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thrombolytics in stroke

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https://www.readbyqxmd.com/read/29790991/understanding-delays-in-acute-stroke-care-a-systematic-review-of-reviews
#1
Yacine Lachkhem, Stéphane Rican, Étienne Minvielle
Background: Stroke is the leading cause of adult long-term disability in Western countries. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator is safe and effective within the first 4.5 h after the onset of stroke. Various factors delaying acute stroke care have been identified in the literature. This review aimed to provide an overview of factors delaying acute stroke care and attempted to show how they interact in a synthetic framework. Methods: We conducted a systematic review of literature reviews published in Medline and DORIS until 2016 on factors influencing acute stroke pathway timeframe...
June 1, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29788103/post-ischaemic-administration-of-the-murine-canakinumab-surrogate-antibody-improves-outcome-in-experimental-stroke
#2
Luca Liberale, Candela Diaz-Cañestro, Nicole R Bonetti, Francesco Paneni, Alexander Akhmedov, Jürg H Beer, Fabrizio Montecucco, Thomas F Lüscher, Giovanni G Camici
Aims: The CANTOS trial underscored the efficacy of selective antibody-based interleukin (IL)-1β inhibition with Canakinumab in secondary prevention of cardiovascular events. Despite the success of the trial, incidence of stroke was not reduced likely due to the low number of events and the relatively young age of patients enrolled. Given the established role of IL-1β in stroke, we tested the efficacy of the murine Canakinumab-equivalent antibody in a mouse model of ischaemic stroke...
May 16, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29788007/knowledge-about-stroke-in-belo-horizonte-brazil-a-community-based-study-using-an-innovative-video-approach
#3
Fidel Meira, Daiane Magalhães, Luiz Sérgio da Silva, Ana Clara Mendonça E Silva, Gisele Sampaio Silva
BACKGROUND AND PURPOSE: Stroke is a leading cause of death in Brazil. Knowledge about the clinical manifestations of stroke as well as its risk factors and its management is still poor in the country. We intended to assess the stroke knowledge of an urban population in Belo Ho-rizonte, Brazil. METHODS: Individuals assisted by a basic health unit were interviewed between February and August 2014. After demographic data collection, the participants were asked to watch a video that consisted of a person presenting stroke signals and they were asked to answer questions about the condition shown on the video...
May 22, 2018: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/29787575/safety-of-intravenous-alteplase-within-4-5-hours-for-patients-awakening-with-stroke-symptoms
#4
Victor C Urrutia, Roland Faigle, Steven R Zeiler, Elisabeth B Marsh, Mona Bahouth, Mario Cerdan Trevino, Jennifer Dearborn, Richard Leigh, Susan Rice, Karen Lane, Mustapha Saheed, Peter Hill, Rafael H Llinas
BACKGROUND: Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria. METHODS: The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety trial of standard dose IV tPA in patients who presented with stroke symptoms within 0-4...
2018: PloS One
https://www.readbyqxmd.com/read/29787393/recanalization-of-chronic-occlusion-of-the-middle-cerebral-artery-with-tissue-plasminogen-activator-treatment-a-case-report
#5
Seung Jae Lee, Jin Sung Cheong, Han Uk Ryu, Hyun Goo Kang
OBJECTIVES: Patients with chronic proximal middle cerebral artery (MCA) occlusion do not present with severe symptoms, but early recanalization of acute occlusion is associated with high morbidity and mortality. Tissue plasminogen activator (tPA) is a recombinant thrombolytic agent approved for treating ischemic stroke, although only a few cases of tPA administration in chronic MCA occlusion have yielded positive results. METHODS: A 71-year-old patient had a history of right MCA territorial infarction with the occlusion occurring 12 years ago (November 2005)...
May 21, 2018: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/29774194/improper-use-of-thrombolytic-agents-in-acute-hemiparesis-following-misdiagnosis-of-acute-ischemic-stroke
#6
Min Chan Kim, Seok Won Kim
Objective: Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke. Methods: We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis...
April 2018: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/29773569/mobile-stroke-unit-reduces-time-to-image-acquisition-and-reporting
#7
E M Nyberg, J R Cox, R G Kowalski, D V Duarte, B Schimpf, W J Jones
Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy...
May 17, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29719556/association-of-blood-glucose-and-clinical-outcome-after-mechanical-thrombectomy-for-acute-ischemic-stroke
#8
Weston R Gordon, Russell M Salamo, Anit Behera, John Chibnall, Amer Alshekhlee, Richard C Callison, Randall C Edgell
Background: Elevated blood glucose levels following acute ischemic stroke have been associated with adverse clinical outcomes in thrombolytic and nonthrombolytic treated patients. The current study examined multiple blood glucose parameters and their association with modified Rankin Scale (mRS) score at 3 months following mechanical thrombectomy and hospital discharge. Methods: Acute ischemic stroke patients undergoing mechanical thrombectomy with a retrievable stent at two stroke centers were studied...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29717825/treatment-of-nonarteritic-acute-central-retinal-artery-occlusion
#9
Rahul A Sharma, Michael Dattilo, Nancy J Newman, Valerie Biousse
Central retinal artery occlusion (CRAO) is an event most often caused by an embolus originating in the ipsilateral carotid artery, aortic arch, or heart. CRAO may result from partial or complete occlusion of the central retinal artery (CRA), which acts as the primary blood supply to the inner neurosensory retina, and typically results in profound vision loss and permanent visual disability. No consensus has emerged regarding the optimal treatment of CRAO. All proposed treatments are of questionable efficacy and many have uncertain risk profiles...
May 2, 2018: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/29715283/leukoaraiosis-and-risk-of-intracranial-hemorrhage-and-outcome-after-stroke-thrombolysis
#10
Chun-Ming Yang, Chien-Ling Hung, Hui-Chen Su, Huey-Juan Lin, Chih-Hung Chen, Chou-Ching Lin, Han-Hwa Hu, Sheng-Hsiang Lin, Pi-Shan Sung
BACKGROUND: The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are lacking. Therefore, in this study, we assessed the association between leukoaraiosis and SICH, and the association between leukoaraiosis and the 90-day functional outcome in the Asian population. METHODS: Data were collected from a two-center prospective registry of acute ischemic stroke patients given intravenous tissue plasminogen activator between 2006 and 2014...
2018: PloS One
https://www.readbyqxmd.com/read/29712879/low-levels-of-caveolin-1-predict-symptomatic-bleeding-after-thrombolytic-therapy-in-patients-with-acute-ischemic-stroke
#11
Mar Castellanos, Cecile van Eendenburg, Carme Gubern, Elisabet Kádár, Gemma Huguet, Josep Puig, Tomás Sobrino, Gerard Blasco, Joaquín Serena, Juan Manuel Sánchez
BACKGROUND AND PURPOSE: Experimental models of cerebral ischemia demonstrate that the decrease in the caveolin-1 membrane protein results in an increase in endothelial permeability. Because this phenomenon is responsible for hemorrhagic transformation (HT) after cerebral ischemia, we aimed to determine whether caveolin-1 levels may predict bleeding after recombinant tissue-type plasminogen activator (r-tPA) administration in patients with acute stroke. METHODS: We studied 133 patients with a first hemispheric stroke treated with r-tPA within 4...
April 30, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29708218/stroke-code-simulation-benefits-advanced-practice-providers-similar-to-neurology-residents
#12
Muhib Khan, Grayson L Baird, Theresa Price, Tricia Tubergen, Omran Kaskar, Michelle De Jesus, Joseph Zachariah, Adam Oostema, Raymond Scurek, Robert R Coleman, Wendy Sherman, Cynthia Hingtgen, Tamer Abdelhak, Brien Smith, Brian Silver
Background: Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents. Methods: This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage...
April 2018: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/29707581/an-overview-of-meta-analyses-of-endovascular-bridging-therapies-for-acute-ischemic-stroke
#13
REVIEW
Si-Yan Chen, Xing-Ru Zhang, Jie Chen, Wan-Qian Ge, Wen-Wen Wang, Xin-Shi Wang, Cheng-Long Xie
Background: Acute Ischemic Stroke (AIS) is a common cause of death worldwide and the leading cause of long-term severe disability. Endovascular bridging therapies (EBT), including endovascular thrombectomy (ET) and intra-arterial thrombolytic (IAT), have been recommended to realize a favorable functional outcome for AIS patients. Methods: An overview of meta-analyses of primary randomized controlled trial (RCT) studies was performed evaluating EBT for AIS patients compared with usual care...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29697301/outcomes-of-early-carotid-stenting-and-angioplasty-in-large-vessel-anterior-circulation-strokes-treated-with-mechanical-thrombectomy-and-intravenous-thrombolytics
#14
T Mehta, N Desai, K Mehta, R Parikh, S Male, M Hussain, M Ollenschleger, G Spiegel, A Grande, M Ezzeddine, B Jagadeesan, R Tummala, L McCullough
Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention...
January 1, 2018: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29683506/noncoding-rnas-in-ischemic-stroke-time-to-translate
#15
REVIEW
Harpreet Kaur, Deepaneeta Sarmah, Jackson Saraf, Kanchan Vats, Kiran Kalia, Anupom Borah, Dileep R Yavagal, Kunjan R Dave, Zhumur Ghosh, Pallab Bhattacharya
Stroke is devastating and a major cause of morbidity and mortality around globe. Current interventions for ischemic stroke include thrombolytics, clot retrieval devices and/or intravenous tissue plasminogen activators (tPA), the latter two becoming the first line of treatment. Owing to the limitations of tPA to elicit therapeutic benefits in a narrow time window, new pharmacological interventions are needed. Exploring noncoding RNAs (ncRNAs) may be a promising option for stroke treatment. ncRNAs are endogenous molecules that play key roles in the pathophysiology of many functions and diseases, including during ischemic stroke...
April 23, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29681849/danhong-injection-combined-with-t-pa-improves-thrombolytic-therapy-in-focal-embolic-stroke
#16
Min Li, Jing Zhou, Weifeng Jin, Xiaohong Li, Yuyan Zhang
Background: Hemorrhagic transformation, neurotoxicity, short treatment time windows, and other defects are considered as the major limitations for the thrombolytic therapy. This study is devoted to figure out whether Danhong injection (DHI) combined with tissue-plasminogen activator (t-PA) could extend the treatment time windows and ameliorate brain injury, hemorrhagic complication and BBB disruption after focal embolic stroke. Methods: In vitro , the combined concentrations of DHI and t-PA were added to wells reacted with plasminogen and D-Val-Leu-Lys-AMC...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29668333/blood-biomarkers-in-ischemic-stroke-potential-role-and-challenges-in-clinical-practice-and-research
#17
Konstantinos Makris, Alexander Haliassos, Maria Chondrogianni, Georgios Tsivgoulis
Fast and accurate diagnosis of stroke is crucial for the immediate application of the right therapy to patients. However, rapid diagnosis is still a challenge since an ischemic stroke cannot be identified based only on clinical assessment. CT or MRI imaging is required to rule out hemorrhagic stroke since thrombolytic therapy can lead to increased intracranial bleeding and further aggravation of hemorrhagic stroke. In addition, clinical situations that imitate the signs and symptoms of stroke may also impede the rapid diagnosis and treatment of stroke victims...
April 18, 2018: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/29661036/when-migraine-mimics-stroke-a-systematic-review
#18
Alberto Terrin, Giulia Toldo, Mario Ermani, Federico Mainardi, Ferdinando Maggioni
Background Migraine with aura may mimic an acute ischemic stroke, so that an improper administration of thrombolytic treatment can expose migrainous patients to severe adverse effects. Methods This systematic review quantifies the relevance of migraine with aura among stroke mimics, checking for thrombolysis' safety in these patients. We reviewed the literature after 1995, distinguishing from studies dealing with stroke mimics treated with systemic thrombolysis and those who were not treated with systemic thrombolysis...
January 1, 2018: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/29651371/tenecteplase-versus-alteplase-for-the-management-of-acute-ischemic-stroke-in-a-low-income-country-nepal-cost-efficacy-and-safety
#19
REVIEW
Gaurav Nepal, Ghanshyam Kharel, Shaik Tanveer Ahamad, Babin Basnet
Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses...
February 9, 2018: Curēus
https://www.readbyqxmd.com/read/29627022/hyperglycemia-predicts-unfavorable-outcomes-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-among-a-chinese-population-a-prospective-cohort-study
#20
Sheng-Feng Lin, A-Ching Chao, Han-Hwa Hu, Ruey-Tay Lin, Chih-Hung Chen, Lung Chan, Huey-Juan Lin, Yu Sun, Yung-Yang Lin, Po-Lin Chen, Shinn-Kuang Lin, Ming-Hui Sun, Cheng-Yu Wei, Yu-Te Lin, Jiunn-Tay Lee, Chi-Huey Bai
BACKGROUND AND PURPOSE: Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. METHODS: This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset...
May 15, 2018: Journal of the Neurological Sciences
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