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Thrombolysis associated intracerebral hemorrhage

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https://www.readbyqxmd.com/read/28720659/microbleeds-cerebral-hemorrhage-and-functional-outcome-after-stroke-thrombolysis-individual-patient-data-meta-analysis
#1
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
https://www.readbyqxmd.com/read/28679847/safety-outcomes-after-thrombolysis-for-acute-ischemic-stroke-in-patients-with-recent-stroke
#2
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...
July 5, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28596196/effect-of-retrievable-stent-size-on-endovascular-treatment-of-acute-ischemic-stroke-a-multicenter-study
#3
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...
June 8, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28546325/reciprocal-interaction-of-24-hour-blood-pressure-variability-and-systolic-blood-pressure-on-outcome-in-stroke-thrombolysis
#4
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...
May 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28494694/antagonizing-dabigatran-by-idarucizumab-in-cases-of-ischemic-stroke-or-intracranial-hemorrhage-in-germany-a-national-case-collection
#5
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
https://www.readbyqxmd.com/read/28471607/patient-outcomes-with-stent-retriever-thrombectomy-for-anterior-circulation-stroke-a-meta-analysis-and-review-of-the-literature
#6
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
https://www.readbyqxmd.com/read/28424044/emergent-carotid-thromboendarterectomy-for-acute-symptomatic-occlusion-of-the-extracranial-internal-carotid-artery
#7
Igor Gunka, Dagmar Krajickova, Michal Lesko, Stanislav Jiska, Jan Raupach, Miroslav Lojik, Radovan Maly
BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28412317/medical-treatment-for-spontaneous-anticoagulation-related-intracerebral-hemorrhage-in-the-netherlands
#8
Laura J de Schipper, M Irem Baharoglu, Yvo B W E M Roos, Frank de Beer
BACKGROUND: Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown. METHODS: An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage...
July 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28356003/young-stroke-patients-treated-with-intravenous-thrombolysis-have-a-more-favorable-outcome-and-mortality-compared-with-older-patients
#9
Jijun Shi, Yongjun Cao, Shoujiang You, Zhichao Huang, Xia Zhang, Huihui Liu, Chun-Feng Liu
BACKGROUND: Previous clinical studies suggest that intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator benefits stroke patients, but the efficacy of IVT in young stroke patients is not well-studied in China. OBJECTIVE: We compared the safety and efficacy of IVT with recombinant tissue plasminogen activator between Chinese young stroke patients (18-50 years old) and older patients (51-80 years old). METHODS: We analyzed data from the Soochow Stroke Registry for 373 stroke patients (18-50 years, n=74 vs...
March 27, 2017: Current Neurovascular Research
https://www.readbyqxmd.com/read/28262403/clinical-predictors-for-favorable-outcomes-from-endovascular-recanalization-in-wake-up-stroke
#10
Sang Min Sung, Tae Hong Lee, Han Jin Cho, Gi Yong Cho, Dae Soo Jung, Jae Il Lee, Jun Kyeung Ko, Samuel Yip
BACKGROUND AND PURPOSE: Patients who have acute stroke symptoms present on awakening are ineligible for standard intravenous thrombolysis due to the unclear onset time of symptoms. Some of these wake-up stroke (WUS) patients may benefit from endovascular recanalization. This study aimed to evaluate clinical predictors of outcomes from endovascular recanalization in WUS patients. METHODS: Forty-one WUS patients with internal carotid (ICA) or middle cerebral artery (MCA) occlusion treated with endovascular recanalization were reviewed...
July 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28156253/severe-carotid-stenosis-and-delay-of-reperfusion-in-endovascular-stroke-treatment-an-interventional-management-of-stroke-iii-study
#11
Steven L Gogela, Yair M Gozal, Bin Zhang, Thomas A Tomsick, Andrew J Ringer, Joseph P Broderick, Pooja Khatri, Todd A Abruzzo
OBJECTIVE The impact of extracranial carotid stenosis on interventional revascularization of acute anterior circulation stroke is unknown. The authors examined the effects of high-grade carotid stenosis on the results of endovascular treatment of patients in the Interventional Management of Stroke (IMS)-III trial. METHODS The 278 patients in the endovascular arm of the IMS-III trial were categorized according to the degree of carotid stenosis as determined by angiography. In comparing patients with severe stenosis or occlusion (≥ 70%) to those without severe stenosis (< 70%), the authors evaluated the time to endovascular reperfusion, modified Thrombolysis in Cerebrovascular Infarction (mTICI) scores, 24-hour mean infarct volumes, symptomatic intracerebral hemorrhage rates, and modified Rankin Scale (mRS) scores at 90 days...
February 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28130468/leukoaraiosis-intracerebral-hemorrhage-and-functional-outcome-after-acute-stroke-thrombolysis
#12
REVIEW
Kannikar Kongbunkiat, Duncan Wilson, Narongrit Kasemsap, Somsak Tiamkao, Fatima Jichi, Vanessa Palumbo, Michael D Hill, Alastair M Buchan, Simon Jung, Heinrich P Mattle, Nils Henninger, David J Werring
OBJECTIVE: To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome. METHODS: We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI)...
February 14, 2017: Neurology
https://www.readbyqxmd.com/read/28127492/renal-dysfunction-is-an-independent-risk-factor-for-poor-outcome-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-new-cutoff-value
#13
Elyar Sadeghi-Hokmabadi, Demet Funda Baş, Mehdi Farhoudi, Aliakbar Taheraghdam, Daryoush Savadi Oskouei, Mohammad Yazdchi, Maziyar Hashemilar, Nevzat Uzuner, Reshad Mirnour, Ertugrul Colak, Atilla Özcan Özdemir
Objective. This study was set to assess the effect of renal dysfunction on outcome of stroke patients treated with intravenous thrombolysis (IVT). Methods. This multicenter research involved 403 patients from January 2009 to March 2015. Patients were divided into two groups: (1) control group with GFR ≥ 45 mL/min/1.73 m(2) and (2) low GFR group with GFR < 45 mL/min/1.73 m(2). Outcome measurements were poor outcome (mRS 3-6) and mortality at 3 months and symptomatic intracerebral hemorrhage (SICH) within the first 24-36 hours...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28081270/outcome-and-treatment-effects-in-stroke-associated-with-acute-cervical-ica-occlusion
#14
Michael Gliem, John-Ih Lee, Aurica Barckhan, Bernd Turowski, Hans-Peter Hartung, Sebastian Jander
BACKGROUND: Endovascular therapy (EVT) with stent retrievers in addition to i.v. thrombolysis (IVT) has proven effective in acute stroke patients with middle cerebral artery (MCA, M1 segment) and distal internal carotid artery (ICA) occlusion. Limited data exist concerning acute cervical ICA occlusion, either alone or in combination with intracranial ICA occlusion (tandem occlusion). Therefore we analyzed outcome and treatment effects in stroke associated with cervical ICA occlusion, with specific focus on the impact of intracranial ICA or M1 patency...
2017: PloS One
https://www.readbyqxmd.com/read/28065404/cerebral-microbleeds-and-risk-of-intracerebral-hemorrhage-post-intravenous-thrombolysis
#15
MULTICENTER STUDY
Ramin Zand, Georgios Tsivgoulis, Mantinderpreet Singh, Michael McCormack, Nitin Goyal, Muhammad Fawad Ishfaq, Reza Bavarsad Shahripour, Katherine Nearing, Lucas Elijovich, Anne W Alexandrov, David S Liebeskind, Andrei V Alexandrov
BACKGROUND: Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. METHODS: In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded...
March 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28035779/reduction-of-intracerebral-hemorrhage-by-rivaroxaban-after-tpa-thrombolysis-is-associated-with-downregulation-of-par-1-and-par-2
#16
Ryuta Morihara, Toru Yamashita, Syoichiro Kono, Jingwei Shang, Yumiko Nakano, Kota Sato, Nozomi Hishikawa, Yasuyuki Ohta, Stefan Heitmeier, Elisabeth Perzborn, Koji Abe
This study aimed to assess the risk of intracerebral hemorrhage (ICH) after tissue-type plasminogen activator (tPA) treatment in rivaroxaban compared with warfarin-pretreated male Wistar rat brain after ischemia in relation to activation profiles of protease-activated receptor-1, -2, -3, and -4 (PAR-1, -2, -3, and -4). After pretreatment with warfarin (0.2 mg/kg/day), low-dose rivaroxaban (60 mg/kg/day), high-dose rivaroxaban (120 mg/kg/day), or vehicle for 14 days, transient middle cerebral artery occlusion was induced for 90 min, followed by reperfusion with tPA (10 mg/kg/10 ml)...
September 2017: Journal of Neuroscience Research
https://www.readbyqxmd.com/read/28034965/is-unexplained-early-neurological-deterioration-after-intravenous-thrombolysis-associated-with-thrombus-extension
#17
Pierre Seners, Robert Hurford, Marie Tisserand, Guillaume Turc, Laurence Legrand, Olivier Naggara, Jean-Louis Mas, Catherine Oppenheim, Jean-Claude Baron
BACKGROUND AND PURPOSE: Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension. METHODS: From our database of consecutively thrombolysed patients, we identified anterior circulation stroke patients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography...
February 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28028726/predictors-of-in-hospital-mortality-and-dependence-at-discharge-in-patients-with-mca-stroke-with-intravenous-thrombolysis
#18
Renata Dal-Prá Ducci, Marcos Christiano Lange, Viviane de Hiroki Flumignan Zétola
Early risk stratification of mortality and dependence is important for guiding medical decision-making in stroke care. The study aim is to evaluate whether there are any differences between risk factors for in-hospital mortality and dependence at discharge in patients with first-episode ischemic stroke in the middle cerebral artery (MCA) receiving intravenous thrombolysis (IVT) treatment. The study comprised a single-center cohort of patients admitted consecutively for first-episode MCA ischemic stroke. A logistic regression analysis was performed to determine the variables associated with in-hospital mortality and dependence at discharge...
December 27, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27885484/the-impact-of-cerebral-microbleeds-on-intracerebral-hemorrhage-and-poor-functional-outcome-of-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-systematic-review-and-meta-analysis
#19
REVIEW
Shuang Wang, Yan Lv, Xin Zheng, Jing Qiu, Hui-Sheng Chen
It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis...
July 2017: Journal of Neurology
https://www.readbyqxmd.com/read/27699498/thrombolysis-in-dementia-patients-with-acute-stroke-is-it-justified
#20
REVIEW
Maurizio Paciaroni, Leonardo Pantoni
The administration of thrombolytic therapy in elderly patients with dementia and acute ischemic stroke may be controversial, because the reported risk of rt-PA associated intracerebral hemorrhage in these patients is higher compared with that of patients without dementia and because these patients are already disabled. Moreover, there are known risk factors for hemorrhagic transformation in patients with dementia: amyloid angiopathy, leukoaraiosis and the presence of microbleeds. In this review, we describe the impact of dementia on functional outcome following thrombolytic therapy for acute ischemic stroke and discuss some of the issues related to the use of this therapy in this specific patient's population...
January 2017: Neurological Sciences
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