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hemorrhagic transformation ischemic stroke

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https://www.readbyqxmd.com/read/27909202/prediction-of-blood-brain-barrier-disruption-and-intracerebral-hemorrhagic-infarction-using-arterial-spin-labeling-magnetic-resonance-imaging
#1
Takeya Niibo, Hajime Ohta, Shirou Miyata, Ichiro Ikushima, Kazuchika Yonenaga, Hideo Takeshima
BACKGROUND AND PURPOSE: Arterial spin-labeling magnetic resonance imaging is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke. We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in acute ischemic stroke patients. METHODS: In a retrospective study, arterial spin-labeling was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline magnetic resonance angiography...
December 1, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27891675/surgical-management-of-infective-endocarditis-complicated-by-ischemic-stroke
#2
Kevin E Hodges, Syed T Hussain, William J Stewart, Gosta B Pettersson
Embolism to the central nervous system is a frequent and important complication of infective endocarditis. While early surgery improves outcomes in many groups of patients with infective endocarditis, ischemic stroke secondary to septic embolism carries the risk of hemorrhagic transformation and neurological deterioration with heparinization and cardiopulmonary bypass. We review the literature regarding the surgical management of infective endocarditis in patients with cerebral emboli.
November 27, 2016: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/27865697/sulfonylurea-pretreatment-and-in-hospital-use-does-not-impact-acute-ischemic-strokes-ais-outcomes-following-intravenous-thrombolysis
#3
Georgios Tsivgoulis, Nitin Goyal, Sulaiman Iftikhar, Ramin Zand, Jason J Chang, Lucas Elijovich, Anne W Alexandrov, Marc D Malkoff, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Preliminary studies have indicated that sulfonylurea drugs (SUD) may confer protection against cerebral swelling and hemorrhagic transformation in severe acute ischemic stroke (AIS). We sought to determine whether pretreatment and in-hospital use of SUD may be associated with better outcomes in diabetic AIS patients treated with intravenous thrombolysis (IVT). SUBJECTS AND METHODS: We analyzed consecutive diabetic AIS patients treated with IVT during a 3-year period...
November 16, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27822079/intravenous-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke-a-feasibility-and-safety-study
#4
Elyar Sadeghi-Hokmabadi, Mehdi Farhoudi, Aliakbar Taheraghdam, Mazyar Hashemilar, Daryous Savadi-Osguei, Reza Rikhtegar, Kaveh Mehrvar, Ehsan Sharifipour, Parisa Youhanaee, Reshad Mirnour
BACKGROUND: In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. METHODS: In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded...
2016: International Journal of General Medicine
https://www.readbyqxmd.com/read/27818831/safety-and-efficacy-of-acute-clopidogrel-load-in-patients-with-moderate-and-severe-ischemic-strokes
#5
Amir Shaban, Dominique J Monlezun, Natalia Rincon, Jonathan Tiu, Melisa Valmoria, Sheryl Martin-Schild
Objective. To study the safety and efficacy of a clopidogrel loading dose in patients with moderate and severe acute ischemic strokes. Background. The safety of clopidogrel loading has been extensively investigated in patients with minor strokes and transient ischemic attacks. Methods. Acute ischemic stroke patients presenting consecutively to our center from 07/01/08 to 07/31/13 were screened. Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin) given within 6 hours of admission...
2016: Stroke Research and Treatment
https://www.readbyqxmd.com/read/27803392/selecting-patients-for-intra-arterial-therapy-in-the-context-of-a-clinical-trial-for-neuroprotection
#6
Patrick Lyden, Sara Weymer, Chris Coffey, Merit Cudkowicz, Samantha Berg, Sarah O'Brien, Marc Fisher, E Clarke Haley, Pooja Khatri, Jeff Saver, Steven Levine, Howard Levy, Marilyn Rymer, Lawrence Wechsler, Ashutosh Jadhav, Elizabeth McNeil, Salina Waddy, Kent Pryor
BACKGROUND AND PURPOSE: The advent of intra-arterial neurothrombectomy (IAT) for acute ischemic stroke opens a potentially transformative opportunity to improve neuroprotection studies. Combining a putative neuroprotectant with recanalization could produce more powerful trials but could introduce heterogeneity and adverse event possibilities. We sought to demonstrate feasibility of IAT in neuroprotectant trials by defining IAT selection criteria for an ongoing neuroprotectant clinical trial...
December 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27801765/should-we-treat-a-patient-s-symptoms-or-angiography-image-in-tia-two-case-reports
#7
Hana Karpatová, Jana Jankových, Robert Mikulík
OBJECTIVES: Data on vascular status in the first hours after onset of transient ischemic attack (TIA) and its clinical significance are missing. Also, it is not known whether arterial occlusion, if present in TIA, should be the target for revascularization. We present 2 patients to demonstrate that TIA can be due to acute major intracranial arterial occlusion and to show how such arterial occlusion may affect the outcome. CASE REPORTS: Two patients (54 and 63 years old) were diagnosed with TIA and at the same time had occlusion of the middle cerebral artery...
November 2016: Neurologist
https://www.readbyqxmd.com/read/27789787/initial-experience-with-sofia-as-an-intermediate-catheter-in-mechanical-thrombectomy-for-acute-ischemic-stroke
#8
Johnny H Y Wong, Huy M Do, Nicholas A Telischak, Adrienne M Moraff, Robert L Dodd, Michael P Marks, Shreya M Ingle, Jeremy J Heit
BACKGROUND: The benefits of mechanical thrombectomy for emergent large vessel occlusion (ELVO) have been established. Combined mechanical/aspiration (Solumbra) and a direct aspiration as a first pass technique (ADAPT) are valid procedures requiring an intermediate catheter for clot suction. Recently, SOFIA (Soft torqueable catheter Optimized For Intracranial Access) was developed as a single lumen flexible catheter with coil and braid reinforcement, but its suitability for mechanical thrombectomy had not been evaluated...
October 27, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27771196/fluid-attenuated-inversion-recovery-hyperintensity-is-associated-with-hemorrhagic-transformation-following-reperfusion-therapy
#9
Sung-Ho Ahn, Bum Joon Kim, Yeon-Jung Kim, Sun U Kwon, Jong S Kim, Dong-Wha Kang
BACKGROUND: It is still controversial whether early fluid-attenuated inversion recovery (FLAIR) hyperintensity within acute ischemic lesions carries the risk of hemorrhagic transformation (HT) after reperfusion therapy. Furthermore, the association between the location of FLAIR hyperintensity and HT has not been investigated. METHODS: We retrospectively reviewed patients who underwent reperfusion therapy within 6 hours of stroke onset and magnetic resonance imaging including a FLAIR sequence before completing reperfusion therapy...
October 19, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27758944/combination-of-thrombolysis-and-statins-in-acute-stroke-is-safe-results-of-the-stars-randomized-trial-stroke-treatment-with-acute-reperfusion-and-simvastatin
#10
Joan Montaner, Alejandro Bustamante, Silvia García-Matas, Maite Martínez-Zabaleta, Carmen Jiménez, Javier de la Torre, Francisco R Rubio, Tomás Segura, Jaime Masjuán, David Cánovas, Mar Freijo, Raquel Delgado-Mederos, Javier Tejada, Aida Lago, Yolanda Bravo, Natália Corbeto, Dolors Giralt, Bárbara Vives-Pastor, Anna de Arce, Francisco Moniche, Pilar Delgado, Marc Ribó
BACKGROUND AND PURPOSE: The STARS trial (Stroke Treatment With Acute Reperfusion and Simvastatin) was conducted to demonstrate the efficacy and safety of simvastatin treatment in acute stroke. METHODS: STARS07 was a multicentre, phase IV, prospective, randomized, double-blind, placebo-controlled trial. Patients with Acute ischemic stroke recruited within 12 hours from symptom onset were randomized to oral simvastatin 40 mg or placebo, once daily for 90 days. Primary outcome was proportion of independent patients (modified Rankin Scale score of ≤2) at 90 days...
November 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27740982/imaging-of-ischemic-stroke
#11
Michelle P Lin, David S Liebeskind
PURPOSE OF REVIEW: This article provides an overview of cerebrovascular hemodynamics, acute stroke pathophysiology, and collateral circulation, which are pivotal in the modern imaging of ischemic stroke that guides the care of the patient with stroke. RECENT FINDINGS: Neuroimaging provides extensive information on the brain and vascular health. Multimodal CT and MRI delineate the hemodynamics of ischemic stroke that may be used to guide treatment decisions and prognosticate regarding expected outcomes...
October 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27699498/thrombolysis-in-dementia-patients-with-acute-stroke-is-it-justified
#12
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...
October 3, 2016: Neurological Sciences
https://www.readbyqxmd.com/read/27677185/lipoic-acid-use-and-functional-outcomes-after-thrombolysis-in-patients-with-acute-ischemic-stroke-and-diabetes
#13
Kang-Ho Choi, Man-Seok Park, Joon-Tae Kim, Hyung-Seok Kim, Ja-Hae Kim, Tai-Seung Nam, Seong-Min Choi, Seung-Han Lee, Byeong-Chae Kim, Myeong-Kyu Kim, Ki-Hyun Cho
BACKGROUND: Alpha-lipoic acid (aLA) is a strong antioxidant commonly used for treating diabetic polyneuropathy. Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on patients with stroke remain unknown. We investigated whether patients treated with aLA have better functional outcomes after acute ischemic stroke (AIS) and reperfusion therapy than patients not receiving aLA. METHODS: In this retrospective study of 172 prospectively registered patients with diabetes and AIS treated with tissue plasminogen activator (tPA), we investigated the relationship between aLA use and functional outcome both after 3 months and after 1 year...
2016: PloS One
https://www.readbyqxmd.com/read/27673305/time-to-treatment-with-endovascular-thrombectomy-and-outcomes-from-ischemic-stroke-a-meta-analysis
#14
Jeffrey L Saver, Mayank Goyal, Aad van der Lugt, Bijoy K Menon, Charles B L M Majoie, Diederik W Dippel, Bruce C Campbell, Raul G Nogueira, Andrew M Demchuk, Alejandro Tomasello, Pere Cardona, Thomas G Devlin, Donald F Frei, Richard du Mesnil de Rochemont, Olvert A Berkhemer, Tudor G Jovin, Adnan H Siddiqui, Wim H van Zwam, Stephen M Davis, Carlos Castaño, Biggya L Sapkota, Puck S Fransen, Carlos Molina, Robert J van Oostenbrugge, Ángel Chamorro, Hester Lingsma, Frank L Silver, Geoffrey A Donnan, Ashfaq Shuaib, Scott Brown, Bruce Stouch, Peter J Mitchell, Antoni Davalos, Yvo B W E M Roos, Michael D Hill
IMPORTANCE: Endovascular thrombectomy with second-generation devices is beneficial for patients with ischemic stroke due to intracranial large-vessel occlusions. Delineation of the association of treatment time with outcomes would help to guide implementation. OBJECTIVE: To characterize the period in which endovascular thrombectomy is associated with benefit, and the extent to which treatment delay is related to functional outcomes, mortality, and symptomatic intracranial hemorrhage...
September 27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27639588/plasma-immunoproteasome-predicts-early-hemorrhagic-transformation-in-acute-ischemic-stroke-patients
#15
Xingyong Chen, Yinzhou Wang, Ming Fu, Huixin Lei, Qiong Cheng, Xu Zhang
BACKGROUND AND PURPOSE: Currently, blood biomarkers associated with an increased hemorrhagic transformation (HT) risk remain uncertain. We aimed to determine the significance of immunoproteasome as predictors of early HT in acute ischemic stroke patients. METHODS: This study enrolled 316 patients with ischemic stroke. HT was assessed by computed tomography examination performed on day 5 ± 2 after stroke onset or immediately in case of clinical deterioration (CD)...
September 14, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27611108/immediate-versus-delayed-treatment-for-recently-symptomatic-carotid-artery-stenosis
#16
Vladimir Vasconcelos, Nicolle Cassola, Edina Mk da Silva, Jose Cc Baptista-Silva
BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis...
September 9, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27586690/secondary-prevention-in-non-valvular-atrial-fibrillation-patients-a-practical-approach-with-edoxaban
#17
Jaime Masjuan, Alicia DeFelipe
Patients with atrial fibrillation and prior stroke or transient ischemic attack exhibit a very high risk of recurrence. Secondary prevention with oral anticoagulants is mandatory. Overall, clinical guidelines recommend the use of target-specific oral anticoagulants over vitamin K antagonists for secondary prevention of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation and previous stroke are not receiving the appropriate antithrombotic treatment, perhaps due to the perceived risks of anticoagulation including the risk of hemorrhagic transformation of an ischemic stroke...
September 20, 2016: International Journal of Neuroscience
https://www.readbyqxmd.com/read/27566245/the-glucagon-like-peptide-1-receptor-agonist-exendin-4-ameliorates-warfarin-associated-hemorrhagic-transformation-after-cerebral-ischemia
#18
Fangzhe Chen, Weifeng Wang, Hongyan Ding, Qi Yang, Qiang Dong, Mei Cui
BACKGROUND: As the number of patients with cardioembolic ischemic stroke is predicted to be double by 2030, increased burden of warfarin-associated hemorrhagic transformation (HT) after cerebral ischemia is an expected consequence. However, thus far, no effective treatment strategy is available for HT prevention in routine clinical practice. While the glucagon-like peptide-1 receptor (GLP-1R) agonist exendin-4 (Ex-4) is known to protect against oxidative stress and neuronal cell death caused by ischemic brain damage, its effect on preventing warfarin-associated HT after cerebral ischemia is yet unknown...
2016: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/27562122/the-impact-of-intravenous-thrombolysis-on-outcome-of-patients-with-acute-ischemic-stroke-after-90%C3%A2-years-old
#19
S Sagnier, P Galli, M Poli, S Debruxelles, P Renou, S Olindo, F Rouanet, I Sibon
BACKGROUND: Age increases the risk of mortality and poor prognosis following stroke. The benefit of intravenous thrombolysis in very old patients remains uncertain. The purpose of the study was to evaluate the efficacy and safety of thrombolysis in very old patients considering their perfusion-imaging profile. METHODS: We conducted a retrospective study including patients older than 90 y.o. admitted for an acute ischemic stroke. A computed tomography perfusion-imaging (CTP) was performed in patients who received thrombolysis...
2016: BMC Geriatrics
https://www.readbyqxmd.com/read/27561990/dynamic-change-of-neutrophil-to-lymphocyte-ratio-and-hemorrhagic-transformation-after-thrombolysis-in-stroke
#20
Zhiliang Guo, Shuhong Yu, Lulu Xiao, Xin Chen, Ruidong Ye, Ping Zheng, Qiliang Dai, Wen Sun, Changsheng Zhou, Shuiping Wang, Wusheng Zhu, Xinfeng Liu
BACKGROUND: The neutrophil to lymphocyte ratio (NLR) has been shown to predict short- and long-term outcomes in ischemic stroke patients. We sought to explore the temporal profile of the plasma NLR in stroke patients treated with intravenous thrombolysis (IVT) and its relationship with intracranial bleeding complications after thrombolysis. METHODS: A total of 189 ischemic stroke patients were prospectively enrolled. Blood samples for leukocyte, neutrophil, and lymphocyte counts were obtained at admission and at 3-6, 12-18, and 36-48 h after IVT...
2016: Journal of Neuroinflammation
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