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thrombolytics in stroke

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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
#1
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/29134925/effects-of-ssri-exposure-on-hemorrhagic-complications-and-outcome-following-thrombolysis-in-ischemic-stroke
#2
Schellen Christoph, Ferrari Julia, Lang Wilfried, Sykora Marek
Background Selective serotonin reuptake inhibitors (SSRI) may interfere with platelet function, and pre-stroke SSRI treatment has been associated with increased hematoma volumes and mortality in hemorrhagic stroke patients. The effects of SSRI on the risk of hemorrhagic complications after thrombolysis in ischemic stroke patients are unclear. Aims To examine the effects of pre-stroke SSRI exposure on bleeding complications, functional outcome, and mortality following thrombolysis in ischemic stroke. Methods Data including standard demographic and clinical variables as well as baseline and follow-up stroke severity (measured by National Institutes of Health Stroke Score), functional outcome (measured by modified Rankin Scale) at 3 months, and mortality at 7 and 90 days were extracted from the Virtual International Stroke Trials Archive...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29133696/the-influence-of-initial-stroke-severity-on-mortality-overall-functional-outcome-and-in-hospital-placement-at-90-days-following-acute-ischemic-stroke-a-tertiary-hospital-stroke-register-study
#3
Sonu Bhaskar, Peter Stanwell, Andrew Bivard, Neil Spratt, Rhonda Walker, Gemma H Kitsos, Mark W Parsons, Malcolm Evans, Louise Jordan, Michael Nilsson, John Attia, Christopher Levi
BACKGROUND AND PURPOSE: Epidemiological studies on the extent of the interaction and/or influence of stroke severity on clinical outcomes are important. The aim of the present study was to investigate the putative (and degree of) impact of initial stroke severity in predicting the overall functional outcome, in-hospital placement, and mortality in acute ischemic stroke (AIS) in comparison with age, admission to the stroke unit and thrombolytic treatment. MATERIALS AND METHODS: The John Hunter Hospital acute stroke register was used to collect a retrospective cohort of AIS patients being assessed for reperfusion therapy and admitted between January 2006 and December 2013...
November 2017: Neurology India
https://www.readbyqxmd.com/read/29132832/the-proposed-concordance-statistic-for-benefit-provided-a-useful-metric-when-modeling-heterogeneous-treatment-effects
#4
David van Klaveren, Ewout W Steyerberg, Patrick W Serruys, David M Kent
OBJECTIVES: Clinical prediction models that support treatment decisions are usually evaluated for their ability to predict the risk of an outcome rather than treatment benefit - the difference between outcome risk with versus without therapy. We aimed to define performance metrics for a model's ability to predict treatment benefit. STUDY DESIGN AND SETTING: We analyzed data of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, and of 3 recombinant tissue plasminogen activator trials...
November 10, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29132407/frequency-and-determinants-for-hemorrhagic-transformation-of-posterior-cerebral-stroke-posterior-ischemic-stroke-and-hemorrhagic-transformation
#5
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
#6
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/29127268/sickle-mice-are-sensitive-to-hypoxia-ischemia-induced-stroke-but-respond-to-tissue-type-plasminogen-activator-treatment
#7
Yu-Yo Sun, Jolly Lee, Henry Huang, Mary B Wagner, Clinton H Joiner, David R Archer, Chia-Yi Kuan
BACKGROUND AND PURPOSE: The effects of lytic stroke therapy in patients with sickle cell anemia are unknown, although a recent study suggested that coexistent sickle cell anemia does not increase the risk of cerebral hemorrhage. This finding calls for systemic analysis of the effects of thrombolytic stroke therapy, first in humanized sickle mice, and then in patients. There is also a need for additional predictive markers of sickle cell anemia-associated vasculopathy. METHODS: We used Doppler ultrasound to examine the carotid artery of Townes sickle mice tested their responses to repetitive mild hypoxia-ischemia- and transient hypoxia-ischemia-induced stroke at 3 or 6 months of age, respectively...
November 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29123838/prehospital-triage-for-endovascular-clot-removal-in-acute-stroke-patients
#8
Yu Suzuki, Yasuhiro Hasegawa, Kohtaro Tsumura, Toshihiro Ueda, Kazunari Suzuki, Makoto Sugiyama, Hiroyuki Nozaki, Shojiro Kawaguchi, Makoto Nakane, Goro Nagashima, Takayuki Kitamura, Kengo Yokomine, Jinichi Sasanuma
Aim: To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city-wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation. Methods: Kawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs)...
January 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29097489/treatment-and-outcome-of-hemorrhagic-transformation-after-intravenous-alteplase-in-acute-ischemic-stroke-a-scientific-statement-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#9
REVIEW
Shadi Yaghi, Joshua Z Willey, Brett Cucchiara, Joshua N Goldstein, Nicole R Gonzales, Pooja Khatri, Louis J Kim, Stephan A Mayer, Kevin N Sheth, Lee H Schwamm
PURPOSE: Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. METHODS: A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH...
November 2, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29095323/thrombolytic-therapy-in-acute-ischemic-stroke-in-patients-not-fulfilling-conventional-criteria
#10
Man Sum Chi, Lok Yiu Chan
INTRODUCTION: There are many exclusion criteria in early randomized control trials for intravenous recombinant tissue plasminogen activator use in acute ischemic stroke, thus, many patients were not eligible for the treatment. OBJECTIVE: This study aimed to compare the safety and short-term treatment outcome between those who fulfilled the criteria and those who did not. METHODS: All acute ischemic stroke patients treated with intravenous thrombolysis from 2004 to 2015 in Tuen Mun hospital were recruited...
November 2017: Neurologist
https://www.readbyqxmd.com/read/29075576/cost-benefits-of-rapid-recanalization-using-intraarterial-thrombectomy
#11
Hye Seon Jeong, Jong Wook Shin, Hyon-Jo Kwon, Hyeon-Song Koh, Hae-Sung Nam, Hee Seon Yu, Na Young Yoon, Jei Kim
OBJECTIVES: Thrombolytic therapy is associated with favorable clinical outcomes after successful and rapid recanalization in patients with acute ischemic stroke. This study aimed to evaluate the cost benefits and clinical outcomes at 1 year after intraarterial thrombectomy (IAT) by the rapidity of the successful recanalization. MATERIALS & METHODS: Clinical outcomes of and medical costs incurred by 230 patients with acute ischemic stroke who underwent IAT were compared by the rapidity from symptom onset to successful recanalization (2b/3 thrombolysis in cerebral infarction grade): ≤6-hr (n = 143), >6-hr (n = 31), and no-recanalization (n = 56)...
October 2017: Brain and Behavior
https://www.readbyqxmd.com/read/29071134/solitaire-stent-in-the-treatment-of-acute-ischemic-stroke-with-large-cerebral-artery-occlusion
#12
Wenbao Liang, Zhijie Ou, Rui Luo
OBJECTIVE: To investigate the effect of mechanical thrombectomy with solitaire stent in the treatment of acute ischemic stroke with large cerebral artery occlusion. METHODS: Fifteen acute ischemic stroke patients with a proximal intracranial occlusion in the anterior circulation were included within 6 hours after symptom onset (unknown time of onset allowed in wake upstroke). Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded...
2017: Translational Neuroscience
https://www.readbyqxmd.com/read/29065915/interventions-for-acute-stroke-management-in-africa-a-systematic-review-of-the-evidence
#13
Leonard Baatiema, Carina K Y Chan, Adem Sav, Shawn Somerset
BACKGROUND: The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa...
October 24, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29060633/segmentation-of-hyper-acute-cerebral-infarct-based-on-random-forest-and-sparse-coding-from-diffusion-weighted-imaging
#14
Xiaodong Zhang, Ahmed Elazab, Qingmao Hu
Irreversible infarcts are critical for the assessment of potential risk and benefit pertaining to thrombolysis in hyper-acute ischemic stroke. It is a challenging work to segment infarct at hyper-acute stage due to the substantial variability. A general abnormal tissue segmentation method is proposed and applied to segment hyper-acute ischemic infarct in this paper. Multiple features are designed to train a random forest classifier for voxel classification. Sparse coding based bag-of-features is adopted to train a region classifier for infarct region recognition...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29058289/down-regulation-of-nox4-by-betulinic-acid-protects-against-cerebral-ischemia-reperfusion-in-mice
#15
Pei Lu, Chen-Chen Zhang, Xiao-Min Zhang, Hui-Ge Li, Ai-Lin Luo, Yu-Ke Tian, Hui Xu
Ischemic stroke leads to high potentiality of mortality and disability. The current treatment for ischemic stroke is mainly focused on intravenous thrombolytic therapy. However, ischemia/ reperfusion induces neuronal damage, which significantly influences the outcome of patients with ischemic stroke, and the exact mechanism implicated in ischemia/reperfusion injury remains unclear, although evidence shows that oxidative stress is likely to be involved. Betulinic acid is mainly known for its anti-tumor and anti-inflammatory activities...
October 2017: Journal of Huazhong University of Science and Technology. Medical Sciences
https://www.readbyqxmd.com/read/29052571/susceptibility-weighted-imaging-in-thrombolytic-therapy-of-acute-ischemic-stroke
#16
REVIEW
Lin Li, Ming-Su Liu, Guang-Qin Li, Yang Zheng, Tong-Li Guo, Xin Kang, Mao-Ting Yuan
OBJECTIVE: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. DATA SOURCES: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke...
October 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29040276/the-impact-of-acute-kidney-injury-on-in-hospital-mortality-in-acute-ischemic-stroke-patients-undergoing-intravenous-thrombolysis
#17
Florica Gadalean, Mihaela Simu, Florina Parv, Ruxandra Vorovenci, Raluca Tudor, Adalbert Schiller, Romulus Timar, Ligia Petrica, Silvia Velciov, Cristina Gluhovschi, Flaviu Bob, Adelina Mihaescu, Bogdan Timar, Goce Spasovski, Viviana Ivan
INTRODUCTION: Acute kidney injury (AKI) increases the risk of death in acute ischemic stroke (AIS) patients. Intravenous thrombolytic therapy (iv. rt-PA) seems to be the most effective treatment for AIS patients. The effects of AKI on iv. rt-PA treated AIS cases is less studied. Our paper addresses this issue. METHODS: 45 consecutive stroke patients treated with iv. rt-PA (median age = 64 years; 29 male) and 59 age and sex matched controls not eligible for iv. rt-PA have been enrolled in our study...
2017: PloS One
https://www.readbyqxmd.com/read/29037226/xingnaojing-for-moderate-to-severe-acute-ischemic-stroke-xmas-study-protocol-for-a-randomized-controlled-trial
#18
Xinxing Lai, Kegang Cao, Lingbo Kong, Qiang Liu, Ying Gao
BACKGROUND: Xingnaojing injection (XNJ) is widely used for the treatment of stroke in China. However, there is currently a lack of high-quality evidence of its efficacy for acute ischemic stroke. The main objective of this study is to determine whether the addition of XNJ to standard care improves the 3-month functional outcome in patients with acute ischemic stroke (AIS). METHODS/DESIGN: The XMAS study is a multicenter, prospective, randomized controlled, open-label trial with a blinded endpoints design...
October 16, 2017: Trials
https://www.readbyqxmd.com/read/29037011/visibility-of-ct-early-ischemic-change-is-significantly-associated-with-time-from-stroke-onset-to-baseline-scan-beyond-the-first-3-hours-of-stroke-onset
#19
Jian Gao, Mark W Parsons, Hiroyuki Kawano, Christopher R Levi, Tiffany-Jane Evans, Longting Lin, Andrew Bivard
BACKGROUND AND PURPOSE: Non-contrast brain computed tomography (NCCT) remains the most common imaging modality employed to select patients for thrombolytic therapy in acute ischemic stroke. The current study used the Alberta Stroke Program Early CT Score (ASPECTS) to identify early ischemic changes on brain NCCT imaging with the aim to investigate whether a relationship exists between time from symptoms onset to NCCT with the presence of early ischaemic change quantified by ASPECTS. METHODS: We studied 1,329 ischemic stroke patients who had NCCT within 8 hours of stroke onset...
September 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28987516/cannabis-can-augment-thrombolytic-properties-of-rtpa-case-report-of-an-intracranial-hemorrhage-in-a-heavy-cannabis-user
#20
Amar Shere, Hemant Goyal
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke...
September 28, 2017: American Journal of Emergency Medicine
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