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Stroke AND thrombolysis

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https://www.readbyqxmd.com/read/29679441/feasibility-safety-and-outcome-of-recanalisation-treatment-in-childhood-stroke
#1
Sandra Bigi, Andrea Dulcey, Jan Gralla, Corrado Bernasconi, Amber Melliger, Alexandre N Datta, Marcel Arnold, Johannes Kaesmacher, Joel Fluss, Annette Hackenberg, Oliver Maier, Johannes Weber, Claudia Poloni, Urs Fischer, Maja Steinlin
Objective Intravenous thrombolysis and endovascular therapy (IVT/EVT) are evidence-based treatments for adults with arterial ischemic stroke (AIS). However, randomized controlled trials in pediatric patients are lacking. This study aimed to describe feasibility, safety, and outcome of IVT/EVT in children with AIS. Methods Retrospective study (01/2000-12/2015) of a multicenter, population-based consecutive cohort of patients aged 1 month - 16 years diagnosed with AIS presenting with a pedNIHSS ≥4. Clinical and radiological data of patients receiving IVT/EVT were compared to those receiving standard care (SC) using linear regression to adjust for potential confounders...
April 20, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29678936/effect-of-stroke-thrombolysis-predicted-by-distal-vessel-occlusion-detection
#2
Wolfgang G Kunz, Matthias P Fabritius, Wieland H Sommer, Christopher Höhne, Pierre Scheffler, Lukas T Rotkopf, Wolfgang P Fendler, Bastian O Sabel, Felix G Meinel, Franziska Dorn, Birgit Ertl-Wagner, Maximilian F Reiser, Kolja M Thierfelder
OBJECTIVE: Among ischemic stroke patients with negative CT angiography (CTA), we aimed to determine the predictive value of enhanced distal vessel occlusion detection using CT perfusion postprocessing (waveletCTA) for the treatment effect of IV thrombolysis (IVT). METHODS: Patients were selected from 1,851 consecutive patients who had undergone CT perfusion. Inclusion criteria were (1) significant cerebral blood flow (CBF) deficit, (2) no occlusion on CTA, and (3) infarction confirmed on follow-up...
April 20, 2018: Neurology
https://www.readbyqxmd.com/read/29674752/protecting-the-ischaemic-penumbra-as-an-adjunct-to-thrombectomy-for-acute-stroke
#3
REVIEW
Jean-Claude Baron
After ischaemic stroke, brain damage can be curtailed by rescuing the 'ischaemic penumbra' - that is, the severely hypoperfused, at-risk but not yet infarcted tissue. Current evidence-based treatments involve restoration of blood flow so as to salvage the penumbra before it evolves into irreversibly damaged tissue, termed the 'core'. Intravenous thrombolysis (IVT) can salvage the penumbra if given within 4.5 h after stroke onset; however, the early recanalization rate is only ~30%. Direct removal of the occluding clot by mechanical thrombectomy considerably improves outcomes over IVT alone, but despite early recanalization in > 80% of cases, ~50% of patients who receive this treatment do not enjoy functional independence, usually because the core is already too large at the time of recanalization...
April 19, 2018: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/29673825/early-prediction-of-poor-outcome-despite-successful-recanalization-after-endovascular-treatment-for-anterior-large-vessel-occlusion-stroke
#4
Huaiming Wang, Meng Zhang, Yonggang Hao, Wenjie Zi, Dong Yang, Zhiming Zhou, Yu Geng, Zhen Wang, Hua Li, Gelin Xu, Graeme J Hankey, Yunyun Xiong, Xinfeng Liu
OBJECTIVE: Successful recanalization (SR) of the occluded artery does not always translate into a good outcome for patients with acute anterior circulation large-vessel occlusion stroke. This study aimed to develop a scale to predict poor outcome early despite SR after endovascular treatment (EVT) for candidates identified using current guidelines. METHODS: The eligible patients with SR were retrospectively enrolled between 2014 and 2016. Poor outcome was defined as modified Rankin Scale of 3 to 6 at 90 days...
April 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29672312/impact-of-brain-atrophy-on-early-neurological-deterioration-and-outcome-in-severe-ischemic-stroke-treated-by-intravenous-thrombolysis
#5
Olivier Tschirret, Gabriela Moreno Legast, Adeline Mansuy, Nathan Mewton, Marielle Buisson, Salem Hannoun, Leila Chamard, Dominique Sappey-Marinier, Carlos El Khoury, Magali Bischoff, Audrey de Parisot, Laurent Derex, Norbert Nighoghossian, Yves Berthezène, Laura Mechtouff
BACKGROUND: Brain atrophy has shown a protective effect on the risk of early neurological deterioration (END) related to malignant edema in patients with hemispheric infarction but could be deleterious on the outcome. AIMS: We aimed to assess whether brain atrophy has an impact on the risk of END and on the outcome in severe ischemic strokes after intravenous (IV) thrombolysis. METHODS: From a prospective thrombolysis registry, 137 patients who had a National Institutes of Health Stroke Scale (NIHSS) ≥15, MRI at admission, and IV thrombolysis were included...
April 19, 2018: European Neurology
https://www.readbyqxmd.com/read/29671862/predictors-of-periprocedural-complications-in-patients-undergoing-percutaneous-coronary-interventions-within-coronary-bypass-grafts
#6
Rafał A Januszek, Artur Dziewierz, Zbigniew Siudak, Tomasz Rakowski, Dariusz Dudek, Stanisław Bartuś
BACKGROUND: During the first decade following the coronary bypass grafting, at least 10 of the patients require percutaneous coronary interventions (PCI) due to graft failure. Saphenous vein grafts (SVG) are innately at a higher risk of periprocedural complications. The present study aimed to investigate predictors of periprocedural complications of PCI within coronary artery bypass grafts. METHODS: This study analyzed data gathered in the Polish National Registry (ORPKI) between January 2015 and December 2016...
April 19, 2018: Cardiology Journal
https://www.readbyqxmd.com/read/29668889/safety-and-efficacy-of-dual-vs-triple-antithrombotic-therapy-in-patients-with-atrial-fibrillation-following-percutaneous-coronary-intervention-a-systematic-review-and-meta-analysis-of-randomized-clinical-trials
#7
Harsh B Golwala, Christopher P Cannon, Ph Gabriel Steg, Gheorghe Doros, Arman Qamar, Stephen G Ellis, Jonas Oldgren, Jurrien M Ten Berg, Takeshi Kimura, Stefan H Hohnloser, Gregory Y H Lip, Deepak L Bhatt
Aims: Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. Methods and results: A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs...
April 13, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29666704/practice-patterns-and-barriers-for-intravenous-thrombolysis-a-survey-of-neurologists-in-saudi-arabia
#8
Mohammed H Alanazy, Rima B Barakeh, Alanood Asiri, Maha F Edrees, Ahmad R Abuzinadah, Bandar N Aljafen, Taim Muayqil
Only a small fraction of patients with acute ischemic stroke receive intravenous thrombolysis (IVT). We sought to assess barriers and practice patterns in using IVT for acute ischemic stroke among neurologists in Saudi Arabia. An electronic survey was sent to all neurologists registered with the Saudi Commission for Health Specialties. A total of 148 (77.5%) neurologists responded. The most common reported barriers for IVT administration were delayed presentation to hospitals (82.4%) and unclear time of symptom onset (50...
2018: Neurology Research International
https://www.readbyqxmd.com/read/29664359/stroke-care-in-africa-a-systematic-review-of-the-literature
#9
Gerard Urimubenshi, Dominique A Cadilhac, Jeanne N Kagwiza, Olivia Wu, Peter Langhorne
Background Appropriate systems of stroke care are important to manage the increasing death and disability associated with stroke in Africa. Information on existing stroke services in African countries is limited. Aim To describe the status of stroke care in Africa. Summary of review We undertook a systematic search of the published literature to identify recent (1 January 2006-20 June 2017) publications that described stroke care in any African country. Our initial search yielded 838 potential papers, of which 38 publications were eligible representing 14/54 African countries...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29663986/-interpretation-of-2018-guidelines-for-the-early-management-of-patients-with-acute-ischemic-stroke
#10
Gang Wang, Bangjiang Fang, Xuezhong Yu, Zhijun Li
In 2018, the American Heart Association/American Stroke Association (AHA/ASA) has developed the latest 2018 guidelines for the early management of patients with acute ischemic stroke (AIS), based on the latest evidences. The 2018 guidelines including recommendations on pre-hospital and in-hospital management treatment, has revised and add new recommendations from 2013 guideline. The major changes in 2018 guideline involve applications of brain imaging in early stage, intravenous thrombolysis and mechanical thrombectomy, et al...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29663187/mri-patient-selection-for-endovascular-thrombectomy-in-acute-ischemic-stroke-correlation-between-pretreatment-diffusion-weighted-imaging-and-outcome-scores
#11
Marcello Longo, Gianmarco Bernava, Alessandro Calamuneri, Antonio A Caragliano, Antonio Pitrone, Rosario Papa, Enricomaria Mormina, Francesca Granata, Rosa Musolino, Agostino Tessitore, Giuseppe Centorrino, Federico Midiri, Federica Vernuccio, Sergio L Vinci
INTRODUCTION: Eligibility for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) depends, amongst other factors, on CT- or MR-based scores. The aim of this study was to investigate the role of Alberta Stroke Program Early CT score based on diffusion weighted imaging (MR-ASPECT) in the assessment of brain damage pre-EVT, patient selection for EVT and outcome. MATERIALS AND METHODS: We included in this study patients with National Institute of Health stroke score (NIHSS) at admission ≥ 8, MR-ASPECT ≥ 5 and anterior AIS, who were treated with EVT in our hospital...
April 16, 2018: La Radiologia Medica
https://www.readbyqxmd.com/read/29661036/when-migraine-mimics-stroke-a-systematic-review
#12
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/29652229/a-useful-diagnostic-method-to-reduce-the-in-hospital-time-delay-for-mechanical-thrombectomy-volume-perfusion-computed-tomography-with-added-vessel-reconstruction
#13
Ho Jun Yi, Jae Hoon Sung, Dong Hoon Lee, Seung Ho Yang, Jae Taek Hong
OBJECTIVE Volume perfusion CT (VPCT) with added CT angiography (CTA)-like reconstruction from VPCT source data (VPCTA) can reveal multiple intracranial parameters. The authors examined the usefulness of VPCTA in terms of reducing the in-hospital time delay for mechanical thrombectomy. METHODS A total of 180 patients who underwent mechanical thrombectomy at the authors' institution between January 2014 and March 2017 were divided into 2 groups: a CTA-based thrombectomy decision group (group 1: CTA) and a VPCTA-based decision group (group 2: VPCTA)...
April 13, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29651772/monitoring-neurointerventional-radiation-doses-using-dose-tracking-software-implications-for-the-establishment-of-local-diagnostic-reference-levels
#14
Holly Acton, Karl James, Richard G Kavanagh, Colm O'Tuathaigh, Deirdre Moloney, Gerald Wyse, Noel Fanning, Michael Maher, Owen J O'Connor
OBJECTIVES: There is potential for high radiation exposure during neurointerventional procedures. Increasing regulatory requirements mandate dose monitoring of patients and staff, and justification of high levels of radiation exposure. This paper demonstrates the potential to use radiation dose-tracking software to establish local diagnostic reference levels. METHODS: Consecutive neurointerventional procedures, performed in a single institution within a one-year period, were retrospectively studied...
April 12, 2018: European Radiology
https://www.readbyqxmd.com/read/29651748/improved-reperfusion-and-vasculoprotection-by-the-poly-adp-ribose-polymerase-inhibitor-pj34-after-stroke-and-thrombolysis-in-mice
#15
Mohamad El Amki, Dominique Lerouet, Marie Garraud, Fei Teng, Virginie Beray-Berthat, Bérard Coqueran, Benoît Barsacq, Charlotte Abbou, Bruno Palmier, Catherine Marchand-Leroux, Isabelle Margaill
Benefits from thrombolysis with recombinant tissue plasminogen activator (rt-PA) after ischemic stroke remain limited due to a narrow therapeutic window, low reperfusion rates, and increased risk of hemorrhagic transformations (HT). Experimental data showed that rt-PA enhances the post-ischemic activation of poly(ADP-ribose)polymerase (PARP) which in turn contributes to blood-brain barrier injury. The aim of the present study was to evaluate whether PJ34, a potent PARP inhibitor, improves poor reperfusion induced by delayed rt-PA administration, exerts vasculoprotective effects, and finally increases the therapeutic window of rt-PA...
April 12, 2018: Molecular Neurobiology
https://www.readbyqxmd.com/read/29651500/outcome-of-endovascular-treatment-for-acute-basilar-artery-occlusion-in-the-modern-era-a-single-institution-experience
#16
Chuanhui Li, Wenbo Zhao, Chuanjie Wu, Shuyi Shang, Jian Chen, Ming Ren, Jiangang Duan, Qingfeng Ma, Guilin Li, Yunzhou Zhang, Hongqi Zhang, Liqun Jiao, Xunming Ji
PURPOSE: The beneficial effect of endovascular treatment (EVT) for patients with acute basilar artery occlusion (ABAO) remains uncertain. The purpose of the present study was to evaluate clinical outcome of EVT for patients with ABAO and analyze prognostic factors of good outcome. METHODS: From our prospectively established database, we reviewed all patients with ABAO receiving EVT during January 2014 to December 2016. Baseline characteristics and outcomes were evaluated...
April 12, 2018: Neuroradiology
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
#17
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/29643261/primary-results-of-the-multicenter-arise-ii-study-analysis-of-revascularization-in-ischemic-stroke-with-embotrap
#18
Osama O Zaidat, Hormozd Bozorgchami, Marc Ribó, Jeffrey L Saver, Heinrich P Mattle, René Chapot, Ana Paula Narata, Olivier Francois, Ashutosh P Jadhav, Jonathan A Grossberg, Christian H Riedel, Alejandro Tomasello, Wayne M Clark, Hannes Nordmeyer, Eugene Lin, Raul G Nogueira, Albert J Yoo, Tudor G Jovin, Adnan H Siddiqui, Thierry Bernard, Mairsíl Claffey, Tommy Andersson
BACKGROUND AND PURPOSE: EmboTrap is a novel stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke secondary to large-vessel occlusions. Here, we evaluated EmboTrap's safety and efficacy compared with established stent retrievers. METHODS: ARISE II (Analysis of Revascularization in Ischemic Stroke With EmboTrap) was a single-arm, prospective, multicenter study, comparing the EmboTrap device to a composite performance goal criterion derived using a Bayesian meta-analysis from the pivotal SWIFT (Solitaire device) and TREVO 2 (Trevo device) trials...
April 11, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29629522/the-influence-of-sex-in-stroke-thrombolysis-a-systematic-review-and-meta-analysis
#19
REVIEW
Mingsu Liu, Guangqin Li, Jie Tang, Yan Liao, Lin Li, Yang Zheng, Tongli Guo, Xin Kang, Maoting Yuan
BACKGROUND AND PURPOSE: There is increasing recognition of the importance of stroke in females to both clinical and public health. The natural course of stroke is worse in females than in males, but the evidence regarding sex disparities in the responses to thrombolysis in stroke patents is still controversial. We compared outcomes after thrombolysis treatment between females and males. METHODS: Clinical trials reported in the Embase, PubMed, and Cochrane Library electronic databases up to March 13, 2017 were included in this analysis...
April 2018: Journal of Clinical Neurology
https://www.readbyqxmd.com/read/29628944/is-the-efficacy-of-endovascular-treatment-for-acute-ischemic-stroke-sex-related
#20
Andreia Carvalho, André Cunha, Tiago Gregório, Ludovina Paredes, Henrique Costa, Miguel Veloso, Sérgio Castro, Manuel Ribeiro, Pedro Jorge Gonçalves Barros
Background: Several reports refer to differences in stroke between females and males, namely in incidence and clinical outcome, but also in response to treatments. Driven by a recent analysis of the MR CLEAN trial, which showed a higher benefit from acute stroke endovascular treatment (EVT) in males, we intended to determine if clinical outcomes after EVT differ between sexes, in a real-world setting. Methods: We analyzed 145 consecutive patients submitted to EVT for anterior circulation large-vessel occlusion, between January 2015 and September 2016, and compared the outcomes between sexes...
February 2018: Interventional Neurology
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