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Thrombolysis, stroke, ischemia

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https://www.readbyqxmd.com/read/29198901/does-the-primary-imaging-modality-computed-tomography-or-magnetic-resonance-imaging-influence-stroke-physicians-certainty-on-whether-or-not-to-give-thrombolysis-to-randomized-acute-stroke-patients
#1
Christine Krarup Hansen, Anders Christensen, Helen Rodgers, Inger Havsteen, Christina Kruuse, Hanne Christensen
BACKGROUND: Door-to-needle time of 20 minutes to stroke patients with intravenous tissue plasminogen activator (iv-tPA) is feasible when computed tomography (CT) is used as first-line of brain imaging. Magnetic resonance imaging (MRI)-based assessment is more time-consuming but superior in detecting acute ischemia. The certainty with which stroke physicians prescribe or refrain from giving iv-tPA treatment to CT- versus MRI-examined patients has not previously been studied. The aim of the present study was to determine the effect of a primary imaging strategy of CT or MRI on clinicians' certainty to prescribe or refrain from giving iv-tPA to patients with suspected acute stroke...
November 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29162447/co-administration-of-liposomal-fasudil-and-tissue-plasminogen-activator-ameliorated-ischemic-brain-damage-in-occlusion-model-rats-prepared-by-photochemically-induced-thrombosis
#2
Tatsuya Fukuta, Yosuke Yanagida, Tomohiro Asai, Naoto Oku
Delivery of neuroprotectants with liposomes has been shown to be effective for the treatment of ischemic stroke. We have recently revealed that intravenous administration of liposomal fasudil (Fasudil-Lip), a Rho-kinase inhibitor, prior to thrombolysis with tissue plasminogen activator (t-PA) can extend the narrow therapeutic time window (TTW) of t-PA. In the present study, we examined the influence of t-PA treatment on liposomal accumulation into the ischemic region and cerebroprotective effect of combined treatment with Fasudil-Lip and t-PA performed at the same timing after the onset of ischemia in middle cerebral artery occlusion (MCAO) prepared by photochemically induced thrombosis...
November 18, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/29142624/significances-and-outcomes-of-mechanical-thrombectomy-for-acute-infarction-in-very-elderly-patients-a-single-center-experience
#3
Dong Hun Kim, Sang Uk Kim, Jae Hoon Sung, Dong Hoon Lee, Ho Jun Yi, Sang Won Lee
Objective: Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods: Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy...
November 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29137061/low-free-triiodothyronine-levels-predict-symptomatic-intracranial-hemorrhage-and-worse-short-term-outcome-of-thrombolysis-in-patients-with-acute-ischemia-stroke
#4
Mingjing Qiu, Min Fang, Xueyuan Liu
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29136204/thrombolysis-is-an-independent-risk-factor-for-poor-outcome-after-carotid-revascularization
#5
Ananth K Vellimana, Chad W Washington, Chester K Yarbrough, Thomas K Pilgram, Brian L Hoh, Colin P Derdeyn, Gregory J Zipfel
BACKGROUND: Thrombolysis is the standard of care for acute ischemic stroke patients presenting in the appropriate time window. Studies suggest that the risk of recurrent ischemia is lower if carotid revascularization is performed early after the index event. The safety of early carotid revascularization in this patient population is unclear. OBJECTIVE: To evaluate the safety of carotid revascularization in patients who received thrombolysis for acute ischemic stroke...
November 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29079502/inhibiting-12-15-lipoxygenase-to-treat-acute-stroke-in-permanent-and-tpa-induced-thrombolysis-models
#6
H Karatas, Joo Eun Jung, E H Lo, K van Leyen
12/15-Lipoxygenase (12/15-LOX) contributes to the brain damage after middle cerebral artery occlusion (MCAO) in the acute phase of stroke. The aim of this study was to investigate the effects of a 12/15-LOX inhibitor, LOXBlock-1(LB1), in mice using a FeCl3-induced permanent distal MCAO model and FeCl3-induced ischemia/thrombolysis with tPA. In order to induce permanent distal MCAO, 30% FeCl3 was used in C57BL6 mice. LB1 or DMSO treatments were applied intraperitoneally 2hrs following MCAO. For FeCl3-induced ischemia/thrombolysis experiments, 10% FeCl3 was preferred so as to obtain reperfusion with tPA in CD1 mice...
October 24, 2017: Brain Research
https://www.readbyqxmd.com/read/29054842/acute-biventricular-mechanical-circulatory-support-for-cardiogenic-shock
#7
Sudeep Kuchibhotla, Michele L Esposito, Catalina Breton, Robert Pedicini, Andrew Mullin, Ryan O'Kelly, Mark Anderson, Dennis L Morris, George Batsides, Danny Ramzy, Mark Grise, Duc Thinh Pham, Navin K Kapur
BACKGROUND: Biventricular failure is associated with high in-hospital mortality. Limited data regarding the efficacy of biventricular Impella axial flow catheters (BiPella) support for biventricular failure exist. The aim of this study was to explore the clinical utility of percutaneously delivered BiPella as a novel acute mechanical support strategy for patients with cardiogenic shock complicated by biventricular failure. METHODS AND RESULTS: We retrospectively analyzed data from 20 patients receiving BiPella for biventricular failure from 5 tertiary-care hospitals in the United States...
October 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29053904/a-direct-aspiration-first-pass-technique-adapt-for-acute-stroke-therapy-a-systematic-review-and-meta-analysis
#8
Benjamin Gory, Xavier Armoiry, Rotem Sivan-Hoffman, Michel Piotin, Mikael Mazighi, Bertrand Lapergue, Raphaël Blanc, Francis Turjman
BACKGROUND AND PURPOSE: ADAPT (A Direct Aspiration First Pass Technique), involving the first-line use of large-bore distal aspiration catheter, is a new strategy in the mechanical thrombectomy of acute ischemic stroke caused by large vessel occlusion. However, its impact on reperfusion rates, clinical outcomes, and complication rates is not fully examined. METHOD: We conducted a systematic review of the literature searching multiple databases for reports on thrombectomy of acute stroke with the ADAPT technique and performed meta-analyses of clinical and radiographic outcomes...
October 20, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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
#9
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...
December 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
#10
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
#11
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
#12
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...
December 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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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