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Thrombolysis associated intracerebral hemorrhage

Carolin Hoyer, Alexandra Filipov, Eva Neumaier-Probst, Kristina Szabo, Anne Ebert, Angelika Alonso
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have gained increasing importance for stroke prevention in patients with non-valvular atrial fibrillation (AF). With changing prescription practice, among other factors, clinicians can expect to see rising numbers of patients with ischemic stroke and pre-existing NOAC therapy. Few data exist regarding a potential impact of NOAC on stroke severity and outcome. AIMS: To evaluate the impact of pre-admission NOAC therapy on ischemic stroke severity...
February 23, 2018: Journal of Thrombosis and Thrombolysis
Ilya Bragin, Justine M Chen
Thrombocytopenia (platelet count: < 100,000/mm3 ) is considered a contraindication in the use of intravenous thrombolysis for acute ischemic stroke. Little literature exists regarding tissue plasminogen activator (tPA) usage in thrombocytopenic patients, especially in older patients. Age and stroke severity are major prognostic indicators of the risk of hemorrhagic transformation. The Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index estimates a patient's risk of intracerebral hemorrhage (ICH) and clinical response to thrombolysis by combining age in years with the National Institutes of Health Stroke Scale (NIHSS) scores...
December 11, 2017: Curēus
David J Seiffge, Georg Kägi, Patrik Michel, Urs Fischer, Yannick Béjot, Susanne Wegener, Marialuisa Zedde, Guillaume Turc, Charlotte Cordonnier, Peter S Sandor, Gilles Rodier, Andrea Zini, Manuel Cappellari, Sabine Schädelin, Alexandros A Polymeris, David Werring, Sebastian Thilemann, Ilaria Maestrini, Eivind Berge, Christopher Traenka, Jochen Vehoff, Gian Marco De Marchis, Monika Kapauer, Nils Peters, Gaia Sirimarco, Leo H Bonati, Marcel Arnold, Philippe A Lyrer, Emmanuel De Maistre, Andreas Luft, Dimtrios A Tsakiris, Stefan T Engelter
OBJECTIVE: Information about Rivaroxaban plasma levels (RivLev) may guide treatment decisions in patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) taking rivaroxaban. METHODS: In a multicenter registry-based study (Novel-Oral-Anticoagulants-In-Stroke-Patients collaboration;NOACISP; of patients with stroke while taking rivaroxaban, we compared RivLev in patients with AIS and ICH. We determined how many AIS-patients had RivLev≤100ng/ml, indicating possible eligibility for thrombolysis and how many ICH-patients had RivLev≥75ng/ml, possibly eligible for the use of specific reversal agents...
February 2, 2018: Annals of Neurology
Ying Xu, Maree L Hackett, John Chalmers, Richard I Lindley, Xia Wang, Qiang Li, Thompson Robinson, Hisatomi Arima, Pablo M Lavados, Craig S Anderson
Background: Seizures after ischemic stroke have not been well-studied. We aim to determine the frequency, determinants, and significance of early seizures after thrombolysis for acute ischemic stroke. Methods: Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) IV alteplase...
August 2017: Neurology. Clinical Practice
Manuel Cappellari, Gianni Turcato, Massimo Zannoni, Stefano Forlivesi, Antonio Maccagnani, Antonio Bonora, Giorgio Ricci, Gian Luca Salvagno, Gianfranco Cervellin, Bruno Bonetti, Giuseppe Lippi
The exposure to air pollutants may increase both incidence and mortality of stroke. We aimed to investigate the association of short- and medium-term exposure to particulate matter (PM) and nitrogen dioxide (NO2 ) with the outcome of intravenous thrombolysis (IVT) for stroke. We conducted a retrospective analysis based on data prospectively collected from 944 consecutive IVT-treated stroke patients. The main outcome measure was 3-month mortality. The secondary outcome measures were causes of neurological deterioration (≥ 1 NIHSS point from baseline or death < 7 days), including intracerebral hemorrhage, cerebral edema (CED), and persistence or new appearance of hyperdense cerebral artery sign...
February 2018: Journal of Thrombosis and Thrombolysis
Ge Tan, Haijiao Wang, Sihan Chen, Deng Chen, Lina Zhu, Da Xu, Yu Zhang, Ling Liu
Whether low dose alteplase is comparable to standard dose in efficacy and safety for intravenous thrombolysis (IVT) in Asian stroke patients remains unverified. PubMed, EMBASE, and Cochrane Library Database from the beginning to June 30, 2017 were searched. IVT efficacy was measured by favorable outcome (modified Rankin Scale scores of 0-1) at 3 months, and safety measured by mortality within 3 months and symptomatic intracerebral hemorrhage (SICH). Pooled estimates were conducted using fixed- or random-effects model depending on heterogeneity...
November 22, 2017: Scientific Reports
Miguel Tábuas-Pereira, João Sargento-Freitas, Fernando Silva, Joana Parra, Patrícia Mendes, Vera Seara, Miguel Mesquita, Mariana Baptista, Gustavo Cordeiro, Luis Cunha
BACKGROUND: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. OBJECTIVES: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death...
November 13, 2017: European 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
Y Chen, S Yan, M Xu, G Zhong, D S Liebeskind, M Lou
BACKGROUND AND PURPOSE: Remote intracerebral hemorrhage (rICH) is infrequent after intravenous thrombolysis (IVT) and its mechanism remains poorly understood. We aimed to assess its frequency and possible relationship with the severity of white matter hyperintensity (WMH) in patients with acute ischemic stroke. METHODS: We prospectively analyzed data from consecutive patients with acute ischemic stroke with magnetic resonance imaging and IVT. WMH volume was quantitatively measured...
February 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Mona Laible, Markus Alfred Möhlenbruch, Johannes Pfaff, Ekkehart Jenetzky, Peter Arthur Ringleb, Martin Bendszus, Timolaos Rizos
BACKGROUND: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. METHODS: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included...
October 31, 2017: Cerebrovascular Diseases
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
A Ross Naylor
There is a paucity of high-quality evidence regarding what constitutes "optimal medical therapy" for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher doses confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet therapy will significantly reduce stroke due to early postoperative carotid thrombosis...
March 2017: Seminars in Vascular Surgery
Yu-Hsiang Su, Chih-Hung Chen, Huey-Juan Lin, Yu-Wei Chen, Mei-Chiun Tseng, Han-Chieh Hsieh, Chih-Hung Chen, Sheng-Feng Sung
PURPOSE: Only a small percentage of ischemic stroke patients were treated with intravenous thrombolysis in Taiwan, partly because of the narrow reimbursement criteria of the National Health Insurance (NHI). We aimed to assess the safety and effectiveness of intravenous thrombolysis not covered by the NHI. METHODS: This is a retrospective analysis of register data from four hospitals. All patients who received intravenous tissue plasminogen activator and fulfilled the American Heart Association/American Stroke Association (AHA/ASA) thrombolysis guidelines between January 2007 and June 2012 were distinguished into two groups: those in accordance (reimbursement group) and those not in accordance (non-reimbursement group) with the NHI reimbursement criteria...
March 15, 2017: Acta Neurologica Taiwanica
Susan J Carr, Xia Wang, Veronica V Olavarria, Pablo M Lavados, Jorge A Rodriguez, Jong S Kim, Tsong-Hai Lee, Richard I Lindley, Octavio M Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Mark Woodward, John Chalmers, Craig S Anderson, Thompson G Robinson
BACKGROUND AND PURPOSE: Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS: A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0...
September 2017: Stroke; a Journal of Cerebral Circulation
Andreas Charidimou, Guillaume Turc, Catherine Oppenheim, Shenqiang Yan, Jan F Scheitz, Hebun Erdur, Pascal P Klinger-Gratz, Marwan El-Koussy, Wakoh Takahashi, Yusuke Moriya, Duncan Wilson, Chelsea S Kidwell, Jeffrey L Saver, Asma Sallem, Solene Moulin, Myriam Edjlali-Goujon, Vincent Thijs, Zoe Fox, Ashkan Shoamanesh, Gregory W Albers, Heinrich P Mattle, Oscar R Benavente, H Rolf Jäger, Gareth Ambler, Junya Aoki, Jean-Claude Baron, Kazumi Kimura, Wataru Kakuda, Shunya Takizawa, Simon Jung, Christian H Nolte, Min Lou, Charlotte Cordonnier, David J Werring
BACKGROUND AND PURPOSE: We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome. METHODS: We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator...
July 18, 2017: Stroke; a Journal of Cerebral Circulation
Alexander E Merkler, Setareh Salehi Omran, Gino Gialdini, Michael P Lerario, Shadi Yaghi, Mitchell S V Elkind, Babak B Navi
BACKGROUND AND PURPOSE: It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes. METHODS: Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality...
August 2017: Stroke; a Journal of Cerebral Circulation
D Yang, Y Hao, W Zi, H Wang, D Zheng, H Li, M Tu, Y Wan, P Jin, G Xiao, Y Xiong, G Xu, X Liu
BACKGROUND AND PURPOSE: In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS: Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device...
August 2017: AJNR. American Journal of Neuroradiology
Lars Kellert, Christian Hametner, Niaz Ahmed, Geraldine Rauch, Mary J MacLeod, Francesco Perini, Kennedy R Lees, Peter A Ringleb
BACKGROUND AND PURPOSE: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS: From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed...
July 2017: Stroke; a Journal of Cerebral Circulation
Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Katharina Althaus, Jörg Berrouschot, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Klaus Gröschel, Claus G Haase, Andreas Harloff, Valentin Held, Andreas Kauert, Peter Kraft, Arne Lenz, Wolfgang Müllges, Mark Obermann, Someieh Partowi, Jan Purrucker, Peter A Ringleb, Joachim Röther, Raluca Rossi, Niklas Schäfer, Andreas Schneider, Ramona Schuppner, Rüdiger J Seitz, Kristina Szabo, Robert Wruck
Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
Rotem Sivan-Hoffmann, Benjamin Gory, Muriel Rabilloud, Dorin N Gherasim, Xavier Armoiry, Roberto Riva, Paul-Emile Labeyrie, Udi Gonike-Sadeh, Islam Eldesouky, Francis Turjman
Mechanical thrombectomy with stent retrievers is now the reference therapy for acute ischemic stroke (AIS) in the anterior circulation in association with thrombolysis. We conducted an extensive systematic review and meta-analysis to evaluate the clinical and angiographic outcomes of stent-retriever thrombectomy in patients with acute anterior circulation stroke. Available literature published to date on observational studies and three randomized trials (MR CLEAN, ESCAPE, and EXTEND-IA) involving the stent-retriever device were reviewed...
September 2016: Israel Medical Association Journal: IMAJ
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