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Intraarterial thrombolysis

Y-J Yu, W Xiong
OBJECTIVE: To investigate the curative effect of tirofiban combined with recombinant tissue-plasminogen activator (rt-PA) selective intra-arterial thrombolysis on acute middle cerebral artery occlusion (MCAO). MATERIALS AND METHODS: A total of 60 adult male Japanese white rabbits weighing 2.5-3.0 kg were selected, and the acute cerebral infarction model was established via autologous thromboembolism of middle cerebral artery. Rabbits were randomly divided into 4 groups: tirofiban group (Ti group, 5 μg/kg, n=15), rt-PA group (rt-PA group, 2 mg/kg, n=15), tirofiban + rt-PA group (Ti + rt-PA group, 3 μg/kg Ti + 1 mg/kg rt-PA, n=15), and control group (Co group, n=15)...
May 2018: European Review for Medical and Pharmacological Sciences
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
Young-Jin Kim, Kwang-Wook Cho, Seong-Rim Kim, Do-Sung Yoo, Hae-Kwan Park, Cheol Ji
Objective: Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not...
December 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
Hye Seon Jeong, Jong Wook Shin, Hyon-Jo Kwon, Hyeon-Song Koh, Hae-Sung Nam, Hee Seon Yu, Na Young Yoon, Jei Kim
OBJECTIVES: Thrombolytic therapy is associated with favorable clinical outcomes after successful and rapid recanalization in patients with acute ischemic stroke. This study aimed to evaluate the cost benefits and clinical outcomes at 1 year after intraarterial thrombectomy (IAT) by the rapidity of the successful recanalization. MATERIALS & METHODS: Clinical outcomes of and medical costs incurred by 230 patients with acute ischemic stroke who underwent IAT were compared by the rapidity from symptom onset to successful recanalization (2b/3 thrombolysis in cerebral infarction grade): ≤6-hr ( n  = 143), >6-hr ( n  = 31), and no-recanalization ( n  = 56)...
October 2017: Brain and Behavior
Hussain Shallwani, Hakeem J Shakir, Leonardo Rangel-Castilla, Jason M Davies, Ashish Sonig, Mithun G Sattur, Bernard R Bendok, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neuroendovascular intervention has become a key treatment option for acute ischemic stroke. The Sofia (6F) PLUS catheter was designed for neurovascular access for diagnostic or therapeutic interventions. OBJECTIVE: To report the first series describing use of the Sofia PLUS intermediate/distal access reperfusion catheter in the treatment of acute ischemic stroke. METHODS: In this retrospective study, 41 stroke cases were identified in which the catheter was utilized for thrombolysis/thrombectomy...
March 1, 2018: Neurosurgery
Sami Al Kasab, Robert J Adams, Ellen Debenham, David J Jones, Christine Ann Holmstedt
BACKGROUND: Patients in rural communities lack access to acute stroke therapies. Rapid administration of lytic therapy increases the likelihood of favorable functional outcome in acute ischemic stroke (AIS). At the Medical University of South Carolina (MUSC), we implemented a Web-based telestroke program that allows patients presenting with AIS at a rural hospital to receive expert stroke consultation within minutes. This increases their chances of receiving lytic therapy, and therefore increases the likelihood of good functional outcome...
August 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Ilko L Maier, Daniel Behme, Marlena Schnieder, Ioannis Tsogkas, Katharina Schregel, Alexander Kleinknecht, Katrin Wasser, Mathias Bähr, Michael Knauth, Marios Psychogios, Jan Liman
BACKGROUND: Although endovascular treatment for proximal cerebral vessel occlusion is very effective, it remains controversial if intravenous thrombolysis (IVT) prior to endovascular treatment is superior compared to endovascular treatment alone. In this study we compared functional outcomes and recanalization rates of endovascularly treated stroke patients with and without bridging IVT. METHODS: Patients with acute large artery occlusion within the anterior and posterior cerebral circulation eligible for intraarterial revascularization with and without prior IVT were included in this monocentric, prospective observational study...
January 15, 2017: Journal of the Neurological Sciences
Ahmet Yigit Goktay, Cagin Senturk
Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (<10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation...
2017: Advances in Experimental Medicine and Biology
Lalitha Pidaparthi, Anitha Kotha, Venkat Reddy Aleti, Abhijeet Kumar Kohat, Mridula R Kandadai, Suryaprabha Turaga, Jabeen A Shaik, Suvarna Alladi, Meena A Kanikannan, Borgohain Rupam, Subhash Kaul
BACKGROUND: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. OBJECTIVE: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. MATERIALS AND METHODS: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included...
July 2016: Annals of Indian Academy of Neurology
In Joon Lee, Seong Hoon Kim, Seung Duk Lee, Jae Hwan Lee, Hyun Beom Kim
PURPOSE: To evaluate the feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation (LDLT). MATERIALS AND METHODS: From January 2012 to June 2014, 189 consecutive patients at a single institution underwent LDLT with right-lobe grafts. Among them, 10 were diagnosed with hepatic artery occlusion within 24 hours after LDLT. All 10 underwent endovascular treatment, including drug-eluting stent placement (n = 2), intraarterial thrombolysis (n = 5), or both (n = 3)...
February 2017: Journal of Vascular and Interventional Radiology: JVIR
Sidhartha Tavri, Suvranu Ganguli, Roy G Bryan, Jeremy Goverman, Raymond Liu, Zubin Irani, T Gregory Walker
PURPOSE: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. MATERIALS AND METHODS: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo)...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
S Claiborne Johnston, Pierre Amarenco, Gregory W Albers, Hans Denison, J Donald Easton, Scott R Evans, Peter Held, Jenny Jonasson, Kazuo Minematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong
BACKGROUND: Ticagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia. METHODS: We conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90)...
July 7, 2016: New England Journal of Medicine
Juan Du, Yongqiang Cui, Zheng Wu, Guiping Wang, Xiangkai Kong, Xiaofeng Zhang, Wenbo Duan, Yiling Cai
OBJECTIVE: To investigate the causes and strategy of difficult intraarterial mechanical thrombectomy (≥3 times) in patients with acute ischemic stroke (AIS). METHODS: The clinical data of 8 cases of AIS with thrombectomy ≥3 times admitted in Department of Neurology, the 306(th) Hospital of People's Liberation Army from June to October in 2015 was analyzed retrospectively. There were 7 male and 1 female patients, aged from 38 to 86 years with an average age of (70±15) years, in which 5 cases were cardiogenic cerebral embolism and 3 cases were large artery atherosclerotic infarction...
May 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
L Rangel-Castilla, K V Snyder, A H Siddiqui, E I Levy, L N Hopkins
Acute ischemic stroke (AIS) is the leading cause of long-term disability and the second cause of death worldwide. Intravenous (IV) tissue plasminogen activator (tPA) remains the only FDA-approved treatment for AIS. The use of IV tPA in AIS related to large-vessel occlusion (LVO) has shown low recanalization rates and poor clinical outcomes. Over the last decade, endovascular treatment has demonstrated safety and effectiveness in the management of LVO-associated AIS due to the evolution of endovascular techniques and technologies, beginning with intraarterial thrombolysis, aspiration, self- expanding intracranial stents, and now retrievable stents...
December 18, 2015: Journal of Cardiovascular Surgery
Gregory G Salzler, Ashley Graham, Peter H Connolly, Darren B Schneider, Andrew J Meltzer
BACKGROUND: Contemporary endovascular management of acute limb ischemia (ALI) generally consists of tissue plasminogen activator (tPA) based catheter-directed thrombolysis (CDT) with or without pharmacomechanical thrombectomy (PMT). Although abciximab (Reopro), a GPIIb/IIIa receptor antagonist, is widely used in coronary revascularization, its safety and effectiveness in the treatment of ALI are unknown. Here, we review our contemporary experience with the endovascular management of ALI and assess the safety and effectiveness of abciximab...
January 2016: Annals of Vascular Surgery
Grant C Sorkin, Travis M Dumont, Maxim Mokin, Jorge L Eller, Sabareesh K Natarajan, Elad I Levy, Adnan H Siddiqui
UNLABELLED: A 57-year-old woman with National Institutes of Health Stroke Scale (NIHSS) score of 26 was found to have an acute left carotid occlusion with tandem left M1 thrombus within 1.5 hours of symptom onset. After no neurologic improvement following standard-dose intravenous (IV) recombinant tissue plasminogen activator (rtPA), emergent neuroendovascular revascularization with carotid stenting and intracranial thrombectomy were performed under conscious sedation. Thrombolysis in myocardial infarction (TIMI)-3 flow restoration and symptom resolution were achieved postprocedure; however, complete carotid stent thrombosis was noted on final angiographic runs (25 minutes later), correlating with neurologic decline...
July 2015: Journal of Vascular and Interventional Neurology
Matthew J Kogut, David S Shin, Siddharth A Padia, Guy E Johnson, Daniel S Hippe, Karim Valji
PURPOSE: Hepatic artery thrombosis (HAT) is a major cause of morbidity and death following liver transplantation. The purpose of this study was to evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) in liver transplant recipients with HAT. MATERIALS AND METHODS: Adult liver transplant recipients who underwent attempted IAT for HAT were identified. This included patients with early and late HAT (occurring less than or greater than 30 d after transplantation)...
September 2015: Journal of Vascular and Interventional Radiology: JVIR
Russell Cerejo, Seby John, Andrew B Buletko, Ather Taqui, Ahmed Itrat, Natalie Organek, Sung-Min Cho, Lila Sheikhi, Ken Uchino, Farren Briggs, Andrew P Reimer, Stacey Winners, Gabor Toth, Peter Rasmussen, Muhammad S Hussain
INTRODUCTION: Favorable outcomes in intraarterial therapy (IAT) for acute ischemic stroke (AIS) are related to early vessel recanalization. The mobile stroke treatment unit (MSTU) is an on-site, prehospital, treatment team, laboratory, and CT scanner that reduces time to treatment for intravenous thrombolysis and may also shorten time to IAT. METHODS: Using our MSTU database, we identified patients that underwent IAT for AIS. We compared the key time metrics to historical controls, which included patients that underwent IAT at our institution six months prior to implementation of the MSTU...
November 2015: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Ying Mao, Guang-Xian Nan, Li Zhang, Yu-Jing Huang
No abstract text is available yet for this article.
December 2015: Acta Neurologica Belgica
Daniel Knap, Maciej Honkowicz, Tomasz Kirmes, Marcin Koroński, Mateusz Bukański, Marzena Kysiak, Bartosz Kadłubicki, Izabela Dymon, Dominik Sieroń, Jan Baron
OBJECTIVE: Presentation of the own experience in the treatment of ischemic stroke using endovascular methods of simultaneous evaluation of their effectiveness and safety. MATERIALS AND METHODS: The retrospective study involved a group of 18 patients hospitalized in 2005-2012 who were treated with intraarterial thrombolysis and mechanical thrombectomy. Overall there were 24 procedures performed. The investigated group consisted of seven (38.89%) women and 11 (61...
2015: Neurologia i Neurochirurgia Polska
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