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Intravenous thrombolysis

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https://www.readbyqxmd.com/read/28527588/mechanical-thrombectomy-for-acute-ischemic-stroke-in-a-patient-with-concomitant-spontaneous-intracerebral-hemorrhage
#1
Stefano Forlivesi, Paolo Bovi, Manuel Cappellari
Data from randomized clinical trials and current guidelines suggest that patients with anterior circulation occlusion with contraindications to intravenous thrombolysis may benefit from direct mechanical thrombectomy. Nevertheless, no data are available on the efficacy and safety of direct mechanical thrombectomy in patients with concomitant spontaneous intracerebral hemorrhage. We report the case of a 51-year-old woman with a spontaneous intracerebral hemorrhage in the right parietal and occipital lobes, who experienced, 7 days later, an occlusion of the proximal left middle cerebral artery...
May 17, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28522232/efficacy-of-new-measures-saving-time-in-acute-stroke-management-a-quantified-analysis
#2
Ana María Iglesias Mohedano, Andrés García Pastor, Fernando Díaz Otero, Pilar Vázquez Alen, Marta Vales Montero, Elisa Luque Buzo, Nuria Redondo Ráfales, Beatriz Chavarria Cano, Yolanda Fernández Bullido, Jose Antonio Villanueva Osorio, Antonio Gil Núñez
BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014...
May 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28513116/worse-outcome-in-patients-with-acute-stroke-and-atrial-fibrillation-following-thrombolysis
#3
Michael Findler, Jeremy Molad, Natan M Bornstein, Eitan Auriel
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and a common cause of ischemic stroke. Stroke patients with AF have been shown to have a poorer neurological outcome than stroke patients without AF. OBJECTIVES: To determine the impact of pre-existing AF on residual degree of disability in patients treated with IV thrombolysis. METHODS: In this case-control study, data of 214 stroke patients (63 with AF and 151 without AF) were collected from the National Acute Stroke Israeli Registry, a nationwide quadrennial stroke database...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28504557/carotid-angioplasty-assisted-mechanical-thrombectomy-without-urgent-stenting-may-be-a-better-option-in-acute-tandem-occlusions
#4
Cetin K Akpinar, Erdem Gürkaş, Emrah Aytac
Background The aim of the study was to assess the efficacy of balloon angioplasty-assisted mechanical thrombectomy without urgent stenting in the carotid artery as another approach for endovascular treatment of tandem occlusions. Methods Fifteen consecutive cases of tandem occlusions treated with the endovascular approach between January 2014 and May 2016 were reviewed. The study cohort included patients with an etiology of large vessel atherosclerosis. Extracranial carotid stenting was performed in another session if post-thrombectomy mRS modified Rankin Score (mRS) was 0-2...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28496428/effect-of-cyclosporine-on-lesion-growth-and-infarct-size-within-the-white-and-gray-matter
#5
Elodie Ong, Nathan Mewton, Julien Bouvier, Fabien Chauveau, Thomas Ritzenthaler, Laura Mechtouff, Laurent Derex, Marielle Buisson, Yves Berthezène, Michel Ovize, Norbert Nighoghossian, Tae-Hee Cho
BACKGROUND: In a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis. MATERIALS AND METHODS: We analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28493511/direct-endovascular-treatment-an-alternative-for-bridging-therapy-in-anterior-circulation-large-vessel-occlusion-stroke
#6
H Wang, W Zi, Y Hao, D Yang, Z Shi, M Lin, S Wang, W Liu, Z Wang, X Liu, F Guo, Y Liu, G Xu, Y Xiong, X Liu
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation large-vessel occlusion (LVO) is indispensable remains unclear. The aim was to retrospectively compare, in a Chinese population, the effectiveness and safety of direct endovascular treatment (DEVT) initiated within 4.5 h after onset with bridging therapy in acute anterior circulation LVO stroke patients. METHODS: A total of 363 patients, 160 in the bridging therapy group and 203 in the DEVT group, were enrolled between 2014 and 2016...
May 11, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28490161/endovascular-stroke-therapy-focused-on-stent-retriever-thrombectomy-and-direct-clot-aspiration-historical-review-and-modern-application
#7
REVIEW
Dong-Hun Kang, Jaechan Park
Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays...
May 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28488565/evaluation-of-parametric-response-mapping-to-assess-therapeutic-response-to-human-mesenchymal-stem-cells-after-experimental-stroke
#8
Rui He, Anaïck Moisan, Olivier Detante, Chantal Rémy, Alexandre Krainik, Emmanuel Luc Barbier, Benjamin Lemasson
Stroke is the leading cause of disability in adults. After the very narrow time frame during which treatment by thrombolysis and mechanical thrombectomy is possible, cell therapy has huge potential for enhancing stroke recovery. Accurate analysis of the response to new therapy, using imaging biomarkers, is needed to assess therapeutic efficacy. The aim of this study is to compare two analysis techniques: the parametric response map (PRM), a voxel-based technique, and the standard whole-lesion approach. These two analyses were performed on data collected at 4 time points in a transient middle cerebral artery occlusion (MCAo) model, which was treated with human mesenchymal stem cell (hMSC) therapy...
May 9, 2017: Cell Transplantation
https://www.readbyqxmd.com/read/28485795/correlation-study-between-interleukin-6-levels-and-coronary-reflow
#9
F-M Guo, X-H Han, Y-Y Guo, D-M Zhang, F-J Tang, L Zhao, L-L Ji, W-B Liu
OBJECTIVE: To analyze the correlation between local interleukin-6 (IL-6) levels in different parts of blood vessel and the record of Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) after myocardial ischemia-reperfusion (IR) model. MATERIALS AND METHODS: Establishment of IR model in Yorkshire pigs, the pigs were divided into two groups (n=6). Experiment group pigs were administrated with Shenfu injection (SF) intravenously (1 mL/kg), control group was given saline injection...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28485794/effects-of-tumor-necrosis-factor-and-e-selectin-on-coronary-artery-flow
#10
W-B Liu, X-H Han, Y-Y Guo, D-M Zhang, F-J Tang, L Zhao, L-L Ji, F-M Guo
OBJECTIVE: The aim of the study is to investigate the correlation between tumor necrosis factor (TNF-α), E-selectin and coronary artery flow following myocardial ischemia-reperfusion model (IR) in Yorkshire pigs. MATERIALS AND METHODS: Establishment of IR model in pigs. Following the injury model, Experiment group was administrated intravenously Shenfu injection solution (SFI, 1 mL/kg). The control group received the same amount of saline. After 30 min of blood reflux, thrombolysis in myocardial infarction frame count (TFC) was recorded following surgery...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28484930/heart-shaped-bilateral-medullary-pyramidal-infarction-as-a-pathognomonic-finding-of-anterior-spinal-artery-occlusion
#11
Sammy Searcy, Oluwaseun O Akinduro, Andrew Spector, Jang W Yoon, Benjamin L Brown, William D Freeman
BACKGROUND: Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction. METHODS: Case reports and literature review. RESULTS: A 57-year-old man rapidly had severe vomiting and diarrhea 2 h after a meal. Examination revealed bulbar weakness and areflexic tetraplegia...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28480034/co-administration-of-tissue-plasminogen-activator-and-hyperbaric-oxygen-in-ischemic-stroke-a-continued-promise-for-neuroprotection
#12
REVIEW
Ze-Song Yang, Jun Mu
Intravenous recombinant tissue-type plasminogen activator (r-tPA, alteplase) remains the recommended therapy for acute ischemic stroke. However, several factors are limiting its practical use. It makes it urgent for us to search more efficient strategies that can save the ischemic neurons, and safely extend the time window, while in the mean time reducing the detrimental effects for stroke thrombolysis. Hyperbaric oxygen therapy (HBOT) is considered to be potentially neuroprotective. Co-administration of r-tPA and HBOT has already been proved to be effective, safe and feasible in myocardial infarction...
January 2017: Medical Gas Research
https://www.readbyqxmd.com/read/28479799/advanced-age-and-higher-national-institutes-of-health-stroke-scale-score-as-predictors-of-poor-outcome-in-ischemic-stroke-patients-treated-with-alteplase-a-study-from-a-tertiary-care-centre-in-rural-north-west-india
#13
Amit Bhardwaj, Girish Sharma, Sunil Kumar Raina, Ashish Sharma, Monica Angra
INTRODUCTION: Thrombolytic therapy in acute ischemic stroke has been approved for treatment of acute stroke for past two decades. However, identification of predictors of poor outcome after the intravenous (IV) alteplase therapy in acute stroke patients is a matter of research. The present study was conducted with the aim of identifying poor prognostic factors in patients of acute ischemic stroke patients. METHODS: The data of 31 acute stroke patients treated with alteplase were gathered to identify the factors that were independent predictors of the poor outcome...
April 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28479465/safety-of-early-carotid-endarterectomy-after-intravenous-thrombolysis-in-acute-ischemic-stroke
#14
Igor Gunka, Dagmar Krajickova, Michal Lesko, Ondrej Renc, Jan Raupach, Stanislav Jiska, Miroslav Lojik, Vendelin Chovanec, Radovan Maly
BACKGROUND: The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. MATERIAL AND METHODS: A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28478979/risk-factors-and-stroke-characteristic-in-patients-with-postoperative-strokes
#15
Yi Dong, Wenjie Cao, Xin Cheng, Kun Fang, Xiaolong Zhang, Yuxiang Gu, Bing Leng, Qiang Dong
BACKGROUND: Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes...
May 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28471898/early-neurological-deterioration-during-alteplase-infusion-for-acute-ischemic-stroke-an-uncommon-complication-of-intravenous-thrombolysis
#16
Apostolos Safouris, Odysseas Kargiotis, Georgios Magoufis, Aristeidis H Katsanos, Eleftherios Stamboulis, Georgios Tsivgoulis
INTRODUCTION: Recognizing new-territory ischemic stroke as an uncommon complication of intravenous thrombolysis is very important as it can lead to neurological deterioration during tissue-plasminogen-activator infusion. CASE REPORT: We report a case of an 80-year-old patient that has been treated with intravenous thrombolysis for right middle cerebral artery acute ischemic stroke. During infusion he had an abrupt neurological deterioration that proved to be a distal embolization of an asymptomatic non-occluding tip-of-the-basilar thrombus to the territory of left posterior cerebral artery that has been missed by the treating neurologist and radiologist in the pretreatment computed tomography angiography...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28471897/thrombolyic-and-vasodilator-treatment-in-a-patient-with-prolonged-retinal-ischemia
#17
Sri Raghav Sista, John H Pula, Deepak Reddy, Chris Abdo, Sarah Parker, Mark A Getz, Jorge C Kattah
Vasospastic transient monocular vision loss associated with systemic lupus erythematosus and antiphospholipid syndrome is typically short lasting and responsive to vasodilators. Virchow's triad of endothelial dysfunction, arterial stasis, and a hypercoagulable state are factors in systemic lupus erythematosus/antiphospholipid syndrome that may potentially contribute to prolonged retinal hypoperfusion and central retinal artery occlusion. Consequently, rapid intervention to address all components of Virchow's triad may increase the probability of a good outcome...
May 2017: Neurologist
https://www.readbyqxmd.com/read/28460493/simple-estimates-of-symptomatic-intracranial-hemorrhage-risk-and-outcome-after-intravenous-thrombolysis-using-age-and-stroke-severity
#18
Hye Jung Lee, Ji Sung Lee, Jay Chol Choi, Yong-Jin Cho, Beom Joon Kim, Hee-Joon Bae, Dong-Eog Kim, Wi-Sun Ryu, Jae-Kwan Cha, Dae Hyun Kim, Hyun-Wook Nah, Kang-Ho Choi, Joon-Tae Kim, Man-Seok Park, Jeong-Ho Hong, Sung Il Sohn, Kyusik Kang, Jong-Moo Park, Wook-Joo Kim, Jun Lee, Dong-Ick Shin, Min-Ju Yeo, Kyung Bok Lee, Jae Guk Kim, Soo Joo Lee, Byung-Chul Lee, Mi Sun Oh, Kyung-Ho Yu, Tai Hwan Park, Juneyoung Lee, Keun-Sik Hong
No abstract text is available yet for this article.
May 2, 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28457790/initial-assessment-and-triage-of-the-stroke-patient
#19
Richard M Zweifler
Nearly 800,000 strokes occur in the United States each year, and stroke is the leading cause of preventable permanent disability. Timely recognition and treatment are imperative to reduce stroke-related morbidity and mortality. Given the evidence supporting intravenous thrombolysis and mechanical thrombectomy for ischemic stroke, stroke symptoms must be rapidly identified and mimics quickly excluded prior to therapeutic decisions. Intravenous tissue plasminogen activator is recommended for all qualified patients and patients with presentations suggesting large vessel occlusion should be evaluated for mechanical thrombectomy...
April 27, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28454980/are-the-results-of-intravenous-thrombolysis-trials-reproduced-in-clinical-practice-comparison-of-observed-and-expected-outcomes-with-the-stroke-thrombolytic-predictive-instrument-stpi
#20
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...
April 25, 2017: Revue Neurologique
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