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thrombolytics in stroke

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https://www.readbyqxmd.com/read/28725968/microglial-mediated-pdgf-cc-activation-increases-cerebrovascular-permeability-during-ischemic-stroke
#1
Enming Joseph Su, Chunzhang Cao, Linda Fredriksson, Ingrid Nilsson, Christina Stefanitsch, Tamara K Stevenson, Juanjuan Zhao, Margret Ragsdale, Yu-Yo Sun, Manuel Yepes, Chia-Yi Kuan, Ulf Eriksson, Dudley K Strickland, Daniel A Lawrence, Li Zhang
Treatment of acute ischemic stroke with the thrombolytic tissue plasminogen activator (tPA) can significantly improve neurological outcomes; however, thrombolytic therapy is associated with an increased risk of intra-cerebral hemorrhage (ICH). Previously, we demonstrated that during stroke tPA acting on the parenchymal side of the neurovascular unit (NVU) can increase blood-brain barrier (BBB) permeability and ICH through activation of latent platelet-derived growth factor-CC (PDGF-CC) and signaling by the PDGF receptor-α (PDGFRα)...
July 19, 2017: Acta Neuropathologica
https://www.readbyqxmd.com/read/28721332/to-stent-or-not-to-stent-a-tale-of-two-occlusions
#2
Ali S Haider, Lyndon K Lee, Tijani Osumah, Saira Alli, Umair Khan, Steven Vayalumkal, Aida Kafai Golahmadi, Richa Thakur, Phu Nguyen, Kennith F Layton
Stenting and balloon angioplasty, along with mechanical thrombectomy, have gained notability as adjunctive treatment options to intravenous tissue plasminogen activator (IV-tPA) for tandem internal carotid artery (ICA) and middle cerebral artery (MCA) occlusions (TIM occlusions). Acute ischemic strokes (AISs) secondary to TIM occlusions are associated with poor patient outcomes primarily due to low recanalization rates following intravenous thrombolysis, consequently prompting the need for more invasive recanalization efforts...
June 17, 2017: Curēus
https://www.readbyqxmd.com/read/28717986/thrombolysis-for-stroke-in-ireland-increasing-access-and-maintaining-safety-in-a-challenging-environment
#3
P McElwaine, J McCormack, C Brennan, H Coetzee, P Cotter, R Doyle, A Hickey, F Horgan, C Loughnane, C Macey, P Marsden, D McCabe, R Mulcahy, I Noone, E Shelley, T Stapleton, D Williams, P Kelly, J Harbison
BACKGROUND: In the setting of a national audit of acute stroke services, we examined the delivery of thrombolytic therapy for ischaemic stroke and whether current practice was achieving safe outcomes and consistent delivery for patients. METHOD: Data obtained from the recent national stroke audit was compared against previous Irish audit, the most recent SSNAP UK stroke audit and the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) study...
July 17, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28717091/thrombolysis-related-multiple-lobar-hemorrhaging-in-cerebral-amyloid-angiopathy-with-extensive-strictly-lobar-cerebral-microbleeding
#4
Makoto Eriguchi, Yusuke Yakushiji, Jun Tanaka, Masashi Nishihara, Hideo Hara
A hemi-paralyzed 86-year-old man was diagnosed with ischemic stroke and underwent thrombolysis. Pre-thrombolysis brain magnetic resonance imaging revealed extensive strictly lobar cerebral microbleeding (CMB). Post-thrombolytic computed tomography revealed asymptomatic multiple intracerebral hemorrhaging (ICH). His age, CMB topography, and decreased cerebral spinal fluid amyloid-β 40 and 42 levels were compatible with a diagnosis of cerebral amyloid angiopathy (CAA). There is no consensus on the safety of thrombolysis for acute stroke patients with CAA...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28712618/would-a-large-tpa-trial-for-those-4-5-to-6-0-hours-from-stroke-onset-be-good-value-for-information
#5
Djøra I Soeteman, Nicolas A Menzies, Ankur Pandya
OBJECTIVES: To quantify the potential value of new research in patients treated with thrombolytic treatment (tissue-type plasminogen activator [tPA]) in the 4.5- to 6.0-hour time window after stroke onset and to determine the optimal size of a future trial using value of information analysis. METHODS: Expected value of partial perfect and sample information (EVPPI and EVSI) analyses were conducted using a probabilistic Markov model. Data for modified Rankin Scale (mRS) distributions in patients 4...
July 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28710023/transient-brain-hypothermia-reduces-the-reperfusion-injury-of-delayed-tissue-plasminogen-activator-and-extends-its-therapeutic-time-window-in-a-focal-embolic-stroke-model
#6
Mohammadreza Zarisfi, Fatemeh Allahtavakoli, Mahsa Hassanipour, Mohammad Khaksari, Hossain Rezazadeh, Mohammad Allahtavakoli, Mohammad Mohsen Taghavi
It has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether shortIt has been reported that restriction of reperfusion after thrombolytic therapy in ischemic stroke may reduce tissue plasminogen activator (tPA) adverse effects and extend its time window. We examined whether short-term and mild local brain cooling can prevent hyperemia and/or adverse effects of delayed tPA in rat embolic stroke model...
July 11, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28706119/disparities-and-trends-in-door-to-needle-time-the-fl-pr-cresd-study-florida-puerto-rico-collaboration-to-reduce-stroke-disparities
#7
Sofia A Oluwole, Kefeng Wang, Chuanhui Dong, Maria A Ciliberti-Vargas, Carolina M Gutierrez, Li Yi, Jose G Romano, Enmanuel Perez, Brittany Ann Tyson, Maranatha Ayodele, Negar Asdaghi, Hannah Gardener, David Z Rose, Enid J Garcia, Juan Carlos Zevallos, Dianne Foster, Mary Robichaux, Salina P Waddy, Ralph L Sacco, Tatjana Rundek
BACKGROUND AND PURPOSE: In the United States, about half of acute ischemic stroke patients treated with tPA (tissue-type plasminogen activator) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (door-to-needle time [DTNT] ≤60) and 45 minutes (DTNT ≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT ≤60 and DTNT ≤45. METHODS: Among 65 654 acute ischemic stroke admissions in the National Institute of Neurological Disorders and Stroke-funded FL-PR CReSD study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) from 2010 to 2015, we included 6181 intravenous tPA-treated cases (9...
July 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28705822/focal-low-and-global-high-permeability-predict-the-possibility-risk-and-location-of-hemorrhagic-transformation-following-intra-arterial-thrombolysis-therapy-in-acute-stroke
#8
Y Li, Y Xia, H Chen, N Liu, A Jackson, M Wintermark, Y Zhang, J Hu, B Wu, W Zhang, J Tu, Z Su, G Zhu
BACKGROUND AND PURPOSE: The contrast volume transfer coefficient (K(trans)), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS: We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment...
July 13, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28696508/neutrophil-extracellular-traps-in-ischemic-stroke-thrombi
#9
Elodie Laridan, Frederik Denorme, Linda Desender, Olivier François, Tommy Andersson, Hans Deckmyn, Karen Vanhoorelbeke, Simon F De Meyer
OBJECTIVE: Neutrophil extracellular traps (NETs) have been shown to promote thrombus formation. Little is known about the exact composition of thrombi that cause ischemic stroke. In particular no information is yet available on the presence of NETs in cerebral occlusions. Such information is however essential to improve current thrombolytic therapy with t-PA. This study aimed at investigating the presence of neutrophils and more specifically NETs in ischemic stroke thrombi. METHODS: Sixty-eight thrombi retrieved from ischemic stroke patients undergoing endovascular treatment were characterized by immunostaining using neutrophil markers (CD66b and neutrophil elastase) and NETs markers (citrullinated histones H3 (H3Cit) and extracellular DNA)...
July 11, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28690532/safe-intravenous-thrombolysis-after-traumatic-cardiopulmonary-resuscitation-with-rib-fractures-a-case-report
#10
Andrea Dressing, Zina Graeter, Juergen Bardutzky
We report a case of successful intravenous thrombolysis for a distal middle cerebral artery occlusion shortly after traumatic cardiopulmonary resuscitation due to an episode of ventricular tachycardia. A high prevalence of fatal cardiac arrhythmias in acute stroke patients raises the question of safety when administrating thrombolytic therapy after traumatic cardiopulmonary resuscitation; guidelines do not provide a satisfactory statement about this. Our case suggests that intravenous tissue-type plasminogen activator for acute ischemic stroke can be administered after a thorough risk-to-benefit evaluation without major adverse effects in patients after traumatic cardiopulmonary resuscitation, as bleeding complications seem rare and can be monitored and treated...
May 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28685662/simultaneous-functional-photoacoustic-microscopy-and-electrocorticography-reveal-the-impact-of-rtpa-on-dynamic-neurovascular-functions-after-cerebral-ischemia
#11
Aishwarya Bandla, Lun-De Liao, Su Jing Chan, Ji Min Ling, Yu-Hang Liu, Yen-Yu Ian Shih, Han-Chi Pan, Peter Tsun-Hon Wong, Hsin-Yi Lai, Nicolas Kon Kam King, You-Yin Chen, Wai Hoe Ng, Nitish V Thakor
The advance of thrombolytic therapy has been hampered by the lack of optimization of the therapy during the hyperacute phase of focal ischemia. Here, we investigate neurovascular dynamics using a custom-designed hybrid electrocorticography (ECoG)-functional photoacoustic microscopy (fPAM) imaging system during the hyperacute phase (first 6 h) of photothrombotic ischemia (PTI) in male Wistar rats following recombinant tissue plasminogen activator (rtPA)-mediated thrombolysis. We reported, for the first time, the changes in neural activity and cerebral hemodynamic responses following rtPA infusion at different time points post PTI...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28665908/small-rural-hospitals-have-a-harder-time-achieving-success-in-continuous-quality-improvement-an-example-from-a-stroke-care-network
#12
Kelley Elkins, Lisa Bellamy, Jing Guo, Michael R Dobbs
BACKGROUND: University of Kentucky HealthCare established a Stroke Care Network (SCN) in 2008 to address the challenges of rural stroke care and improve care quality. METHODS: The SCN collects quality data from each affiliate that include volumes, mortality, length of stay, turnaround times, rt-PA door-to-needle time, 8 stroke core measures, and dysphagia screen measure. Characteristics of affiliate hospital studies include number of beds, Stroke Disease-Specific Care (DSC) certification by The Joint Commission, Appalachian designated county or not, time dedicated to stroke coordinator, submission of quality data for the calendar year, success of data, and utilization of American Heart Association's Get With the Guidelines...
July 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28664028/a-case-of-acute-isolated-posterior-cerebral-artery-occlusion-successfully-treated-with-endovascular-clot-aspiration
#13
Taiki Yamamoto, Tomotaka Ohshima, Masaki Sato, Shunsaku Goto, Kojiro Ishikawa, Toshihisa Nishizawa, Shinji Shimato, Kyozo Kato
Posterior cerebral artery (PCA) strokes produce various symptoms. Therefore, the diagnosis is often delayed and patients arrive late for thrombolytic therapy. We report a case of acute isolated PCA occlusion that was successfully treated with endovascular clot aspiration. A 63-year-old man presented with right complete homonymous hemianopia. Diffusion-weighted image (DWI) showed a high-intensity area (HIA) in the occipital lobe, and magnetic resonance angiography (MRA) showed PCA occlusion. Emergency endovascular clot aspiration was performed immediately after the diagnosis...
April 2017: NMC Case Rep J
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#14
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#15
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g. premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28642017/patterns-of-care-and-temporal-trends-in-ischemic-stroke-management-a-brazilian-perspective
#16
Monique Bueno Alves, Gisele Sampaio Silva, Renata Carolina Acri Miranda, Rodrigo Meireles Massaud, Andreia Maria Heins Vaccari, Miguel Cendoroglo-Neto, Solange Diccini
BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed...
June 20, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28641323/ischaemia-reperfusion-injury-and-hyperbaric-oxygen-pathways-a-review-of-cellular-mechanisms
#17
REVIEW
Ashish Francis, Richard Baynosa
Ischaemia-induced tissue injury has wide-ranging clinical implications including myocardial infarction, stroke, compartment syndrome, ischaemic renal failure and replantation and revascularization. However, the restoration of blood flow produces a 'second hit' phenomenon, the effect of which is greater than the initial ischaemic event and characterizes ischaemia-reperfusion (IR) injury. Some examples of potential settings of IR injury include: following thrombolytic therapy for stroke, invasive cardiovascular procedures, solid organ transplantation, and major trauma resuscitation...
June 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28610565/the-influence-of-dehydration-on-the-prognosis-of-acute-ischemic-stroke-for-patients-treated-with-tissue-plasminogen-activator
#18
Fei-Fan Wu, Yen-Chu Hung, Y H Tsai, Jen-Tsung Yang, Tsong-Hai Lee, Chia-Wei Liow, Jiann-Der Lee, Chung-Jen Lin, Tsung-I Peng, Leng-Chieh Lin
BACKGROUND: Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA). METHODS: Between 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio...
June 13, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28601092/ischemic-stroke-complicating-thrombolytic-therapy-with-tenecteplase-for-st-elevation-myocardial-infarction-two-case-reports
#19
Salim Arous, Meryem Haboub, Mohamed El Ghali Benouna, Tarik Bentaoune, Rachida Habbal
BACKGROUND: Hemorrhagic complications are quite common in the rare cases where thrombolysis is performed. Ischemic stroke in the aftermath of thrombolysis for a ST elevation myocardial infarction is a very rare and paradoxical complication. With these observations in mind we report two interesting cases of ischemic stroke which occurred after fibrinolytic therapy with tenecteplase for a ST elevation myocardial infarction. CASE PRESENTATION: The first case was a 56-year-old African man who presented with an acute infero-basal ST elevation myocardial infarction 6 hours after chest pain onset...
June 11, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28585904/egyptian-experience-in-increasing-utilization-of-reperfusion-therapies-in-acute-ischemic-stroke
#20
Magd Fouad Zakaria, Hany Aref, Azza Abd ElNasser, Nagia Fahmy, Mohamed Amir Tork, Mohamed Mahmoud Fouad, Ahmed ElBokl, Tamer Roushdy, Sara ElFaramawy, Mohammad Abdullah El-Shiekh, Ramez Reda Moustafa
Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
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