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Intravenous thrombolysis

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https://www.readbyqxmd.com/read/29146830/mechanical-thrombectomy-performs-similarly-in-real-world-practice-a-2016-nationwide-study-from-the-czech-republic
#1
Ondrej Volny, Antonin Krajina, Silvie Belaskova, Michal Bar, Petra Cimflova, Roman Herzig, Daniel Sanak, Ales Tomek, Martin Köcher, Miloslav Rocek, Radek Padr, Filip Cihlar, Miroslava Nevsimalova, Lubomir Jurak, Roman Havlicek, Martin Kovar, Petr Sevcik, Vladimir Rohan, Jan Fiksa, Bijoy K Menon, Robert Mikulik
BACKGROUND: Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis. METHODS: Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke-Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES...
November 16, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29146829/is-bridging-therapy-still-required-in-stroke-due-to-carotid-artery-terminus-occlusions
#2
Romain Bourcier, Pierre-Louis Alexandre, François Eugène, Béatrice Delasalle-Guyomarch, Benoit Guillon, Basile Kerleroux, Suzana Saleme, Gaultier Marnat, Samy Boucebci, Mahmood Mirza, Jean-Christophe Ferré, Chrysanthi Papagiannaki, Hubert Desal
INTRODUCTION: Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. OBJECTIVE: To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT)...
November 16, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29144166/imaging-assessment-of-acute-ischaemic-stroke-a-review-of-radiological-methods
#3
Aubrey Smith, Chris Rowland Hill
Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that maybe harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain...
November 16, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29137061/low-free-triiodothyronine-levels-predict-symptomatic-intracranial-hemorrhage-and-worse-short-term-outcome-of-thrombolysis-in-patients-with-acute-ischemia-stroke
#4
Mingjing Qiu, Min Fang, Xueyuan Liu
The aim of the study was to determine whether thyroid hormones level on admission in patients with ischemic stroke, treated with intravenous recombinant tissue type plasminogen activator (rtPA), was associated with symptomatic intracranial hemorrhage (sICH) and worse outcomes at 3 months.Patients with acute ischemic stroke (AIS) receiving intravenous rtPA thrombolytic treatment on our stroke unit between January 2015 and June 2016 were included in this study. Serum-free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (tT3), total thyroxine (tT4), and thyroid-stimulating hormone (TSH) were detected on admission...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29136121/mechanical-thrombectomy-for-acute-ischemic-stroke-secondary-to-infective-endocarditis
#5
Juan Ambrosioni, Xabier Urra, Marta Hernández-Meneses, Manel Almela, Carlos Falces, Adrian Tellez, Eduard Quintana, David Fuster, Elena Sandoval, Barbara Vidal, Jose M Tolosana, Asunción Moreno, Angel Chamorro, José M Miró
Intravenous thrombolysis is contraindicated in acute ischemic stroke secondary to infective endocarditis. We report our initial experience of six cases with proximal vessel occlusion treated with mechanical thrombectomy. It was safe (no bleeding) and effective (significant, early neurological improvement) and might therefore be useful in this clinical setting.
November 9, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29132407/frequency-and-determinants-for-hemorrhagic-transformation-of-posterior-cerebral-stroke-posterior-ischemic-stroke-and-hemorrhagic-transformation
#6
Francesca Valentino, Luana Gentile, Valeria Terruso, Sergio Mastrilli, Paolo Aridon, Paolo Ragonese, Caterina Sarno, Giovanni Savettieri, Marco D'Amelio
BACKGROUND: hemorrhagic transformation is a threatening ischemic stroke complication. Frequency of hemorrhagic transformation differs greatly among studies, and its risk factors have been usually studied in patients with anterior ischemic stroke who received thrombolytic therapy. We evaluated, in a hospital-based series of patients with posterior ischemic stroke not treated with thrombolysis, frequency and risk factors of hemorrhagic transformation. Patients with posterior circulation stroke were seen in our Department during the period January 2004 to December 2009...
November 13, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29128152/intravenous-thrombolytic-therapy-for-acute-anterior-ischemic-stroke-experience-at-the-french-military-teaching-hospital-in-toulon-from-2003-to-2014
#7
P Sahuc-Rodrigues, E Sagui, D Wybrecht, J-B Veyrières, S Gazzola, A Dagain, J Valance, P Alla, A Faivre
INTRODUCTION: Intravenous thrombolysis with rt-PA is the key treatment for acute ischemic stroke (IS), and has largely been developed at the Military Teaching Hospital in Toulon since 2003. This report is of the results of our practices compared with those in the literature, as well as our attempts to identify factors predictive of a favorable outcome after thrombolysis. METHODS: All patients treated with rt-PA for IS in the carotid territory between 2003 and 2014 were prospectively included...
November 8, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/29125072/predictors-of-dependence-after-mca-ischemic-stroke-submitted-to-thrombolysis
#8
Renata Dal-Prá Ducci, Marcos Christiano Lange, Francisco Manoel Branco Germiniani, Viviane de Hiroki Flumignan Zétola
OBJECTIVES: Stroke is one of the most common causes of disability-adjusted life years worldwide. The aim of this study is to identify variables associated with dependence at 3 months and also after the first 3 months after the first-ever ischemic stroke (IS) in middle cerebral artery (MCA) territory submitted to intravenous thrombolysis (IVT). METHODS: A single-center cohort study of patients with first-ever MCA IS treated with IVT at the Hospital de Clínicas, Universidade Federal do Paraná, was followed over 5 years...
November 10, 2017: Neurological Research
https://www.readbyqxmd.com/read/29120918/tissue-is-more-important-than-time-insights-into-acute-ischemic-stroke-from-modern-brain-imaging
#9
Andrew Bivard, Mark Parsons
PURPOSE OF REVIEW: The clinical practice of acute ischemic stroke treatment has undergone a major change over the last 5 years, as multimodal imaging becomes more accessible, and evidence mounts that individualized treatment is possible. Multimodal imaging performed before treatment provides invaluable information to treating clinicians, which includes confirmation of the diagnosis, and provides guidance on the appropriateness and the likely outcome of intravenous or endovascular treatment for individual patients (and their families)...
November 7, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29118803/multimodal-therapy-for-non-superacute-vertebral-basilar-artery-occlusion
#10
Xiongjun He, Liang Zhang, Juan Yang, Hui Zheng, Kaifeng Li, Yajie Liu
Objective: The aim of this study was to evaluate the feasibility and safety of multimodal therapy for patients with non-superacute vertebral basilar artery occlusion. Method: We performed a retrospective analysis of multimodal therapy for patients with vertebral basilar artery occlusion. All patients who were beyond the time window to receive intravenous thrombolysis and who had deterioration of symptoms after drug treatment received small-balloon dilatation of the occlusive artery to estimate vascular occlusion aetiology...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118798/internal-carotid-artery-and-the-proximal-m1-segment-are-optimal-targets-for-mechanical-thrombectomy
#11
Niko Sillanpää, Sara Protto, Jukka T Saarinen, Juha-Pekka Pienimäki, Janne Seppänen, Heikki Numminen, Harri Rusanen
Background and Purpose: Mechanical thrombectomy (MT) is an established treatment of acute anterior circulation stroke caused by large vessel occlusion (LVO). We compared the clinical outcome (3-month modified Rankin Scale, mRS) in hyperacute (<3h from the onset of symptoms) ischemic stroke between an MT and an intravenous thrombolysis (IVT) cohort in proximal (ICA and the proximal M1 segment of the middle cerebral artery) and distal (the distal M1 and the M2 segment) LVOs. Methods: We prospectively reviewed 67 patients who underwent MT with newer-generation stent retrievers...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29116545/intravenous-thrombolysis-in-sle-related-stroke-a-case-report-and-literature-review
#12
Xiaodong Chen, Gelin Xu
Patients with systemic lupus erythematosus (SLE) bear an increased risk of ischemic stroke. However, evidences for treating acute stroke due to artery thrombosis in SLE patients are extremely limited. A 45-year-old woman experienced sudden left hemiplegia. She was transported to the emergency department of our hospital 2 hours after the initial symptom. According to the medical records, the patient was diagnosed with SLE at the age of 28. CT scanned 150 min after the initial symptom showed no evidence of acute changes or hemorrhage...
November 7, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/29115734/more-extensive-white-matter-hyperintensity-is-linked-with-higher-risk-of-remote-intracerebral-hemorrhage-after-intravenous-thrombolysis
#13
Yi Chen, Shenqiang Yan, Mengjun Xu, Genlong Zhong, David S Liebeskind, Min Lou
BACKGROUND AND PURPOSES: Remote intracerebral hemorrhage (rICH) is infrequent after intravenous thrombolysis (IVT) and its mechanism remains poorly understood. We aim to assess its frequency and possible relationship with the severity of white matter hyperintensity (WMH) in acute ischemic stroke (AIS) patients. METHODS: We prospectively analyzed data from consecutive AIS patients with MRI and IVT. WMH volume was quantitatively measured. rICH was defined as intracranial hemorrhage that appears in brain regions without visible ischemic changes on 24h follow-up imaging...
November 8, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29114975/real-world-evidence-for-off-label-intravenous-thrombolysis-in-acute-ischemic-stroke
#14
Georgios Tsivgoulis, Vasileios-Arsenios Lioutas
The most feared complication of intravenous tissue-plasminogen-activator (tPA) delivery in patients with acute ischemic stroke (AIS) is symptomatic intracerebral hemorrhage (sICH) which has been the driver behind most of the exclusion criteria in all randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of intravenous thrombolysis (IVT) for AIS(1) . This article is protected by copyright. All rights reserved.
November 8, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29114095/direct-mechanical-intervention-versus-bridging-therapy-in-stroke-patients-eligible-for-intravenous-thrombolysis-a-pooled-analysis-of-2-registries
#15
Sebastian Bellwald, Ralph Weber, Tomas Dobrocky, Hannes Nordmeyer, Simon Jung, Jeffrie Hadisurya, Pasquale Mordasini, Marie-Luise Mono, Christian P Stracke, Hakan Sarikaya, Corrado Bernasconi, Klaus Berger, Marcel Arnold, René Chapot, Jan Gralla, Urs Fischer
BACKGROUND AND PURPOSE: Randomized controlled trials have shown that mechanical thrombectomy (MT) plus best medical treatment improves outcome in stroke patients with large-vessel occlusion in the anterior circulation. Whether direct MT is equally effective as bridging thrombolysis (intravenous thrombolysis plus MT) in intravenous thrombolysis eligible patients remains unclear. METHODS: We compared clinical and radiological outcomes at 3 months in 249 bridging patients with 111 patients receiving direct MT for large-vessel occlusion anterior circulation stroke from 2 prospective registries (study period Essen: June 2012 to August 2013, Bern February 2009 to August 2014)...
November 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29111341/low-dose-tissue-plasminogen-activator-in-acute-ischemic-stroke-a-systematic-review-and-meta-analysis
#16
Ji-Wei Cheng, Xiao-Jing Zhang, Li-Shan Cheng, Guo-Yi Li, Li-Jun Zhang, Kang-Xiang Ji, Qing Zhao, Yu Bai
BACKGROUND: Intravenous thrombolysis using tissue plasminogen activator (tPA) improves significantly the neurologic function in patients with acute ischemic stroke (AIS). However, it brings financial burden to patients and is associated with symptomatic intracranial hemorrhage (SICH). Whether low-dose tPA can effectively reduce SICH and has the same efficacy as standard-dose tPA is still controversial. METHODS: We searched for English clinical trials published before March, 2017on the comparison of the efficacy and safety between low and standard dose of tPA in the treatment of AIS using MEDLINE, Embase, and Cochrane Library...
October 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29107635/predictors-of-need-for-critical-care-support-adverse-events-and-outcome-after-stroke-thrombolysis
#17
Panagiotis Papamichalis, Spyridon Karagiannis, Efthimios Dardiotis, Achilleas Chovas, Dimitrios Papadopoulos, Tilemachos Zafeiridis, Dimitris Babalis, Georgios Paraforos, Vasiliki Zisopoulou, Apostolia-Lemonia Skoura, Ioannis Staikos, Konstantinos Bouliaris, Michail Papamichalis, Georgios Hadjigeorgiou, Apostolos Komnos
BACKGROUND: Results from trials and international registries exhibit heterogeneity regarding safety, efficacy, markers of prognosis, and markers of the need for critical care support after intravenous thrombolysis (IVT) for strokes. The purpose of our study was to indentify such markers after performance of comparisons among patients who received thrombolysis in our intensive care unit. MATERIALS AND METHODS: Our study included 124 patients who received IVT in accordance with international criteria...
October 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29106687/aspects-large-vessel-occlusion-and-time-of-symptom-onset-estimation-of-eligibility-for-endovascular-therapy
#18
Maxim Mokin, Aparna Pendurthi, Vladimir Ljubimov, William S Burgin, Adnan H Siddiqui, Elad I Levy, Christopher T Primiani
BACKGROUND: Understanding how many patients are eligible for endovascular therapy can help develop more effective stroke systems of care. OBJECTIVE: To determine the proportion of patients eligible for endovascular therapy. METHODS: In this single center retrospective cohort study, we identified patients with acute ischemic stroke from large vessel occlusion (LVO) from January 2014 to December 2015. Selection criteria including LVO location, Alberta stroke program early computed tomography score (ASPECTS) range, hospital arrival time, and the use of intravenous thrombolysis were applied to calculate proportions of patients eligible for endovascular therapy...
July 6, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29105904/predictors-of-symptomatic-intracranial-hemorrhage-in-off-label-thrombolysis-an-analysis-of-the-sits-registry
#19
Sibu Mundiyanapurath, Katharina Hees, Niaz Ahmed, Nils Wahlgren, Lorenz Uhlmann, Meinhard Kieser, Peter Arthur Ringleb, Werner Hacke, Simon Nagel
BACKGROUND: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke. Off-label intravenous thrombolysis for ischemic stroke is common. We aimed to analyse its safety in a large database. METHODS: Retrospective analysis of the SITS thrombolysis registry regarding 11 off-label criteria according to the European license for alteplase. Symptomatic intracranial haemorrhage (SICH) according to SITS was defined as primary safety endpoint and SICH according to the ECASS II definition and the NINDS definition as secondary safety endpoints...
November 6, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29103370/boerhaave-s-syndrome-complicated-by-a-saccharomyces-cerevisiae-pleural-empyema-case-report-and-review-of-the-literature
#20
Arno Teblick, Hilde Jansens, Karolien Dams, Francis J Somville, Philippe G Jorens
Objective and Importance Boerhaave's syndrome is a sudden and rare form of oesophageal rupture and is often complicated by local or systemic infection of the mediastinum or pleural cavity. Several micro-organisms are documented as cause of pleural empyema in patients with Boerhaave's syndrome. Intervention (& Technique) We report on a previously healthy 74-year-old male who was admitted at a regional hospital with severe retrosternal and abdominal pain after an episode of vigorous vomiting the morning after ingestion of large quantity of beer...
November 5, 2017: Acta Clinica Belgica
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