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Stroke AND thrombolysis

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https://www.readbyqxmd.com/read/29221777/prevalence-of-sleep-apnea-at-the-acute-phase-of-ischemic-stroke-with%C3%A2-or-without-thrombolysis
#1
Jaana K Huhtakangas, Juha Huhtakangas, Risto Bloigu, Tarja Saaresranta
OBJECTIVE: The aim of the study was to compare the prevalence, type, and severity of sleep apnea during the acute phase of ischemic stroke among patients either receiving or not receiving thrombolysis. METHODS: We recruited 246 consecutive adult ischemic stroke patients. Patients underwent cardiorespiratory sleep study with portable three-channel device during the first 48 h after the symptom onset of ischemic stroke. RESULTS: We enrolled 110 (65...
December 2017: Sleep Medicine
https://www.readbyqxmd.com/read/29220346/decreased-lymphocyte-to-monocyte-ratio-predicts-poor-prognosis-of-acute-ischemic-stroke-treated-with-thrombolysis
#2
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/29218822/european-academy-of-neurology-european-stroke-organisation-consensus-statement-and-practical-guidance-for-pre-hospital-management-of-stroke
#3
A Kobayashi, A Czlonkowska, G A Ford, A C Fonseca, G J Luijckx, J Korv, N Pérez de la Ossa, C Price, D Russell, A Tsiskaridze, M Messmer-Wullen, J De Keyser
Reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving chances of a favorable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations...
December 7, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29218699/clinical-outcome-of-cardioembolic-stroke-treated-by-intravenous-thrombolysis
#4
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/29217364/collaterals-predict-outcome-regardless-of-time-last-known-normal
#5
Richa Sharma, Rafael H Llinas, Victor Urrutia, Elisabeth B Marsh
BACKGROUND AND PURPOSE: Recent studies suggest that patients with large-vessel ischemic strokes (large-vessel occlusion [LVO]) with favorable imaging may benefit from mechanical thrombolysis even when treated outside the standard 6-hour window. However, many patients in these studies presented with unknown times of onset. We compare outcomes in thrombectomy patients treated at less than versus greater than 6 hours from last known well (LKN), and evaluate whether "unknown time of onset" alters prognosis...
December 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29214305/cardiovascular-outcomes-according-to-urinary-albumin-and-kidney-disease-in-patients-with-type-2-diabetes-at-high-cardiovascular-risk-observations-from-the-savor-timi-53-trial
#6
Benjamin M Scirica, Ofri Mosenzon, Deepak L Bhatt, Jacob A Udell, Ph Gabriel Steg, Darren K McGuire, KyungAh Im, Estella Kanevsky, Christina Stahre, Mikaela Sjöstrand, Itamar Raz, Eugene Braunwald
Importance: An elevated level of urinary albumin to creatinine ratio (UACR) is a marker of renal dysfunction and predictor of kidney failure/death in patients with type 2 diabetes. The prognostic use of UACR in established cardiac biomarkers is not well described. Objective: To evaluate whether UACR offers incremental prognostic benefit beyond risk factors and established plasma cardiovascular biomarkers. Design, Setting, and Participants: The Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI) 53 study was performed from May 2010 to May 2013 and evaluated the safety of saxagliptin vs placebo in patients with type 2 diabetes with overt cardiovascular disease or multiple risk factors...
December 6, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29212743/successful-reperfusion-with-intravenous-thrombolysis-preceding-mechanical-thrombectomy-in-large-vessel-occlusions
#7
Georgios Tsivgoulis, Aristeidis H Katsanos, Peter D Schellinger, Martin Köhrmann, Panayiotis Varelas, Georgios Magoufis, Maurizio Paciaroni, Valeria Caso, Anne W Alexandrov, Edip Gurol, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Although current guidelines advocate pretreatment with intravenous thrombolysis (IVT) in all eligible patients with acute ischemic stroke with large-vessel occlusion before mechanical thrombectomy, there are observational data questioning the efficacy of this approach. One of the main arguments in favor of IVT pretreatment is the potential for tissue-type plasminogen activator-induced successful reperfusion (SR) before the onset of endovascular procedure. METHODS: We performed a systematic review and meta-analysis of randomized controlled clinical trials and observational cohorts providing rates of SR with IVT in patients with large-vessel occlusion before the initiation of mechanical thrombectomy...
December 6, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29212096/-stroke-mimics-and-stroke-chameleons-differential-diagnosis-of-stroke
#8
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
#9
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/29209268/implementation-and-evaluation-of-an-economic-model-for-telestroke-experience-from-virtuall-france
#10
Nolwenn Riou-Comte, Gioia Mione, Lisa Humbertjean, Arielle Brunner, Arnaud Vezain, Karine Lavandier, Sophie Marchal, Serge Bracard, Marc Debouverie, Sébastien Richard
Background: Telestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall, France, which includes one expert center (hub) and six spokes. Methods: The model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29206838/implementation-of-stroke-teams-and-simulation-training-shortened-process-times-in-a-regional-stroke-network-a-network-wide-prospective-trial
#11
Damla Tahtali, Ferdinand Bohmann, Natalia Kurka, Peter Rostek, Anelia Todorova-Rudolph, Martin Buchkremer, Mario Abruscato, Ann-Kathrin Hartmetz, Andrea Kuhlmann, Christian Henke, André Stegemann, Sanjay Menon, Björn Misselwitz, Anke Reihs, Stefan Weidauer, Sven Thonke, Uta Meyding-Lamadé, Oliver Singer, Helmuth Steinmetz, Waltraud Pfeilschifter
BACKGROUND: To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units...
2017: PloS One
https://www.readbyqxmd.com/read/29205466/ischemic-core-thresholds-change-with-time-to-reperfusion-a-case-control-study
#12
Andrew Bivard, Tim Kleinig, Ferdinand Miteff, Kenneth Butcher, Longting Lin, Christopher Levi, Mark Parsons
INTRODUCTION: We aimed to identify if acute ischemic stroke patients with known complete reperfusion after thrombectomy had the same baseline CTP ischemic core threshold to predict infarction as thrombolysis patients with complete reperfusion. METHODS: Patients who underwent thrombectomy were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to patients who were treated with intravenous alteplase alone from the International Stroke Perfusion Imaging Registry...
December 4, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/29205017/drip-and-ship-stroke-thrombolysis-in-the-emergency-department-of-a-healthcare-center-a-possibility-for-those-fallen-ill-in-rural-settings
#13
Joonas H Kauppila, Lasse Raatiniemi, Juha-Matti Isokangas, Matti Martikainen, Katja Piironen
Thrombolysis with tissue plasminogen activator is the mainstay in the treatment of acute stroke. Reducing the delay of thrombolysis treatment improves patient prognosis and reduces the incidence of complications. Variable telestroke regimens have improved the availability of stroke thrombolysis, especially in rural settings, where neurologists are not readily available. In the drip-and-ship strategy, stroke thrombolysis is initiated in a peripheral hospital and the patient is then transferred to a tertiary care unit...
2017: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/29203753/-definition-and-treatment-of-stroke-over-the-centuries
#14
Anna Starostka-Tatar, Beata Łabuz-Roszak, Michał Skrzypek, Mariusz Gąsior, Marek Gierlotka
Stroke was already diagnosed in the ancient times. For hundreds of years the treatment of this disease has changed radically. According to the current WHO definition, stroke is a clinical syndrome caused by focal or generalized brain injury that lasts more than 24 hours or leads to death and has no other cause than vascular. Stroke constitutes a big social and economic problem, as it can lead to death or disability. In the highly developed countries stroke is the third most common cause of adult deaths, the second leading cause of dementia, and the most common cause of disability...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29203731/mechanical-thrombectomy-and-rescue-therapy-for-intracranial-large-artery-occlusion-with-underlying-atherosclerosis
#15
BaiXue Jia, Lei Feng, David S Liebeskind, Xiaochuan Huo, Feng Gao, Ning Ma, Dapeng Mo, Xiaoling Liao, Chunjuan Wang, Xingquan Zhao, Yuesong Pan, Hao Li, Liping Liu, Yilong Wang, Yongjun Wang, Zhong-Rong Miao
OBJECTIVE: To investigate the safety and efficacy of mechanical thrombectomy plus rescue therapy for intracranial large artery occlusion (ILAO) with underlying intracranial atherosclerosis (ICAS). METHODS: Patients enrolled in the intervention group of EAST (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. For underlying ICAS identified during the stent retrieval procedure, rescue treatment was required for those with (1) a degree of arterial stenosis >70% or (2) any degree of arterial with blood flow impairment or (3) evidence of re-occlusion...
December 4, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29201550/dehydration-is-a-strong-predictor-of-long-term-prognosis-of-thrombolysed-patients-with-acute-ischemic-stroke
#16
Sha-Sha Li, Ming-Ming Yin, Zhong-He Zhou, Hui-Sheng Chen
Background and Purpose: Dehydration was found to be involved in the poor prognosis of patients with acute ischemic stroke. It is unclear whether dehydration status before onset is related with prognosis of thrombolysed patients with acute ischemic stroke. If it is the case, quickly hydrating may improve the prognosis. The present study was designed to explore the issue. Methods: Eligible 294 patients with acute ischemic stroke after thrombolysis were enrolled in the present study according to inclusion/exclusion criteria...
November 2017: Brain and Behavior
https://www.readbyqxmd.com/read/29201238/susceptibility-vessel-sign-predicts-poor-clinical-outcome-for-acute-stroke-patients-untreated-by-thrombolysis
#17
Huiqin Liu, Wenli Mei, Yue Huang, Yongli Li, Zuzhi Chen, Dongdong Li, Hong Ye, Jiewen Zhang
The location and length of the susceptibility vessel sign (SVS) predicts poor outcome for patients having received reperfusion therapy. The aim of the present study was to assess the predictive value of SVS regarding the clinical outcome for patients untreated with thrombolysis. A retrospective study on acute stroke patients who underwent multimodal magnetic resonance imaging within 3 days from the onset of symptoms was performed. None of the patients had received thrombolysis therapy. The presence, location and length of the SVS were assessed...
November 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29199997/thrombolysis-for-acute-ischemic-stroke-after-protamine-reversal-of-heparin
#18
Omar Danoun, Pawani Sachar, Kumar Rajamani
No abstract text is available yet for this article.
July 14, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/29199136/cerebral-venous-collaterals-a-new-fort-for-fighting-ischemic-stroke
#19
REVIEW
Lu-Sha Tong, Zhen-Ni Guo, Yi-Bo Ou, Yan-Nan Yu, Xiao-Cheng Zhang, Jiping Tang, John H Zhang, Min Lou
Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae...
November 30, 2017: Progress in Neurobiology
https://www.readbyqxmd.com/read/29198901/does-the-primary-imaging-modality-computed-tomography-or-magnetic-resonance-imaging-influence-stroke-physicians-certainty-on-whether-or-not-to-give-thrombolysis-to-randomized-acute-stroke-patients
#20
Christine Krarup Hansen, Anders Christensen, Helen Rodgers, Inger Havsteen, Christina Kruuse, Hanne Christensen
BACKGROUND: Door-to-needle time of 20 minutes to stroke patients with intravenous tissue plasminogen activator (iv-tPA) is feasible when computed tomography (CT) is used as first-line of brain imaging. Magnetic resonance imaging (MRI)-based assessment is more time-consuming but superior in detecting acute ischemia. The certainty with which stroke physicians prescribe or refrain from giving iv-tPA treatment to CT- versus MRI-examined patients has not previously been studied. The aim of the present study was to determine the effect of a primary imaging strategy of CT or MRI on clinicians' certainty to prescribe or refrain from giving iv-tPA to patients with suspected acute stroke...
November 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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