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Stroke AND thrombolysis

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https://www.readbyqxmd.com/read/28550481/antiplatelet-pretreatment-and-outcomes-in-intravenous-thrombolysis-for-stroke-a-systematic-review-and-meta-analysis
#1
Georgios Tsivgoulis, Aristeidis H Katsanos, Ramin Zand, Vijay K Sharma, Martin Köhrmann, Sotirios Giannopoulos, Efthymios Dardiotis, Anne W Alexandrov, Panayiotis D Mitsias, Peter D Schellinger, Andrei V Alexandrov
Since there are contradictory data regarding the association of antiplatelet pretreatment (AP) with safety and efficacy outcomes of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), we conducted a systematic review and meta-analysis of available randomized-controlled clinical trials (RCTs) to investigate the association of AP with outcomes of AIS patients treated with intravenous alteplase. The outcome events of interest included symptomatic intracranial hemorrhage (sICH), fatal ICH, complete recanalization (CR), 3-month favorable functional outcome (FFO, mRS score 0-1), 3-month functional independence (FI, mRS score 0-2), and mortality...
May 26, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28546325/reciprocal-interaction-of-24-hour-blood-pressure-variability-and-systolic-blood-pressure-on-outcome-in-stroke-thrombolysis
#2
Lars Kellert, Christian Hametner, Niaz Ahmed, Geraldine Rauch, Mary J MacLeod, Francesco Perini, Kennedy R Lees, Peter A Ringleb
BACKGROUND AND PURPOSE: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS: From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed...
May 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28540481/impact-of-perfusion-lesion-in-corticospinal-tract-on-response-to-reperfusion
#3
Ying Zhou, Ruiting Zhang, Sheng Zhang, Shenqiang Yan, Ze Wang, Bruce C V Campbell, David S Liebeskind, Min Lou
OBJECTIVES: We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion. METHODS: We retrospectively examined data in consecutive anterior circulation AIS patients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10(-6) mm(2)/s (CST-ADC) lesions were calculated...
May 24, 2017: European Radiology
https://www.readbyqxmd.com/read/28538414/clinical-predictors-for-the-manifestation-of-late-gadolinium-enhancement-after-acute-myocardial-infarction
#4
Nadine Abanador-Kamper, Lars Kamper, Marc Vorpahl, Hilmar Brinkmann, Vasiliki Karamani, Patrick Haage, Melchior Seyfarth
Despite prompt revascularization, some patients with acute myocardial infarction (AMI) develop myocardial scars, which can be visualized by late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR). Our goal was to identify angiographic findings that were predictive for scar development in patients after reperfused AMI.We examined 136 patients after first ST-elevated myocardial infarction by CMR after a median of 4 days (range: 2-7). Patients with manifestation of LGE were matched to patients without LGE by means of age and gender...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28538247/the-positive-predictive-value-of-an-ambulance-prealert-for-stroke-and-transient-ischaemic-attack
#5
Craig W Brown, Mary J Macleod
OBJECTIVE: Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times...
May 19, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28536425/intravenous-thrombolysis-in-chinese-patients-with-different-subtype-of-mild-stroke-thrombolysis-in-patients-with-mild-stroke
#6
Weiqi Chen, Yuesong Pan, Xingquan Zhao, Liping Liu, Hao Li, Xiaoling Liao, Chunjuan Wang, Yilong Wang, Yongjun Wang
Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate whether patients with mild stroke or its specific etiologic subtype might benefit from rt-PA therapy. Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) and (2) the China National Stroke Registry (CNSR) database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale ≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype...
May 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28536170/door-to-needle-delays-in-minor-stroke-a-causal-inference-approach
#7
Sara K Rostanski, Zachary Shahn, Mitchell S V Elkind, Ava L Liberman, Randolph S Marshall, Joshua I Stillman, Olajide Williams, Joshua Z Willey
BACKGROUND AND PURPOSE: Thrombolysis rates among minor stroke (MS) patients are increasing because of increased recognition of disability in this group and guideline changes regarding treatment indications. We examined the association of delays in door-to-needle (DTN) time with stroke severity. METHODS: We performed a retrospective analysis of all stroke patients who received intravenous tissue-type plasminogen activator in our emergency department between July 1, 2011, and February 29, 2016...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28536167/intravenous-thrombolysis-in-acute-ischemic-stroke-patients-pretreated-with-non-vitamin-k-antagonist-oral-anticoagulants-an-editorial-review
#8
REVIEW
Georgios Tsivgoulis, Apostolos Safouris
No abstract text is available yet for this article.
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#9
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28533683/new-standardized-nursing-cooperation-workflow-to-reduce-stroke-thrombolysis-delays-in-patients-with-acute-ischemic-stroke
#10
Yan Zhou, Zhuojun Xu, Jiali Liao, Fangming Feng, Lai Men, Li Xu, Yanan He, Gang Li
OBJECTIVE: We assessed the effectiveness of a new standardized nursing cooperation workflow in patients with acute ischemic stroke (AIS) to reduce stroke thrombolysis delays. PATIENTS AND METHODS: AIS patients receiving conventional thrombolysis treatment from March to September 2015 were included in the control group, referred to as T0. The intervention group, referred to as T1 group, consisted of AIS patients receiving a new standardized nursing cooperation workflow for intravenous thrombolysis (IVT) at the emergency department of Shanghai East Hospital (Shanghai, People's Republic of China) from October 2015 to March 2016...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28532498/the-golden-hour-of-acute-ischemic-stroke
#11
Rajiv Advani, Halvor Naess, Martin W Kurz
BACKGROUND: Acute Ischemic Stroke (AIS) treatment has been revolutionised in the last two decades with the increasing use of Intravenous Thrombolysis (IVT) and with the advent of Endovascular therapy (EVT). AIS treatment and outcome are time dependant and time saving measures are being implemented at every step of the treatment chain. These changes have resulted in lower treatment times in-hospital, but it is unclear if this translates into more patients being treated within 60 min of symptom onset - the Golden Hour...
May 22, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28527588/mechanical-thrombectomy-for-acute-ischemic-stroke-in-a-patient-with-concomitant-spontaneous-intracerebral-hemorrhage
#12
Stefano Forlivesi, Paolo Bovi, Manuel Cappellari
Data from randomized clinical trials and current guidelines suggest that patients with anterior circulation occlusion with contraindications to intravenous thrombolysis may benefit from direct mechanical thrombectomy. Nevertheless, no data are available on the efficacy and safety of direct mechanical thrombectomy in patients with concomitant spontaneous intracerebral hemorrhage. We report the case of a 51-year-old woman with a spontaneous intracerebral hemorrhage in the right parietal and occipital lobes, who experienced, 7 days later, an occlusion of the proximal left middle cerebral artery...
May 17, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28522637/general-anesthesia-versus-conscious-sedation-for-endovascular-treatment-of-acute-ischemic-stroke-the-anstroke-trial-anesthesia-during-stroke
#13
Pia Löwhagen Hendén, Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, Sven-Erik Ricksten
BACKGROUND AND PURPOSE: Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients. METHODS: Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28522232/efficacy-of-new-measures-saving-time-in-acute-stroke-management-a-quantified-analysis
#14
Ana María Iglesias Mohedano, Andrés García Pastor, Fernando Díaz Otero, Pilar Vázquez Alen, Marta Vales Montero, Elisa Luque Buzo, Nuria Redondo Ráfales, Beatriz Chavarria Cano, Yolanda Fernández Bullido, Jose Antonio Villanueva Osorio, Antonio Gil Núñez
BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014...
May 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28513116/worse-outcome-in-patients-with-acute-stroke-and-atrial-fibrillation-following-thrombolysis
#15
Michael Findler, Jeremy Molad, Natan M Bornstein, Eitan Auriel
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and a common cause of ischemic stroke. Stroke patients with AF have been shown to have a poorer neurological outcome than stroke patients without AF. OBJECTIVES: To determine the impact of pre-existing AF on residual degree of disability in patients treated with IV thrombolysis. METHODS: In this case-control study, data of 214 stroke patients (63 with AF and 151 without AF) were collected from the National Acute Stroke Israeli Registry, a nationwide quadrennial stroke database...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28510599/selective-inhibition-of-brain-endothelial-rho-kinase-2-provides-optimal-protection-of-an-in-vitro-blood-brain-barrier-from-tissue-type-plasminogen-activator-and-plasmin
#16
Be'eri Niego, Natasha Lee, Pia Larsson, T Michael De Silva, Amanda E-Ling Au, Fiona McCutcheon, Robert L Medcalf
Rho-kinase (ROCK) inhibition, broadly utilised in cardiovascular disease, may protect the blood-brain barrier (BBB) during thrombolysis from rt-PA-induced damage. While the use of nonselective ROCK inhibitors like fasudil together with rt-PA may be hindered by possible hypotensive side-effects and inadequate capacity to block detrimental rt-PA activity in brain endothelial cells (BECs), selective ROCK-2 inhibition may overcome these limitations. Here, we examined ROCK-2 expression in major brain cells and compared the ability of fasudil and KD025, a selective ROCK-2 inhibitor, to attenuate rt-PA-induced BBB impairment in an in vitro human model...
2017: PloS One
https://www.readbyqxmd.com/read/28506796/from-head-to-toe-sex-and-gender-differences-in-the-treatment-of-ischemic-cerebral-disease
#17
REVIEW
Lorenzo Falsetti, Giovanna Viticchi, Laura Buratti, Clotilde Balucani, Alberto M Marra, Mauro Silvestrini
Stroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men...
May 12, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28500226/mr-perfusion-lesions-after-tia-or-minor-stroke-are-associated-with-new-infarction-at-7-days
#18
Jun Lee, Manabu Inoue, Michael Mlynash, Sharanpal K Mann, Carlo W Cereda, Michael Ke, Gregory W Albers, Jean M Olivot
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled...
May 12, 2017: Neurology
https://www.readbyqxmd.com/read/28496428/effect-of-cyclosporine-on-lesion-growth-and-infarct-size-within-the-white-and-gray-matter
#19
Elodie Ong, Nathan Mewton, Julien Bouvier, Fabien Chauveau, Thomas Ritzenthaler, Laura Mechtouff, Laurent Derex, Marielle Buisson, Yves Berthezène, Michel Ovize, Norbert Nighoghossian, Tae-Hee Cho
BACKGROUND: In a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis. MATERIALS AND METHODS: We analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28494694/antagonizing-dabigatran-by-idarucizumab-in-cases-of-ischemic-stroke-or-intracranial-hemorrhage-in-germany-a-national-case-collection
#20
Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Katharina Althaus, Jörg Berrouschot, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Klaus Gröschel, Claus G Haase, Andreas Harloff, Valentin Held, Andreas Kauert, Peter Kraft, Arne Lenz, Wolfgang Müllges, Mark Obermann, Someieh Partowi, Jan Purrucker, Peter A Ringleb, Joachim Röther, Raluca Rossi, Niklas Schäfer, Andreas Schneider, Ramona Schuppner, Rüdiger J Seitz, Kristina Szabo, Robert Wruck
Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
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