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Thrombolysis, stroke, ischemia

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https://www.readbyqxmd.com/read/28596447/impact-of-thrombus-length-on-outcomes-after-intra-arterial-aspiration-thrombectomy-in-the-therapy-trial
#1
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...
June 8, 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
#2
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 HDAC2 up-regulation from 5 to 7 days after stroke plays a crucial role. In this window phase, suppressing HDAC2 in the peri-infarct cortex of rodents by HDAC inhibitors, knockdown or knockout of HDAC2 promoted recovery of motor function from stroke via epigenetically enhancing cells survival and neuroplasticity of surviving neurons as well as reducing neuroinflammation, whereas over-expressing HDAC2 worsened stroke-induced functional impairment of both WT and HDAC2 CKO mice...
June 7, 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
#3
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
#4
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
https://www.readbyqxmd.com/read/28454980/are-the-results-of-intravenous-thrombolysis-trials-reproduced-in-clinical-practice-comparison-of-observed-and-expected-outcomes-with-the-stroke-thrombolytic-predictive-instrument-stpi
#5
A Decourcelle, S Moulin, N Dequatre-Ponchelle, M Bodenant, C Rossi, M Girot, H Hénon, E Wiel, R Bordet, P Goldstein, J P Pruvo, C Cordonnier, D Leys
AIM: In patients with cerebral ischemia, intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) increases survival without handicap or dependency despite an increased risk of bleeding. This study evaluated whether the results of randomized controlled trials are reproduced in clinical practice. METHOD: Data from a registry of consecutive patients treated by rt-PA at Lille University Hospital were retrospectively analyzed for outcomes, using modified Rankin Scale (mRS) scores, at 3 months...
April 25, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28427984/effect-of-baseline-characteristics-on-the-outcome-of-stent-retriever-based-thrombectomy-in-acute-basilar-artery-occlusions-a-single-center-experience-and-pooled-data-analysis
#6
Wan-Ling Wen, Zi-Fu Li, Yong-Wei Zhang, Peng-Fei Yang, Keith Simfukwe, Yi-Bin Fang, Tian-Yi Zhang, Ben-Qiang Deng, Bo Hong, Jian-Min Liu, Qing-Hai Huang
OBJECTIVES: -To explore the association of baseline characteristics and the outcome of acute basilar artery occlusion (BAO) patients following stent retriever based thrombectomy (SRT). METHODS: -Clinical and imaging information of consecutive SRT treated BAO patients from a comprehensive stroke center and up-to-date literatures were reviewed respectively. The impact of baseline variables towards favorable outcome was evaluated using subgroup analysis and odds ratio extracted from published data resource together with single center records using pooled analysis...
April 17, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28427054/preceding-intravenous-thrombolysis-in-patients-receiving-endovascular-therapy
#7
Hong-Kyun Park, Jong-Won Chung, Jeong-Ho Hong, Min Uk Jang, Hyun-Du Noh, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Moon-Ku Han, Beom Joon Kim, Tai Hwan Park, Sang-Soon Park, Kyung Bok Lee, Jun Lee, Keun-Sik Hong, Yong-Jin Cho, Byung-Chul Lee, Kyung-Ho Yu, Mi-Sun Oh, Ki-Hyun Cho, Joon-Tae Kim, Dong-Eog Kim, Wi-Sun Ryu, Jay Chol Choi, Wook-Joo Kim, Dong-Ick Shin, Min-Ju Yeo, Sung Il Sohn, Ji Sung Lee, Juneyoung Lee, Byung-Woo Yoon, Hee-Joon Bae
BACKGROUND: The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. METHODS: From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013...
April 21, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28400063/first-case-of-ischemic-stroke-which-happened-during-continuous-intravenous-infusion-of-rt-pa
#8
Anna Zurawska, Jaroslaw Czeczotka, Jacek J Rozniecki
Catheter-directed thrombolysis (CDT) is one of the methods in the treatment of patients with acute lower limb ischemia. It is based on intrathrombus infusion of one of the thrombolytic agents. The most common complication of CDT is bleeding. We present a patient with left lower limb ischemia, treated by CDT, in which symptoms of stroke, proved to have ischemic etiology, started during continuous intra-arterial infusion of rt-PA. As the patient presented with the history of atrial fibrillation, the most probable mechanism of stroke was related to detachment of possible intra-atrial thrombus...
May 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28393614/current-and-future-perspectives-on-the-treatment-of-cerebral-ischemia
#9
REVIEW
Brandon R Christophe, Shyle H Mehta, Andrew L A Garton, Jonathan Sisti, E Sander Connolly
After heart disease and combined forms of cancer, stroke is the leading cause of death in the United States. Currently, tissue-plasminogen activator (tPA) thrombolysis is the only thrombolytic therapy that has been shown to improve patient outcome. Presently, the only antithrombotic drug treatment that has proven effective at improving acute ischemic stroke patient outcome is aspirin administration. Despite these studies, no clinical trials have yet demonstrated a reliably effective pharmacological treatment...
April 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28382161/edaravone-encapsulated-agonistic-micelles-rescue-ischemic-brain-tissue-by-tuning-blood-brain-barrier-permeability
#10
Qu Jin, Yu Cai, Sihan Li, Haoran Liu, Xingyu Zhou, Chunqiang Lu, Xihui Gao, Jun Qian, Jun Zhang, Shenghong Ju, Cong Li
Thrombolysis has been a standard treatment for ischemic stroke. However, only 2-7% patients benefit from it because the thrombolytic agent has to be injected within 4.5 h after the onset of symptoms to avoid the increasing risk of intracerebral hemorrhage. As the only clinically approved neuroprotective drug, edaravone (EDV) rescues ischemic brain tissues by eradicating over-produced reactive oxygen species (ROS) without the limitation of therapeutic time-window. However, EDV's short circulation half-life and inadequate cerebral uptake attenuate its therapeutic efficacy...
2017: Theranostics
https://www.readbyqxmd.com/read/28379489/new-thrombolytic-strategy-providing-neuroprotection-in-experimental-ischemic-stroke-mmp10-alone-or-in-combination-with-tpa
#11
C Roncal, S Martinez de Lizarrondo, A Salicio, A Chevilley, J A Rodriguez, A Rosell, P O Couraud, B Weksler, J Montaner, D Vivien, J A Páramo, J Orbe
Aim: Considering that MMP-10 improves stroke injury, we have examined the therapeutic and protective effect of MMP10 and tPA/MMP10 as clot-dissolving and neuroprotective agent in an experimental model of ischemic stroke and studied in vitro the molecular pathways involved in MMP10-mediated effects. Methods and Results: Cerebral ischemia was induced by the local injection of thrombin into the middle cerebral artery followed by reperfusion with MMP10 (6.5µg/Kg) and tPA (10mg/Kg) alone or in combination with MMP10...
April 3, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28347898/stentriever-thrombectomy-failure-a-challenge-in-stroke-management
#12
Claudio Baracchini, Filippo Farina, Matteo Soso, Federica Viaro, Silvia Favaretto, Anna Palmieri, Caterina Kulyk, Enzo Ballotta, Lorena Nico, Giacomo Cester, Francesco Causin
BACKGROUND: and Purpose: Stentriever thrombectomy failure in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) is not a rare event. The purpose of this study was to investigate whether other procedures (tirofiban, permanent stenting) are able to recanalize the occluded vessel and determine a better outcome without increasing mortality and intracranial hemorrhage (ICH) rates. METHODS: Among 513 patients consecutively admitted with anterior circulation stroke, 109 underwent stentriever thrombectomy...
March 24, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28319240/two-paradigms-for-endovascular-thrombectomy-after-intravenous-thrombolysis-for-acute-ischemic-stroke
#13
Gaspard Gerschenfeld, Ioan-Paul Muresan, Raphael Blanc, Michael Obadia, Marie Abrivard, Michel Piotin, Sonia Alamowitch
Importance: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome. Objective: To compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership)...
May 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28277288/ct-imaging-selection-in-acute-stroke
#14
Laurie Bouchez, Roman Sztajzel, Maria Isabel Vargas, Paolo Machi, Zsolt Kulcsar, Pierre-Alexandre Poletti, Vitor Mendes Pereira, Karl-Olof Lövblad
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia...
October 26, 2016: European Journal of Radiology
https://www.readbyqxmd.com/read/28269641/peripheral-sensory-stimulation-is-neuroprotective-in-a-rat-photothrombotic-ischemic-stroke-model
#15
Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor
Ischemic stroke is one of the leading causes of death and disability in the world. Thrombolytic therapy using recombinant tissue plasminogen activator (rtPA), the only FDA-approved drug for acute ischemia, is limited by a narrow therapeutic time window and risk of hemorrhage. There is a serious need for a neuroprotective therapy which is clinically viable. We earlier demonstrated that peripheral sensory stimulation (PSS) is a potential therapeutic intervention for hyperacute ischemia resulting in recovery of neurovascular functions when administered immediately following ischemia onset in a rat model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28267563/protective-effects-of-angiopoietin-like-4-on-the-blood-brain-barrier-in-acute-ischemic-stroke-treated-with-thrombolysis-in-mice
#16
Bin Zhang, Xiaofeng Xu, Xiuli Chu, Xiaoyang Yu, Yuwu Zhao
AIMS: Given the risk of blood-brain barrier damage (BBB) caused by ischemic and tissue plasminogen activator thrombolysis, the preservation of vascular integrity is important. Angiopoietin-like 4 (ANGPTL4), a protein secreted in hypoxia, is involved in the regulation of vascular permeability. We hypothesized that Angptl4 might exert a protective effect in thrombolysis through stabilizing blood-brain barrier and inhibit hyper-permeability. METHODS: We investigated the role of Angptl4 in stroke using a transient focal cerebral ischemia mouse model...
March 4, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28242586/feasibility-and-safety-of-direct-catheter-based-thrombectomy-in-the-treatment-of-acute-ischemic-stroke-cooperation-of-cardiologists-neurologists-and-radiologists-prospective-registry-prague-16
#17
Petr Widimsky, Boris Koznar, Tomas Peisker, Peter Vasko, Filip Rohac, Jana Vavrova, Josef Kroupa, Ivana Stetkarova
AIMS: The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology center. METHODS AND PATIENTS: Single center, prospective observational registry based on the prespecified protocol included 3 months follow-up. The decision to perform acute stroke intervention was done by a neurologist based on the clinical and imaging findings...
February 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28227899/peripheral-sensory-stimulation-is-neuroprotective-in-a-rat-photothrombotic-ischemic-stroke-model
#18
Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor, Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor, Lun-De Liao, Nitish V Thakor, Frances Lim, Chua Le Teng Sherry, Aishwarya Bandla, Chan Kim Chuan
Ischemic stroke is one of the leading causes of death and disability in the world. Thrombolytic therapy using recombinant tissue plasminogen activator (rtPA), the only FDA-approved drug for acute ischemia, is limited by a narrow therapeutic time window and risk of hemorrhage. There is a serious need for a neuroprotective therapy which is clinically viable. We earlier demonstrated that peripheral sensory stimulation (PSS) is a potential therapeutic intervention for hyperacute ischemia resulting in recovery of neurovascular functions when administered immediately following ischemia onset in a rat model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28110588/neuroprotective-effects-of-adjunctive-treatments-for-acute-stroke-thrombolysis-a-review-of-clinical-evidence
#19
Hongxing Zhou, Suyun Huang, Gavin Sunnassee, Weiyu Guo, Jian Chen, Yang Guo, Sheng Tan
The narrow therapeutic time window and risk of intracranial hemorrhage largely restrict the clinical application of thrombolysis in acute ischemic stroke. Adjunctive treatments added to rt-PA may be beneficial to improve the capacity of neural cell to withstand ischemia, and to reduce the hemorrhage risk as well. This review aims to evaluate the neuroprotective effects of adjunctive treatments in combination with thrombolytic therapy for acute ischemic stroke. Relevant studies were searched in the PubMed, Web of Science and EMBASE database...
February 7, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28079139/blood-occludin-level-as-a-potential-biomarker-for-early-blood-brain-barrier-damage-following-ischemic-stroke
#20
Rong Pan, Kewei Yu, Theodore Weatherwax, Handong Zheng, Wenlan Liu, Ke Jian Liu
Concern about intracerebral hemorrhage (ICH) is the primary reason for withholding tPA therapy from patients with ischemic stroke. Early blood brain barrier (BBB) damage is the major risk factor for fatal post-thrombolysis ICH, but rapidly assessing BBB damage before tPA administration is highly challenging. We recently reported that ischemia induced rapid degradation of tight junction protein occludin in cerebromicrovessels. The present study investigates whether the cleaved occludin is released into the blood stream and how blood occludin levels correlate to the extent of BBB damage using a rat model of ischemic stroke...
January 12, 2017: Scientific Reports
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