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thrombolytics in stroke

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https://www.readbyqxmd.com/read/29332028/possible-erythrocyte-contributions-to-and-exacerbation-of-the-post-thrombolytic-no-reflow-phenomenon
#1
Shang-Jen Yu, James P Buerck, Edgar A O'Rear, Thomas L Whitsett
BACKGROUND: Reperfusion injury often occurs with therapeutic intervention addressing the arterial occlusions causing acute myocardial infarction and stroke. The no-reflow phenomenon has been ascribed to leukocyte plugging and blood vessel constriction in the microcirculation. OBJECTIVE: To assess possible red cell contributions to post thrombolytic no-reflow phenomenon. METHODS: Blood clots were formed by recalcifying 1 ml of citrated fresh human venous blood and then lysed by adding 1,000 units of streptokinase (SK) at several intervals within 1 hour...
January 11, 2018: Biorheology
https://www.readbyqxmd.com/read/29322232/mechanical-thrombectomy-using-the-new-solitaire%C3%A2-platinum-stent-retriever-reperfusion-results-complication-rates-and-early-neurological-outcome
#2
Johannes Pfaff, Stefan Rohde, Tobias Engelhorn, Arnd Doerfler, Martin Bendszus, Markus Alfred Möhlenbruch
BACKGROUND AND PURPOSE: The application of radiopaque markers to the Solitaire™ stent-retriever for better visibility during mechanical thrombectomy (MT) has the potential to alter the well-known characteristics of the device; however, it is uncertain whether this adjustment influences efficacy or safety of the enhanced stent-retriever. METHODS: Retrospective analysis of stroke databases of three comprehensive stroke centers. Our investigation was focused on technical and angiographic parameters, including procedure times, reperfusion results (thrombolysis in cerebral infarction, TICI), periprocedural complications and favorable early neurological recovery at discharge (modified Rankin scale ≤2 or National Institutes of Health Stroke Scale, NIHSS = 0 or ∆NIHSS ≥ 10), from consecutive patients with acute anterior circulation ischemic stroke treated with a Solitaire™ Platinum stent-retriever between October 2016 and March 2017...
January 10, 2018: Clinical Neuroradiology
https://www.readbyqxmd.com/read/29317059/pathophysiological-significance-of-protein-hydrophobic-interactions-an-emerging-hypothesis
#3
Marek Kieliszek, Boguslaw Lipinski
Fibrinogen is a unique protein that is converted into an insoluble fibrin in a single enzymatic event, which is a characteristic feature of fibrinogen due to its susceptibility to fibrinolytic degradation and dissolution. Although thrombosis is a result of activated blood coagulation, no explanation is being offered for the persistent presence of fibrin deposits in the affected organs. A classic example is stroke, in which the thrombolytic therapy is effective only during the first 3-4 h after the onset of thrombosis...
January 2018: Medical Hypotheses
https://www.readbyqxmd.com/read/29303110/-role-of-thrombectomy-in-acute-ischemic-stroke
#4
Albert Pall Sigurdsson
This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources...
January 2018: Læknablađiđ
https://www.readbyqxmd.com/read/29288062/the-degree-of-leukoaraiosis-predicts-clinical-outcomes-and-prognosis-in-patients-with-middle-cerebral-artery-occlusion-after-intravenous-thrombolysis
#5
Yanyan Liu, Min Zhang, Yuan Chen, Ping Gao, Wenwei Yun, Xianju Zhou
Leukoaraiosis (LA) is common in elderly patients with ischemic stroke on magnetic resonance imaging. In this study, we investigate whether the degree of LA is associated with clinical outcomes and prognosis of patients with middle cerebral artery occlusion following intravenous thrombolytic. Ninety-seven patients were recruited and divided into three groups based on the degree of LA (no, mild and moderate to severe LA) by the Fazekas scale. Clinical outcomes, recurrent stroke, Fugl-Meyer rating scale (FMS) and complications of intravenous thrombolysis were assessed...
December 26, 2017: Brain Research
https://www.readbyqxmd.com/read/29283052/thrombolytic-therapy-in-the-current-era-myocardial-infarction-and-beyond
#6
Patrick Proctor, Massoud A Leesar, Arka Chatterjee
Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease...
December 27, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/29274045/overwork-accelerates-thrombotic-reaction-implications-for-the-pathogenesis-of-karoshi
#7
Kazunori Otsui, Junichiro Yamamoto, Nobutaka Inoue
Work-related stressors are potential causes of cardiovascular diseases (CVDs) and stroke; however, the pathophysiological mechanisms by which occupational stress induces and exacerbates CVDs remain unclear. The global thrombosis test (GTT) is a novel in vitro assay for evaluating both thrombotic reactions and subsequent thrombolysis. The time required to form an occlusive thrombus with the GTT, called as the occlusion time (OT), and the time to lyse the thrombus, the lysis time (LT), are markers of thrombotic and thrombolytic reactions, respectively...
December 22, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29259732/edaravone-a-synthetic-free-radical-scavenger-enhances-alteplase-mediated-thrombolysis
#8
Kiyoshi Kikuchi, Kentaro Setoyama, Ko-Ichi Kawahara, Tomoka Nagasato, Takuto Terashi, Koki Ueda, Kazuki Nakanishi, Shotaro Otsuka, Naoki Miura, Hisayo Sameshima, Kazuya Hosokawa, Yoichiro Harada, Binita Shrestha, Mika Yamamoto, Yoko Morimoto-Yamashita, Haruna Kikuchi, Ryoji Kiyama, Chinatsu Kamikokuryo, Salunya Tancharoen, Harutoshi Sakakima, Motohiro Morioka, Eiichiro Tanaka, Takashi Ito, Ikuro Maruyama
The combination of alteplase, a recombinant tissue plasminogen activator, and edaravone, an antioxidant, reportedly enhances recanalization after acute ischemic stroke. We examined the influence of edaravone on the thrombolytic efficacy of alteplase by measuring thrombolysis using a newly developed microchip-based flow-chamber assay. Rat models of embolic cerebral ischemia were treated with either alteplase or alteplase-edaravone combination therapy. The combination therapy significantly reduced the infarct volume and improved neurological deficits...
2017: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29246609/safety-and-preliminary-efficacy-of-intravenous-tirofiban-in-acute-ischemic-stroke-patient-without-arterial-occlusion-on-neurovascular-imaging-studies
#9
Lu Lin, Wei Li, Cheng-Chun Liu, Ya Wu, Shu-Han Huang, Xiao-Shu Li, Chun-Rong Liang, Huan Wang, Li-Li Zhang, Zhi-Qiang Xu, Yan-Jiang Wang, Wuwei Feng, Meng Zhang
BACKGROUND: There has been no effective treatment for acute ischemic stroke (AIS) patients who presented to the Emergency Department >4.5h without a visible arterial occlusion on the neurovascular imaging studies. In this study, we aimed to investigate whether intravenous antiplatelet agent tirofiban was safe and potentially effective in AIS patients who had no visible arterial occlusion and was outside of treatment window for Alteplase. The goal of this study was to collect preliminary data to plan a future phase II study...
December 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29241193/comparative-analysis-on-low-and-standard-dose-regimes-of-alteplase-thrombolytic-therapy-for-acute-ischemic-stroke-efficacy-and-safety
#10
Guangjian Zhao, Tingfen Huang, Mei Zheng, Yansen Cui, Yunyong Liu, Zhongrong Cheng, Ziran Wang
OBJECTIVE: This study analyzed the efficacy and safety of low-dose and standard-dose alteplase intravenous thrombolytic therapy for acute ischemic stroke (AIS). METHODS: Patients with AIS who underwent intravenous alteplase thrombolysis from July 2012 to December 2016 were retrospectively analyzed and correspondingly divided into low-dose (0.6-0.89 mg/kg) group and standard-dose group (0.9 mg/kg) according to alteplase dosage. The clinical outcome was evaluated by modified Rankin Scale (mRS) at 90 days after onset...
December 14, 2017: European Neurology
https://www.readbyqxmd.com/read/29220346/decreased-lymphocyte-to-monocyte-ratio-predicts-poor-prognosis-of-acute-ischemic-stroke-treated-with-thrombolysis
#11
Hao Ren, Lin Han, Hongbin Liu, Lin Wang, Xiao Liu, Yanjun Gao
BACKGROUND Our previous study found that lower lymphocyte-to-monocyte ratio (LMR) is an independent risk factor of clinical outcome of acute ischemic stroke (AIS). However, whether lower LMR is independently associated with adverse prognosis of AIS treated with thrombolysis has not been determined. In this study, we explored the relationship between LMR and prognosis of AIS treated with thrombolysis. MATERIAL AND METHODS We retrospectively enrolled 108 patients treated with thrombolysis. LMR was calculated according to lymphocyte count and monocyte count on admission...
December 8, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/29218699/clinical-outcome-of-cardioembolic-stroke-treated-by-intravenous-thrombolysis
#12
D Vaclavik, A Vilionskis, D Jatuzis, M A Karlinski, Z Gdovinova, J Kõrv, G Tsivgoulis, R Mikulik
INTRODUCTION: Cardioembolic stroke (CS) in patients without thrombolytic treatment is associated with a worse clinical outcome and higher mortality compared to other types of stroke. The aim of this study was to determine the clinical outcome of CS in patients treated by intravenous thrombolysis (IVT). MATERIAL AND METHODOLOGY: Data of patients from the SITS-EAST register (Safe Implementation of Treatments in Stroke) were analyzed in patients who received IVT treatment from 2000 to April 2014...
December 8, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/29215306/a-peptide-mimetic-of-tyrosine-phosphatase-step-as-a-potential-therapeutic-agent-for-treatment-of-cerebral-ischemic-stroke
#13
Ranjana Poddar, Sathyanarayanan Rajagopal, Lucas Winter, Andrea M Allan, Surojit Paul
Extensive research over the last two decades has advanced our understanding of the pathophysiology of ischemic stroke. However, current pharmacologic therapies are still limited to rapid reperfusion using thrombolytic agents, and neuroprotective approaches that can reduce the consequences of ischemic and reperfusion injury, are still not available. To bridge this gap, we have evaluated the long-term efficacy and therapeutic time window of a novel peptide-based neuroprotectant TAT-STEP, derived from the brain-enriched and neuron-specific tyrosine phosphatase STEP...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29212289/a-novel-thrombolytic-and-anticoagulant-serine-protease-from-polychaeta-diopatra-sugokai
#14
Hye Jin Kim, Kyou Hee Shim, Seung Ju Yeon, Hwa Sung Shin
Ischemic stroke can result from blockage of blood vessels, forming fibrin clots in the body and causing irreparable brain damage. Remedial thrombolytic agents or anticoagulants have been studied; however, because the FDA-approved tissue plasminogen activator (t-PA) has low efficacy and side effects, it is necessary to develop safer and more effective treatment candidates. This study was aimed at assessing the fibrinolytic and anticoagulation features of a novel serine protease extracted and purified from Diopatra sugokai, a polychaeta that inhabits tidal flats...
December 8, 2017: Journal of Microbiology and Biotechnology
https://www.readbyqxmd.com/read/29212096/-stroke-mimics-and-stroke-chameleons-differential-diagnosis-of-stroke
#15
Frank Erbguth
The analysis of misdiagnosis of stroke has become increasingly relevant because of the time pressure in the thrombolytic treatment of ischemic strokes. Within the narrow time window of thrombolysis, a false-positive stroke diagnosis can lead to a faulty and potentially dangerous thrombolysis. The terms "Stroke Mimic" (SM = false-positive stroke diagnosis) and "Stroke Chameleon" (SC = false-negative stroke diagnosis) have been introduced for misdiagnosis in this field. The rate of SM decreases during the treatment phases from approximately 50 % in the preclinical situation to approximately 2-10 % in the Stroke Unit indicating thrombolytic therapy...
December 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/29209269/if-time-is-brain-where-is-the-improvement-in-prehospital-time-after-stroke
#16
REVIEW
Jeremy N Pulvers, John D G Watson
Despite the availability of thrombolytic and endovascular therapy for acute ischemic stroke, many patients are ineligible due to delayed hospital arrival. The identification of factors related to either early or delayed hospital arrival may reveal potential targets of intervention to reduce prehospital delay and improve access to time-critical thrombolysis and clot retrieval therapy. Here, we have reviewed studies reporting on factors associated with either early or delayed hospital arrival after stroke, together with an analysis of stroke onset to hospital arrival times...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29201439/management-of-an-acute-ischemic-stroke-during-thrombolytic-treatment-in-a-pregnant-patient-with-prosthetic-valve-thrombosis
#17
Macit Kalçık, Mahmut Yesin, Emrah Bayam, Mustafa Ozan Gürsoy, Ahmet Güner, Sabahattin Gündüz, Mehmet Özkan
Prosthetic valve thrombosis (PVT) is a life-threatening complication in pregnant women with mechanical prosthetic heart valves. Thrombolytic therapy (TT) has evolved as an effective treatment alternative to surgery, which is associated with very high maternal and fetal mortality and morbidity in these patients. Acute ischemic stroke may rarely occur during TT for PVT. Here, we present a pregnant patient who was complicated with cerebral thromboembolism during TT for PVT and successfully managed with continuation of TT...
September 2017: Interventional Medicine & Applied Science
https://www.readbyqxmd.com/read/29196200/incidental-thrombotic-thrombocytopenic-purpura-during-acute-ischemic-stroke-and-thrombolytic-treatment
#18
İbrahim Acır, Hacı Ali Erdoğan, Vildan Yayla, Nilay Taşdemir, Murat Çabalar
BACKGROUND: Intravenous tissue plasminogen activator (IV tPA) was shown to be an effective treatment for acute ischemic stroke (AIS). According to stroke guidelines, there is no need to wait for the complete blood count (CBC) and coagulation test results before application of IV alteplase if there is no suspected coagulation disorder. In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented. CASE: A 33-year-old male patient was admitted at the 2...
November 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29191741/thrombolytic-therapy-of-acute-ischemic-stroke-during-early-pregnancy
#19
Anne Landais, Hugo Chaumont, Rachel Dellis
Thrombolytic treatment (recombinant tissue plasminogen activator [rt-PA]) has established efficacy in acute ischemic stroke, but pregnancy has been an exclusion criterion for all clinical trials that validated alteplase in acute stroke, so our knowledge about its use in this condition is limited. Herein we report the successful use of intravenous rt-PA thrombolysis, uncomplicated by neither hemorrhage development nor other complication in a woman who was 13 weeks pregnant with acute ischemic stroke. The brain magnetic resonance imaging diffusion-weighted sequences showed increased signal in the territory of the left middle cerebral artery...
November 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29167657/choices-regarding-thrombolysis-are-modified-by-the-way-to-transfer-the-messages
#20
Jingjing Gong, Yan Zhang, Hongyan Gao, Wei Wei, Jing Lv, Hongyun Liu, Yonghua Huang
Although thrombolysis is the most effective medical treatment for acute ischemic stroke, many stroke patients eligible for thrombolysis miss this treatment as a result of delay or refusal by the patients and/or their proxies. To explore the influences of prognostic information for different intervals from stroke onset to the start of thrombolytic treatment (OTT) and other factors on the preferences of patients/proxies regarding thrombolytic therapy, a cross-sectional, discrete-choice experiment was performed between August 2013 and September 2014...
2017: Frontiers in Neurology
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