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thrombolytics in stroke

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https://www.readbyqxmd.com/read/28228620/a-case-of-intracranial-arterial-dolichoectasia-with-4-repeated-cerebral-infarctions-in-6-months-and-enlargement-of-basilar-artery
#1
Hideyuki Moriyoshi, Soma Furukawa, Mai Iwata, Junichiro Suzuki, Noriyoshi Nakai, Suguru Nishida, Yasuhiro Ito
A 78-year-old man was admitted to our hospital because of sudden right hemiparesis and dysarthria. His cranial MRI showed an area of hyperintensity in left pons on DWI and MRA revealed dilated, elongated and tortuous intracranial artery. We diagnosed as acute phase ischemic stroke and intracranial arterial dolichoectasia (IADE). Intravenous infusion of rt-PA was performed 157 minutes after the onset of symptoms, and his hemiparesis improved. However, he subsequently suffered from cerebral infarction 4 times in 6 months, and we treated him twice with thrombolytic therapy...
February 22, 2017: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/28228323/evaluation-of-the-role-of-susceptibility-weighted-imaging-in-thrombolytic-therapy-for-acute-ischemic-stroke
#2
Guangjian Zhao, Ling Sun, Ziran Wang, Liquan Wang, Zhongrong Cheng, Hongyan Lei, Daiqun Yang, Yansen Cui, Shirui Zhang
We inspected low-intensity venous signals and microbleeds in patients with acute ischemic stroke (AIS) using susceptibility-weighted imaging (SWI) before and after administration of within-thrombolytic-time-window thrombolytic therapies, and observed their prognosis and safety, in order to guide individualized thrombolytic therapies. Patients with AIS were divided into groups A or B according to the presence of symmetric or asymmetric veins on SWI, and were re-inspected by SWI after intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA)...
February 19, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28227899/peripheral-sensory-stimulation-is-neuroprotective-in-a-rat-photothrombotic-ischemic-stroke-model
#3
Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor, Aishwarya Bandla, Chua Le Teng Sherry, Frances Lim, Chan Kim Chuan, Lun-De Liao, Nitish V Thakor, Lun-De Liao, Nitish V Thakor, Frances Lim, Chua Le Teng Sherry, Aishwarya Bandla, Chan Kim Chuan
Ischemic stroke is one of the leading causes of death and disability in the world. Thrombolytic therapy using recombinant tissue plasminogen activator (rtPA), the only FDA-approved drug for acute ischemia, is limited by a narrow therapeutic time window and risk of hemorrhage. There is a serious need for a neuroprotective therapy which is clinically viable. We earlier demonstrated that peripheral sensory stimulation (PSS) is a potential therapeutic intervention for hyperacute ischemia resulting in recovery of neurovascular functions when administered immediately following ischemia onset in a rat model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28226557/in-vitro-examination-of-the-pressure-effect-on-clot-dissolution-with-thrombolytic-patch
#4
Zhen Qin, Chi Hang Chon, John C K Kwok, David C C Lam, Zhen Qin, Chi Hang Chon, John C K Kwok, David C C Lam, Chi Hang Chon, David Cc Lam, Zhen Qin, John Ck Kwok
Bio-kinetic thrombus dissolution model has been developed to describe the thrombus dissolution behavior during endoluminal thrombolytic patch treatment to recanalize blocked vessel in ischemic strokes. The initial model ignored the effect of pulsatile pressure in the lumen. However, pulsatile pressure in the lumen may affect molecule diffusion and bio-chemical reaction rate and accelerate clot dissolution. The effect of pressure on the dissolution rate was examined in this study. The dissolution behaviors of 100-400 μm thick blood clot specimens subject to diastolic, systolic, and pulsatile pressure were characterized using Raman spectroscopy...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28218337/long-term-outcome-after-reperfusion-treated-stroke
#5
Oscar Mühr, Hanna C Persson, Katharina S Sunnerhagen
OBJECTIVE: To explore motor function, health-related quality of life and impact on activities of daily living 5 and 6 years after reperfusion treatment in patients with stroke. METHODS: A total of 75 patients with first-time stroke received either thrombectomy or thrombolytic treatment at the Sahlgrenska University Hospital in Gothenburg during an 18-month period in 2009-2010. Follow-up involved questionnaires and clinical examinations, 5 and 6 years post-stroke...
February 17, 2017: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28217292/oxygen-or-cooling-to-make-a-decision-after-acute-ischemia-stroke
#6
REVIEW
Wen-Cao Liu, Xin-Chun Jin
The presence of a salvageable penumbra, a region of ischemic brain tissue with sufficient energy for short-term survival, has been widely agreed as the premise for thrombolytic therapy with tissue plasminogen activator (tPA), which remains the only United States Food and Drug Administration (FDA) approved treatment for acute ischemia stroke. However, the use of tPA has been profoundly constrained due to its narrow therapeutic time window and the increased risk of potentially deadly hemorrhagic transformation (HT)...
October 2016: Medical Gas Research
https://www.readbyqxmd.com/read/28213478/endovascular-mechanical-thrombectomy-for-cerebral-venous-sinus-thrombosis-a-systematic-review
#7
REVIEW
Adeel Ilyas, Ching-Jen Chen, Daniel M Raper, Dale Ding, Thomas Buell, Panogiotis Mastorakos, Kenneth C Liu
BACKGROUND: Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. OBJECTIVE: To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. METHODS: A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT...
February 17, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#8
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28202820/-clinical-manifestations-of-spinal-epidural-hematoma-stroke-mimic-and-pitfalls-in-diagnosis
#9
Masaru Kuriyama
Clinical manifestations of spinal epidural hematoma are presented, and the cases mimicking acute ischemic stroke have been reviewed from the literature. Many reports described the cases of spinal epidural hematoma with acute hemiparesis mimicking ischemic stroke in which intravenous thrombolytic treatment with recombinant tissue plasminogen activator was considered. A correct diagnosis of acute ischemic stroke must be made within 4.5 hours from the onset of symptoms, a relatively short window period. A spinal epidural hematoma is a potentially important stroke mimic in a wide variety of conditions that mimic a stroke...
February 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28188404/-direct-oral-anticoagulants-and-acute-stroke-insights-into-translational-research-studies
#10
C Foerch, J H Schäfer, W Pfeilschifter, F Bohmann
In recent years a considerable number of translational research studies on intracerebral hemorrhage and ischemic stroke have been published, which are characterized by a particular proximity to practical clinical questions. Animal research has provided insights into the pathophysiological processes and therapy effects, which have so far only been insufficiently investigated in clinical studies. This includes the effectiveness of a rapid reversal of anticoagulation in cases of anticoagulation-associated intracerebral hemorrhage and the safety of thrombolytic treatment in ischemic stroke occurring during treatment with anticoagulants...
February 10, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28187798/critical-care-in-acute-ischemic-stroke
#11
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28185942/the-effects-of-pharmaceutical-thrombolysis-and-multi-modal-therapy-on-patients-with-acute-posterior-circulation-ischemic-stroke-results-of-a-one-center-retrospective-study
#12
Yang Yang, Chunyang Liang, Chunsen Shen, Hao Tang, Shang Ma, Qiang Zhang, Mou Gao, Qin Dong, Ruxiang Xu
BACKGROUND: The treatment method for acute ischemic stroke is rapidly developing, and the effects of endovascular modalities, when used alone or in combination, needs to be studied. We aimed to identify the difference between pharmaceutical thrombolysis and multi-modal therapy (MMT) used in acute posterior circulation ischemic stroke (APCIS) patients and also to detect the predictors for successful recanalization and favorable outcomes. METHODS: A retrospective analysis of patients with APCIS who received thrombolytic pharmaceuticals and MMT from 2011 to 2016 was performed at the stroke center...
February 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28183857/coexistent-sickle-cell-disease-has-no-impact-on-the-safety-or-outcome-of-lytic-therapy-in-acute-ischemic-stroke-findings-from-get-with-the-guidelines-stroke
#13
Robert J Adams, Margueritte Cox, Shelly D Ozark, Julie Kanter, Phillip J Schulte, Ying Xian, Gregg C Fonarow, Eric E Smith, Lee H Schwamm
BACKGROUND AND PURPOSE: The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD. METHODS: We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA...
February 9, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28179050/cerebral-amyloid-angiopathy-in-stroke-medicine
#14
Frank Block, Manuel Dafotakis
BACKGROUND: Cerebral amyloid angiopathy (CAA) is a degenerative vasculopathy that is classically associated with lobar intracerebral or sulcal hemorrhage. Its prevalence is estimated at 30% in the seventh decade and 50% in the eighth and ninth decades. In this review, we summarize the risks linked to CAA with respect to the treatment and prevention of stroke. METHODS: This review is based on pertinent publications retrieved by a selective search employing the terms "amyloid cerebral angiopathy," "stroke," "intra - cerebral bleeding," and "acute stroke therapy...
January 20, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28178411/computed-tomography-based-thrombus-imaging-for-the-prediction-of-recanalization-after-reperfusion-therapy-in-stroke
#15
REVIEW
Ji Hoe Heo, Kyeonsub Kim, Joonsang Yoo, Young Dae Kim, Hyo Suk Nam, Eung Yeop Kim
The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2(*)-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28178410/strategies-to-extend-thrombolytic-time-window-for-ischemic-stroke-treatment-an-unmet-clinical-need
#16
REVIEW
Ike Dela Peña, Cesar Borlongan, Guofang Shen, Willie Davis
To date, reperfusion with tissue plasminogen activator (tPA) remains the gold standard treatment for ischemic stroke. However, when tPA is given beyond 4.5 hours of stroke onset, deleterious effects of the drug ensue, especially, hemorrhagic transformation (HT), which causes the most significant morbidity and mortality in stroke patients. An important clinical problem at hand is to develop strategies that will enhance the therapeutic time window for tPA therapy and reduce the adverse effects (especially HT) of delayed tPA treatment...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28174326/intravenous-thrombolysis-in-unknown-onset-stroke-results-from-the-safe-implementation-of-treatment-in-stroke-international-stroke-thrombolysis-registry
#17
Laura Dorado, Niaz Ahmed, Götz Thomalla, Manuel Lozano, Branko Malojcic, Mushtaq Wani, Mònica Millán, Ales Tomek, Antoni Dávalos
BACKGROUND AND PURPOSE: Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS: Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014...
February 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28158211/major-vessel-occlusion-may-predict-subtherapeutic-anticoagulation-intensity-and-feasibility-of-administration-of-intravenous-thrombolytics
#18
Jun Young Chang, Seunguk Jung, Hyun Park, Moon-Ku Han
OBJECTIVE: We investigated the association between the presence of major vessel occlusion (MVO) and the intensity of the International Normalized Ratio (INR) in cardioembolic high-risk patients taking warfarin. We also evaluated whether the presence of MVO could predict the subtherapeutic range of INR ≤1.7 ensuring safe administration of intravenous thrombolytics. METHODS: The medical records of 177 cardioembolic stroke patients who were taking warfarin between April, 2008 and March, 2015 were retrospectively analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/28156051/ct-of-the-head-for-acute-stroke-diagnostic-performance-of-a-tablet-computer-prior-to-intravenous-thrombolysis
#19
Patrick D McLaughlin, Fiachra Moloney, Siobhan B O'Neill, Karl James, Lee Crush, Oisin Flanagan, Michael M Maher, Gerald Wyse, Noel Fanning
INTRODUCTION: The authors propose that tablet computers could benefit patients with acute stroke in the remote care setting, where time to and accuracy of CT interpretation greatly influences patient outcome. METHODS: One hundred and fifty consecutive patients who presented to the Emergency Department of a tertiary referral neurosciences centre within a time window suitable for intravenous thrombolytic therapy were included. Images were wirelessly transmitted to a tablet computer (iPad 3rd Generation, model = A1430, Apple, Cupertino, CA) and were reviewed by radiologists with three levels of experience for signs of intracranial haemorrhage, large vessel occlusion and parenchymal infarction...
February 3, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28153014/towards-best-practice-in-acute-stroke-care-in-ghana-a-survey-of-hospital-services
#20
Leonard Baatiema, Michael Otim, George Mnatzaganian, Ama De-Graft Aikins, Judith Coombes, Shawn Somerset
BACKGROUND: Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice...
February 2, 2017: BMC Health Services Research
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