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Ecass 3

Henrik Gensicke, Abdulaziz S Al Sultan, Daniel Strbian, Christian Hametner, Sanne M Zinkstok, Solène Moulin, Olivier Bill, Andrea Zini, Visnja Padjen, Georg Kägi, Alessandro Pezzini, David J Seiffge, Christopher Traenka, Silja Räty, Hemasse Amiri, Thomas P Zonneveld, Romina Lachenmeier, Alexandros Polymeris, Yvo B Roos, Christoph Gumbinger, Dejana R Jovanovic, Sami Curtze, Gerli Sibolt, Laura Vandelli, Peter A Ringleb, Didier Leys, Charlotte Cordonnier, Patrik Michel, Philippe A Lyrer, Nils Peters, Turgut Tatlisumak, Paul J Nederkoorn, Stefan T Engelter
OBJECTIVE: To study the effect of platelet count (PC) on bleeding risk and outcome in stroke patients treated with IV thrombolysis (IVT) and to explore whether withholding IVT in PC < 100 × 109/L is supported. METHODS: In this prospective multicenter, IVT register-based study, we compared PC with symptomatic intracranial hemorrhage (sICH; Second European-Australasian Acute Stroke Study [ECASS II] criteria), poor outcome (modified Rankin Scale score 3-6), and mortality at 3 months...
January 24, 2018: Neurology
Jan F Scheitz, Guillaume Turc, Linda Kujala, Alexandros A Polymeris, Mirjam R Heldner, Thomas P Zonneveld, Hebun Erdur, Sami Curtze, Christopher Traenka, Céline Brenière, Roland Wiest, Andrea Rocco, Gerli Sibolt, Henrik Gensicke, Matthias Endres, Nicolas Martinez-Majander, Yannick Béjot, Paul J Nederkoorn, Catherine Oppenheim, Marcel Arnold, Stefan T Engelter, Daniel Strbian, Christian H Nolte
BACKGROUND AND PURPOSE: Selective serotonin-reuptake inhibitors (SSRIs) impair platelet function and have been linked to a higher risk of spontaneous intracerebral hemorrhage-an association that may be augmented by oral anticoagulants (OAC). We aimed to assess whether preadmission treatment with SSRIs in patients with acute ischemic stroke is associated with post-thrombolysis symptomatic intracerebral hemorrhage (sICH) and functional outcome. METHODS: A multicenter retrospective analysis was conducted in prospective registries of patients treated by thrombolysis within 4...
December 2017: Stroke; a Journal of Cerebral Circulation
L Pierot, M Gawlitza, S Soize
Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4...
November 2017: Revue Neurologique
Mingyong Liu, Yuesong Pan, Lichun Zhou, Yongjun Wang
BACKGROUND AND PURPOSE: Predictors of symptomatic intracranial hemorrhage (sICH) in Chinese patients with acute ischemic stroke treated with recombinant tissue plasminogen activator remain unclear. METHODS: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study were assessed to explore risk factors for symptomatic intracranial hemorrhage after intravenous thrombolysis. Three candidate sICH definitions were analyzed...
2017: PloS One
C F Madelung, C Ovesen, C Trampedach, A Christensen, I Havsteen, C K Hansen, H Christensen
OBJECTIVES: Perfusion through leptomeningeal collateral vessels is a likely pivotal factor in the outcome of stroke patients. We aimed to investigate the effect of collateral status on outcome in a cohort of unselected, consecutive stroke patients with middle cerebral artery occlusion undergoing reperfusion therapy. MATERIALS AND METHODS: This retrospectively planned analysis was passed on prospectively collected data from 187 consecutive patients with middle cerebral artery occlusion admitted within 4...
September 14, 2017: Acta Neurologica Scandinavica
Zoe Wolcott, Ayush Batra, Matthew B Bevers, Cristina Sastre, Jane Khoury, Matthew Sperling, Brett C Meyer, Kyle B Walsh, Opeolu Adeoye, Joseph P Broderick, W Taylor Kimberly
OBJECTIVE: ST2 is a member of the toll-like receptor superfamily that can alter inflammatory signaling of helper T-cells. We investigated whether soluble ST2 (sST2) could independently predict outcome and hemorrhagic transformation (HT) in the setting of stroke. METHODS: We measured sST2 in patients enrolled in the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) network biomarker study. 646 patients had plasma samples collected at the time of hospital admission and 210 patients had a second sample collected 48 h after stroke onset...
August 2017: Annals of Clinical and Translational Neurology
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
Ulf Neuberger, Markus Alfred Möhlenbruch, Christian Herweh, Christian Ulfert, Martin Bendszus, Johannes Pfaff
BACKGROUND AND PURPOSE: Intracranial hemorrhage (ICH) after acute ischemic stroke treatments represents a feared complication with possible prognostic implications. In recent years, ICHs were commonly classified according to the ECASS (European Cooperative Acute Stroke Study). To improve the clinical applicability and relevance, the new Heidelberg Bleeding Classification (HBC) has been proposed in 2015. Here, we compared the ECASS and HBC classification with regard to observed events and prognostic relevance...
July 2017: Stroke; a Journal of Cerebral Circulation
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...
June 2017: Revue Neurologique
H Gensicke, A A Frih, D Strbian, A Zini, A Pezzini, V Padjen, M Haueter, D J Seiffge, L Mäkitie, C Traenka, L Poli, N Martinez-Majander, J Putaala, L H Bonati, G Sibolt, G Giovannini, S Curtze, L Beslac-Bumbasirevic, L Vandelli, P A Lyrer, P J Nederkoorn, T Tatlisumak, S T Engelter
BACKGROUND AND PURPOSE: Proteinuria and estimated glomerular filtration rate (eGFR) are indicators of renal function. Whether proteinuria better predicts outcome than eGFR in stroke patients treated with intravenous thrombolysis (IVT) remains to be determined. METHODS: In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m(2) ) and the coexistence of both with regard to (i) poor 3-month outcome (modified Rankin Scale score 3-6), (ii) death within 3 months and (iii) symptomatic intracranial hemorrhage (ECASS-II criteria) were compared...
February 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Sibu Mundiyanapurath, Anne Tillmann, Markus Alfred Möhlenbruch, Martin Bendszus, Peter Arthur Ringleb
INTRODUCTION: Endovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials. OBJECTIVE: To analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values. METHODS: Retrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy...
November 17, 2016: Journal of Neurointerventional Surgery
Andreas Charidimou, Marco Pasi, Marco Fiorelli, Sara Shams, Rüdiger von Kummer, Leonardo Pantoni, Natalia Rost
BACKGROUND AND PURPOSE: We performed a meta-analysis to assess whether leukoaraiosis on brain computed tomographic scans of acute ischemic stroke patients treated with intravenous thrombolysis is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome at 3 to 6 months after stroke, or both. METHODS: We searched PubMed and pooled relevant data in meta-analyses using random effects models. Using odds ratios (OR), we quantified the strength of association between the presence and severity of leukoaraiosis and post-thrombolysis sICH or 3- to 6-month modified Rankin Score >2...
September 2016: Stroke; a Journal of Cerebral Circulation
H Gensicke, A Wicht, O Bill, A Zini, P Costa, G Kägi, R Stark, D J Seiffge, C Traenka, N Peters, L H Bonati, G Giovannini, G M De Marchis, L Poli, A Polymeris, P Vanacker, H Sarikaya, P A Lyrer, A Pezzini, L Vandelli, P Michel, S T Engelter
BACKGROUND AND PURPOSE: The impact of body mass index (BMI) on outcome in stroke patients treated with intravenous thrombolysis (IVT) was investigated. METHODS: In a multicentre IVT-register-based observational study, BMI with (i) poor 3-month outcome (i.e. modified Rankin Scale scores 3-6), (ii) death and (iii) symptomatic intracranial haemorrhage (sICH) based on criteria of the ECASS II trial was compared. BMI was used as a continuous and categorical variable distinguishing normal weight (reference group 18...
December 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Bharath Kumar Cheripelli, Xuya Huang, Rachael MacIsaac, Keith W Muir
BACKGROUND AND PURPOSE: Both intracerebral hemorrhage (ICH) and brain edema have been attributed to reperfusion after intravenous thrombolysis. We explored the interaction of recanalization and core size for imaging outcomes (ICH and vasogenic brain edema). METHODS: In patients with anterior circulation occlusion given intravenous thrombolysis <4.5 hours and imaged with computed tomographic (CT) perfusion and CT angiography, we defined volumes of core (relative delay time >2 s and relative cerebral blood flow <40%) and penumbra (relative delay time >2 s)...
July 2016: Stroke; a Journal of Cerebral Circulation
Li-ping Zhai, Zhi-cai Chen, Shen-qiang Yan, Gen-long Zhong, Sheng Zhang, Meng-jun Xu, Min Lou
OBJECTIVE: To investigate factors related to hemorrhagic transformation and favorable outcomes in wake-up ischemic stroke (WUIS) patients undergoing intravenous thrombolytic therapy. METHODS: Clinical data of 600 patients undergoing multimodal image-guided intravenous recombinant tissue plasminogen activator (rt-PA) therapy in Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine center from May 2009 to May 2015 were retrospectively analyzed...
November 2015: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Shen-qiang Yan, Ying-ying Mao, Gen-long Zhong, Sheng Zhang, Min Lou
OBJECTIVE: To evaluate the safety of intravenous thrombolysis (IVT) in cerebral microbleeds (CMBs) patients with prior antiplatelet therapy. METHODS: Four hundred and forty nine patients with acute ischemic stroke aged (66.8 ± 12.9) years, including 298 males and 151 females, underwent susceptibility-weighted imaging (SWI) examination and MRI-guided IVT therapy between June 2009 and June 2015. The presence of CMBs, previous antiplatelet therapy, HT subtypes according to ECASS II criteria and functional outcome based on modified Rankin scale (mRS) at 3 months were analyzed in logistic regression model...
November 2015: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Hemasse Amiri, Erich Bluhmki, Martin Bendszus, Christoph C Eschenfelder, Geoffrey A Donnan, Didier Leys, Carlos Molina, Peter A Ringleb, Peter D Schellinger, Stefan Schwab, Danilo Toni, Nils Wahlgren, Werner Hacke
RATIONALE AND HYPOTHESIS: Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is an effective and approved therapy for acute ischemic stroke within 4.5 h of onset except for USA, Canada, Croatia, and Moldovia with a current 3 h label. We hypothesized that ischemic stroke patients selected with significant penumbral mismatch on magnetic resonance imaging (MRI) at 4.5-9 h after onset of stroke will have improved clinical outcomes when given intravenous rt-PA (alteplase) compared to placebo...
February 2016: International Journal of Stroke: Official Journal of the International Stroke Society
David M Kent, Robin Ruthazer, Carole Decker, Philip G Jones, Jeffrey L Saver, Erich Bluhmki, John A Spertus
OBJECTIVES: The Stroke-Thrombolytic Predictive Instrument (Stroke-TPI) predicts the probability of good and bad outcomes with and without recombinant tissue plasminogen activator (rtPA). We sought to rebuild and externally validate a simpler Stroke-TPI to support implementation in routine clinical care. METHODS: Using the original derivation cohort of 1,983 patients from a combined database of randomized clinical trials (NINDS [National Institute of Neurological Disorders and Stroke] 1 and 2; ATLANTIS [Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke] A and B; and ECASS [European Cooperative Acute Stroke Study] II), we simplified the Stroke-TPI by reducing variables and interaction terms and by exploring simpler (3- and 8-item) stroke severity scores...
September 15, 2015: Neurology
David J Seiffge, Robbert-JanVan Hooff, Christian H Nolte, Yannick Béjot, Guillaume Turc, Benno Ikenberg, Eivind Berge, Malte Persike, Nelly Dequatre-Ponchelle, Daniel Strbian, Waltraud Pfeilschifter, Andrea Zini, Arnstein Tveiten, Halvor Næss, Patrik Michel, Roman Sztajzel, Andreas Luft, Henrik Gensicke, Christopher Traenka, Lisa Hert, Jan F Scheitz, Gian Marco De Marchis, Leo H Bonati, Nils Peters, Andreas Charidimou, David J Werring, Frederick Palm, Matthias Reinhard, Wolf-Dirk Niesen, Takehiko Nagao, Alessandro Pezzini, Valeria Caso, Paul J Nederkoorn, Georg Kägi, Alexander von Hessling, Visnja Padjen, Charlotte Cordonnier, Hebun Erdur, Philippe A Lyrer, Raf Brouns, Thorsten Steiner, Turgut Tatlisumak, Stefan T Engelter
BACKGROUND: We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). METHODS AND RESULTS: This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months)...
September 29, 2015: Circulation
M Al-Khaled, B Langner, T Brüning
BACKGROUND AND PURPOSE: The most feared complication after treatment with recombinant tissue-plasminogen activator (rt-PA) is the occurrence of symptomatic intracerebral hemorrhage (sICH). The aims of the study were to predict the risk of sICH (ECASS II definition) after a therapy with rt-PA and to examine whether associations exist between SEDAN score and the early mortality in patients with acute ischemic stroke in a monocenter study. METHODS: During a 6-year period (2008-2013), 542 consecutive stroke patients (mean age, 73 ± 3 years; 51...
April 2016: Acta Neurologica Scandinavica
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