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Ecass 3

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...
August 1, 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
Lasse Willer, Inger Havsteen, Christian Ovesen, Anders F Christensen, Hanne Christensen
BACKGROUND: Is computed tomography (CT)-verified leukoaraiosis (LA) a risk factor for post-thrombolytic hemorrhagic transformation and symptomatic hemorrhage? METHODS: (1) Retrospective analysis based on a prospectively planned single-center registry of consecutive tissue plasminogen activator (tPA)-treated patients within 4.5 hours from symptom onset. Standard work-up included baseline noncontrast CT and CT angiography and next day follow-up noncontrast CT. Baseline noncontrast CT LA was graded using Fazekas' score and dichotomized as the absence (Fazekas, 0) or the presence (Fazekas, 1-3)...
June 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Christian Hametner, Lars Kellert, Peter Arthur Ringleb
BACKGROUND: It is not established whether sex influences outcome and safety following intravenous thrombolysis (IVT) in acute stroke. As a significant imbalance exists between the baseline conditions of women and men, regression analysis alone may be subject to bias. Here we aimed to overcome this methodical shortcoming by balancing both groups using coarsened exact matching (CEM) before evaluating outcome. METHODS: From our local prospective stroke database we analyzed consecutive patients who suffered anterior circulation stroke and received IVT from 1998 to 04/2013 (n = 1391, 668 female, 723 male)...
2015: BMC Neurology
Xuya Huang, Bharath Kumar Cheripelli, Suzanne M Lloyd, Dheeraj Kalladka, Fiona Catherine Moreton, Aslam Siddiqui, Ian Ford, Keith W Muir
BACKGROUND: In most countries, alteplase given within 4·5 h of onset is the only approved medical treatment for acute ischaemic stroke. The newer thrombolytic drug tenecteplase has been investigated in one randomised trial up to 3 h after stroke and in another trial up to 6 h after stroke in patients selected by advanced neuroimaging. In the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST), we aimed to assess the efficacy and safety of tenecteplase versus alteplase within 4·5 h of stroke onset in a population not selected on the basis of advanced neuroimaging, and to use imaging biomarkers to inform the design of a definitive phase 3 clinical trial...
April 2015: Lancet Neurology
Tracy E Madsen, Jane C Khoury, Kathleen A Alwell, Charles J Moomaw, Brett M Kissela, Felipe De Los Rios La Rosa, Daniel Woo, Opeolu Adeoye, Matthew L Flaherty, Pooja Khatri, Simona Ferioli, Dawn Kleindorfer
BACKGROUND AND PURPOSE: Sex differences in recombinant tissue-type plasminogen activator (r-tPA) administration are present in some populations. It is unknown whether this is because of eligibility differences or the modifiable exclusion criterion of severe hypertension. Our aim was to investigate sex differences in r-tPA eligibility, in individual exclusion criteria, and in the modifiable exclusion criterion, hypertension. METHODS: We included all ischemic stroke patients ≥18 years among residents of the Greater Cincinnati/Northern Kentucky region who presented to 16-area emergency departments in 2005...
March 2015: Stroke; a Journal of Cerebral Circulation
Elena Meseguer, Julien Labreuche, Celine Guidoux, Philippa C Lavallée, Lucie Cabrejo, Gaia Sirimarco, Jaime G Valcarcel, Isabelle F Klein, Pierre Amarenco, Mikael Mazighi
BACKGROUND: Thirty percent of ischemic stroke (IS) patients suffering from acute stroke are under antiplatelet therapy. AIMS: We evaluated whether prior antiplatelet use before intravenous (IV), intra-arterial (IA) or combined IV/IA therapy may be associated with worse outcomes and an increased intracerebral hemorrhage (ICH) risk after reperfusion therapies. METHODS: We analyzed data from our patient registry (n = 874) and conducted a systematic review of previous observational studies...
February 2015: International Journal of Stroke: Official Journal of the International Stroke Society
M N Islam, R Kuddus, N S Chowdhury, M D Akhter, G Salahuddin, S Parvin
Imaging cerebral infarction in first few hours after the onset of clinical symptoms is a challenge. The role of stroke imaging underwent a paradigm shift from confirmation of infarction from and exclusion of hemorrhage to the detection of the tissue at risk that may be rescued with restoration of circulation. Computed tomography (CT) is generally performed before starting the therapy in order to exclude the presence of bleeding and tumors. Although CT may show findings of infarction as early as 3-6 hours after ictus 30% of CT scans are normal in the first few hours after ischemic insult...
July 2014: Mymensingh Medical Journal: MMJ
Felipe De Los Rios, Dawn O Kleindorfer, Amy Guzik, Santiago Ortega-Gutierrez, Navdeep Sangha, Gyanendra Kumar, James C Grotta, Jin-Moo Lee, Brett C Meyer, Lee H Schwamm, Pooja Khatri
BACKGROUND: The indications and contraindications for intravenous (IV) recombinant tissue plasminogen activator (rtPA) use in ischemic stroke can be confusing to the practicing neurologist. Here we seek to describe practice patterns regarding decision-making among US stroke clinicians. METHODS: Stroke clinicians (attending and fellow) from the 8 National Institutes of Health SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) centers were asked to complete a survey ahead of the 2012 SPOTRIAS Investigators' meeting...
September 2014: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Carolyn A Cronin, Kevin N Sheth, Xin Zhao, Steven R Messé, DaiWai M Olson, Adrian F Hernandez, Deepak L Bhatt, Lee H Schwamm, Eric E Smith
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association guidelines recommend intravenous tissue-type plasminogen activator (tPA) treatment 3 to 4.5 hours from symptom onset according to criteria used in the Third European Cooperative Acute Stroke Study (ECASS III). However, ECASS III excluded certain patient groups in addition to the standard exclusions used for 0 to 3 hours in the United States: age >80 years, history of stroke and diabetes mellitus, oral anticoagulant treatment, and National Institutes of Health Stroke Scale >25...
September 2014: Stroke; a Journal of Cerebral Circulation
Richard Leigh, Shyian S Jen, Argye E Hillis, John W Krakauer, Peter B Barker
BACKGROUND AND PURPOSE: Early blood-brain barrier damage after acute ischemic stroke has previously been qualitatively linked to subsequent intracranial hemorrhage (ICH). In this quantitative study, it was investigated whether the amount of blood-brain barrier damage evident on pre-tissue-type plasminogen activator MRI scans was related to the degree of post-tissue-type plasminogen activator ICH in patients with acute ischemic stroke. METHODS: Analysis was performed on a database of patients with acute ischemic stroke provided by the Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA) Imaging Investigators...
July 2014: Stroke; a Journal of Cerebral Circulation
Yuesong Pan, Qidong Chen, Xiaoling Liao, Xingquan Zhao, Chunjuan Wang, Gaifen Liu, Liping Liu, Chunxue Wang, David Wang, Yilong Wang, Yongjun Wang
OBJECTIVE: Previous studies have shown conflicting results on the use of antiplatelet (AP) agent and its risk of symptomatic intracerebral hemorrhage (sICH) following thrombolysis for acute ischemic stroke. Our study was to explore the safety of intravenous (IV) thrombolysis in Chinese stroke patients who were on AP prior to stroke. METHODS: Data were collected from the thrombolysis implementation and monitor of acute ischemic stroke in China (TIMS-China) registry...
January 2015: Neurological Research
Hebun Erdur, Jan F Scheitz, Serdar Tütüncü, Jochen B Fiebach, Matthias Endres, David J Werring, Christian H Nolte
BACKGROUND AND PURPOSE: Data on safety of intravenous thrombolysis with recombinant tissue-type plasminogen activator for acute ischemic stroke in patients with coexisting cerebral cavernous malformations (CCMs) are scarce. We assessed the risk of thrombolysis-associated hemorrhage in these patients. METHODS: We searched our tertiary care hospital thrombolysis register for patients with CCM confirmed by MRI (3 T, Siemens, TimTrio) before thrombolysis for acute ischemic stroke...
June 2014: Stroke; a Journal of Cerebral Circulation
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