelial colony-forming cells (ECFCs) are promising candidates for cell therapy of ischemic diseases, as less than 10% of patients suffering from an ischemic stroke are eligible for thrombolysis. We previously reported that erythropoietin priming of ECFCs increased their in vitro and in vivo angiogenic properties in mice with hind limb ischemia. OBJECTIVE: the present study aimed to evaluate whether priming of ECFCs with erythropoietin could enhance their homing into the ischemic site after transient middle cerebral artery occlusion (MCAO) followed by reperfusion in rats and potentiate their protective or regenerative effects on brain-blood barrier disruption (BBBd), cerebral apoptosis and cerebral blood flow (CBF) by Single Photon Emission/Computed Tomography (SPECT/CT) imaging...
September 8, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Sajjad Muhammad, Oliver Planz, Markus Schwaninger
BACKGROUND: Thrombolysis is the only approved therapy for acute stroke. However, life-threatening complications such as intracerebral hemorrhage (ICH) can develop after intravenous administration of tissue plasminogen activator (tPA). Both infection and thrombolysis during cerebral ischemia disrupt the blood-brain barrier (BBB). tPA can induce matrix metalloproteinase-9 (MMP-9), which is known to be involved in BBB disruption. However, it has still not been investigated whether preexisting influenza virus infection during thrombolysis after acute stroke affects systemic levels of MMP-9 and its inhibitor TIMP-1 and whether increased systemic MMP-9 levels affect ICH...
2016: Cerebrovascular Diseases Extra
Alexandra Leitão, Anabela Brito, João Pinho, José Nuno Alves, Ricardo Costa, José Manuel Amorim, Manuel Ribeiro, Inês Pinho, Carla Ferreira
Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospitalization for ischemic stroke. The study consists of a retrospective cohort of consecutive ischemic stroke patients admitted in a Portuguese university hospital during 2013, who survived index hospitalization...
August 6, 2016: Internal and Emergency Medicine
Stefan Donath, Junfeng An, Sabrina Lin Lin Lee, Karen Gertz, Anna Lena Datwyler, Ulrike Harms, Susanne Müller, Tracy Deanne Farr, Martina Füchtemeier, Gisela Lättig-Tünnemann, Janet Lips, Marco Foddis, Larissa Mosch, René Bernard, Ulrike Grittner, Mustafa Balkaya, Golo Kronenberg, Ulrich Dirnagl, Matthias Endres, Christoph Harms
UNLABELLED: The aim of this study was to explore the signaling and neuroprotective effect of transactivator of transcription (TAT) protein transduction of the apoptosis repressor with CARD (ARC) in in vitro and in vivo models of cerebral ischemia in mice. In mice, transient focal cerebral ischemia reduced endogenous ARC protein in neurons in the ischemic striatum at early reperfusion time points, and in primary neuronal cultures, RNA interference resulted in greater neuronal susceptibility to oxygen glucose deprivation (OGD)...
August 3, 2016: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Deepak Gupta, Arvind Sharma, Ken Uchino, Andrei V Alexandrov, Khurshid Khan, Ashfaq Shuaib, Maher Saqqur
BACKGROUND: In acute stroke, it is crucial to assess for intracranial large-vessel occlusion and site of occlusion. The National Institutes of Health Stroke Scale score (NIHSSS) is the frequently used clinical tool to predict the site of arterial occlusion. In this study we aimed to determine the following: (1) if there is a correlation between the site of occlusion and the NIHSSS at presentation (bNIHSSS); and (2) if there is a bNIHSSS cutoff which can distinguish proximal occlusions (PO) from distal occlusions (DO)...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jang-Hyun Baek, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Hyo Suk Nam, Joonsang Yoo
BACKGROUND AND PURPOSE: We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. METHODS: We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74...
September 2016: Stroke; a Journal of Cerebral Circulation
Luis Prats-Sánchez, Pol Camps-Renom, Javier Sotoca-Fernández, Raquel Delgado-Mederos, Alejandro Martínez-Domeño, Rebeca Marín, Miriam Almendrote, Laura Dorado, Meritxell Gomis, Javier Codas, Laura Llull, Alejandra Gómez González, Jaume Roquer, Francisco Purroy, Manuel Gómez-Choco, David Cánovas, Dolores Cocho, Moises Garces, Sonia Abilleira, Joan Martí-Fàbregas
BACKGROUND AND PURPOSE: Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator. METHODS: This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry...
August 2016: Stroke; a Journal of Cerebral Circulation
Ryan A McTaggart, Shadi Yaghi, Grayson Baird, Richard A Haas, Mahesh V Jayaraman
BACKGROUND: Embolectomy is the standard of care for emergent large vessel occlusion (ELVO), and needs to be done as quickly as possible for the best possible outcomes. Optimization of workflow and process is certainly paramount. One aspect of this is process improvement to standardize as much as possible the procedure in order to decrease variability among operators, which breeds familiarity for the entire team. OBJECTIVE: To evaluate the impact of a standardized approach to ELVO cases in decreasing times from groin puncture to first deployment of a stent-retriever and final recanalization...
July 8, 2016: Journal of Neurointerventional Surgery
Junya Aoki, Yuki Sakamoto, Kazumi Kimura
BACKGROUND AND PURPOSE: The safety and feasibility of intravenous thrombolysis using recombinant tissue plasminogen activator (IV-tPA) were retrospectively compared between patients with unknown onset time and no ischemia on fluid-attenuated inversion recovery (negative FLAIR) and patients receiving standard therapy. METHODS: Acute stroke patients with unknown onset times were treated using IV-tPA if they had: negative FLAIR; internal carotid artery and/or middle cerebral artery occlusion; and a diffusion-weighted imaging (DWI)-Alberta Stroke Programme Early CT Score ≥5...
July 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Maher Saqqur, Esseddeeg Ghrooda, Aftab Ahmad, Khurshid Khan, Muhammad S Hussain, Ashfaq Shuaib
BACKGROUND: Little data exist on using combined baseline clinical neuroimaging and transcranial Doppler (TCD) information in predicting clinical outcome in stroke patients treated with intravenous (IV) thrombolysis. METHODS: Stroke patients received IV recombinant tissue plasminogen activator (rt-PA) and had diagnostic TCD within 3 hours of symptom onset. The TCD result was interpreted using the thrombolysis in brain ischemia (TIBI) flow grading system. Following multiple regression analysis, a grading system was created with 1 point for each of the following: National Institutes of Health Stroke Scale (NIHSS) score of 16 or higher, TIBI score of 1 or lower, and Alberta Stroke Program Early CT Score (ASPECTS) of 6 or lower...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Claus Z Simonsen, Marie L Schmitz, Mette H Madsen, Irene K Mikkelsen, Ronil V Chandra, Thabele Leslie-Mazwi, Grethe Andersen
BACKGROUND: National Institutes of Health Stroke Scale is the most common scale used in stroke patients. An increase of four points or more within 24 h signifies early neurological deterioration. We aimed to establish how often early neurological deterioration occurs in a cohort selected by magnetic resonance imaging and which factors predicted early neurological deterioration. METHODS: In this single-center study, we collected epidemiological, imaging and outcome data on 569 consecutive patients undergoing reperfusion therapy after magnetic resonance imaging selection...
October 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Jeffrey S Berger, Brian G Katona, W Schuyler Jones, Manesh R Patel, Lars Norgren, Iris Baumgartner, Juuso Blomster, Kenneth W Mahaffey, Peter Held, Marcus Millegård, Gretchen Heizer, Craig Reist, F Gerry Fowkes, William R Hiatt
BACKGROUND: Despite overwhelming data demonstrating the efficacy of antiplatelet therapy in heart disease and stroke, data in peripheral artery disease (PAD) are less compelling. Aspirin has modest evidence supporting a reduction in cardiovascular events in patients with PAD, whereas clopidogrel monotherapy may be more effective in PAD. Ticagrelor, a potent, reversibly binding P2Y12 receptor antagonist, is beneficial in patients with acute coronary syndrome and prior myocardial infarction...
May 2016: American Heart Journal
Tomoyuki Ohara, Masatoshi Koga, Naoki Tokuda, Eijirou Tanaka, Hiroyuki Yokoyama, Kenji Minatoya, Kazuyuki Nagatsuka, Kazunori Toyoda, Kazuo Minematsu
BACKGROUND AND PURPOSE: Patients with acute aortic dissection (AAD) sometimes present predominantly with neurological symptoms from cerebral ischemia. Such stroke patients must not receive thrombolysis therapy, which can be fatal. However, patients remain at risk if there is a failure to notice concurrent AAD. We aimed to clarify the characteristics of AAD patients with stroke to identify markers for early AAD detection before thrombolysis. METHODS: Using the single-center database of Stanford type A-AAD patients between 2007 and 2013, we selected those presenting with acute focal neurological deficits, presumably due to cerebral ischemia...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
S Claiborne Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, J Donald Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong
BACKGROUND: Ticagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. METHODS: We conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90)...
July 7, 2016: New England Journal of Medicine
Yu-Long Ma, Li-Xia Zhang, Guang-Lin Liu, Yanhong Fan, Ye Peng, Wu-Gang Hou
Nearly all clinical trials that have attempted to develop effective strategies against ischemic stroke have failed, excluding those for thrombolysis, and most of these trials focused only on preventing neuronal loss. However, astrocytes have gradually become a target for neuroprotection in stroke. In previous studies, we showed that the newly identified molecular N-myc downstream-regulated gene 2 (Ndrg2) is specifically expressed in astrocytes in the brain and involved in some neurodegenerative diseases. However, the role of NDRG2 in ischemic stroke remained unclear...
May 6, 2016: Molecular Neurobiology
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