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    Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: A review of the literature.
    Acta Obstet Gynecol Scand 2017 Feb 21. Epub 2017 Feb 21.
    Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
    Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. Read More

    Oxygen or cooling, to make a decision after acute ischemia stroke.
    Med Gas Res 2016 Oct-Dec;6(4):206-211. Epub 2016 Dec 30.
    Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases and Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
    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). Blood brain barrier (BBB) damage within the thrombolytic time window is an indicator for tPA-induced HT and both normobaric hyperoxia (NBO) and hypothermia have been shown to protect the BBB from ischemia/reperfusion injury. Read More

    Hybrid operative thrombectomy is noninferior to percutaneous techniques for the treatment of acute iliofemoral deep venous thrombosis.
    J Vasc Surg Venous Lymphat Disord 2017 Mar 12;5(2):177-184. Epub 2017 Jan 12.
    Department of Surgery, Vascular Surgery Division, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, Puerto Rico.
    Objective: Hybrid operative thrombectomy (HOT) is a novel technique for the treatment of acute iliofemoral deep venous thrombosis (IFDVT) and is an alternative to percutaneous techniques (PTs) that use thrombolytics. In this study, we compare perioperative and intermediate outcomes of HOT vs PT as interventions for early thrombus removal.

    Methods: From July 2008 to May 2015, there were 71 consecutive patients who were treated with either PT (n = 31) or HOT (n = 40) for acute or subacute single-limb IFDVT. Read More

    Catheter-directed, ultrasound-assisted thrombolysis is a safe and effective treatment for pulmonary embolism, even in high-risk patients.
    J Vasc Surg Venous Lymphat Disord 2017 Mar 12;5(2):165-170. Epub 2017 Jan 12.
    The Cardiovascular Care Group, Westfield, NJ. Electronic address:
    Objective: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for acute pulmonary embolism (PE) in patients deemed to be "high risk" for thrombolytic therapy.

    Methods: A retrospective evaluation of patients who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 patients considered, all of whom presented with acute PE as diagnosed by computed tomography angiography. Read More

    Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review.
    J Neurointerv Surg 2017 Feb 17. Epub 2017 Feb 17.
    Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
    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. Read More

    Catheter-Based Approaches for the Treatment of Acute Pulmonary Embolism.
    Semin Respir Crit Care Med 2017 Feb 16;38(1):73-83. Epub 2017 Feb 16.
    Respiratory Department, Ramon y Cajal Hospital, IRYCIS, Alcala de Henares University, Madrid, Spain.
    Except when contraindicated, anticoagulation should be initiated when pulmonary embolism (PE) is strongly suspected and the bleeding risk is perceived to be low, even if the evaluation has not been completed. Low-risk patients with acute PE are simply continued on anticoagulation. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. Read More

    Massive Pulmonary Embolism: Extracorporeal Membrane Oxygenation and Surgical Pulmonary Embolectomy.
    Semin Respir Crit Care Med 2017 Feb 16;38(1):66-72. Epub 2017 Feb 16.
    Division of Lung Transplantation, Extracorporeal Life Support Program, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
    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. Read More

    Systemic Thrombolytic Therapy for Acute Pulmonary Embolism: Who Is a Candidate?
    Semin Respir Crit Care Med 2017 Feb 16;38(1):56-65. Epub 2017 Feb 16.
    Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
    Pulmonary embolism (PE) is a major cause of both acute and long-term morbidity for a large number of patients worldwide, and massive PE is frequently fatal. Right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of PE. Patients with clinically overt RV failure, that is, with cardiogenic shock or persistent hypotension at presentation (acute high-risk PE), are clearly in need of immediate reperfusion treatment with systemic thrombolysis or, alternatively, surgical or catheter-directed techniques. Read More

    Risk Stratification for Proven Acute Pulmonary Embolism: What Information Is Needed?
    Semin Respir Crit Care Med 2017 Feb 16;38(1):11-17. Epub 2017 Feb 16.
    Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcala de Henares University, Madrid, Spain.
    Classification of risk drives treatment decisions for patients with acute symptomatic pulmonary embolism (PE). High-risk patients with acute symptomatic PE have hemodynamic instability (i.e. Read More

    Interventional Treatment of LVAD Outflow Graft Stenosis by Introduction of Bare Metal Stents.
    ASAIO J 2017 Feb 9. Epub 2017 Feb 9.
    1 Department of Cardiac-Surgery, Medical University of Vienna, Austria 2 Center for Medical-Physics and Biomedical-Engineering, Medical University of Vienna, Austria 3 Ludwig Boltzmann Cluster for Cardiovascular-Research, Medical University of Vienna, Austria 4 Department of Cardiology, Medical University of Vienna, Austria 5 Department of Interventional-Radiology, Medical University of Vienna, Austria.
    LVAD outflow graft stenosis is a rare but life-threatening complication of MCS-therapy. Current treatment modalities (pump exchange or systemic thrombolytic therapy) are associated with significant mortality and morbidity.Implantation of bare metal stents within the stenosed outflow graft is an alternative. Read More

    Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer.
    Case Rep Otolaryngol 2017 17;2017:5748402. Epub 2017 Jan 17.
    Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan.
    Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. Read More

    [Direct oral anticoagulants and acute stroke : Insights into translational research studies].
    Nervenarzt 2017 Feb 10. Epub 2017 Feb 10.
    Klinik für Neurologie, Goethe-Universität, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland.
    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. Read More

    The effects of pharmaceutical thrombolysis and multi-modal therapy on patients with acute posterior circulation ischemic stroke: Results of a one center retrospective study.
    Int J Surg 2017 Feb 7;39:197-201. Epub 2017 Feb 7.
    Department of Neurosurgery, Affiliated Bayi Brain Hospital, The Army General Hospital, Beijing, 100700, China. Electronic address:
    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. Read More

    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.
    Stroke 2017 Feb 9. Epub 2017 Feb 9.
    From the Department of Neurology (R.J.A., S.D.O.) and Department of Pediatrics (J.K.), Medical University of South Carolina, Charleston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, AB, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (L.H.S.).
    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. Read More

    Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis.
    Ther Clin Risk Manag 2017 24;13:111-115. Epub 2017 Jan 24.
    Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, NRW, Germany.
    Purpose: Evaluation of the efficacy of single-shot, low-dose urokinase administration for the treatment of port catheter-associated fibrin sheaths.

    Methods: Forty-six patients were retrospectively evaluated for 54 episodes of port catheter dysfunction. The presence of a fibrin sheath was detected by angiographic contrast examinations. Read More

    Cerebral Amyloid Angiopathy in Stroke Medicine.
    Dtsch Arztebl Int 2017 Jan;114(3):37-42
    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. Read More

    Computed Tomography-Based Thrombus Imaging for the Prediction of Recanalization after Reperfusion Therapy in Stroke.
    J Stroke 2017 Jan 31;19(1):40-49. Epub 2017 Jan 31.
    Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.
    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. Read More

    Strategies to Extend Thrombolytic Time Window for Ischemic Stroke Treatment: An Unmet Clinical Need.
    J Stroke 2017 Jan 31;19(1):50-60. Epub 2017 Jan 31.
    Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, United States.
    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. Read More

    Intravenous Thrombolysis in Unknown-Onset Stroke: Results From the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry.
    Stroke 2017 Feb 7. Epub 2017 Feb 7.
    From the Department of Neurosciences, University Hospital Germans Trias i Pujol, Badalona, Spain (L.D., M.L., M.M., A.D.); Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A.); Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Germany (G.T.); Department of Neurology, University Hospital Center Zagreb, Croatia (B.M.); Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom (M.W.); and Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic (A.T.).
    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. Read More

    Long Term Antiarrhythmic Effects of Thrombolytic Therapy in Pulmonary Embolism.
    Heart Lung Circ 2017 Jan 24. Epub 2017 Jan 24.
    Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital.
    Background: The role of thrombolytic therapy in acute pulmonary embolism patients is still controversial considering the occurrence of arrhythmias. Short-term effects of thrombolytics are well-known whereas long-term effects on cardiac electrophysiology have not been reported before. The objective of our study was to assess the arrhythmic differences in pulmonary embolism patients who received thrombolytics followed by anticoagulation or anticoagulation alone. Read More

    Novel Thrombolytic Drug Based on Thrombin Cleavable Microplasminogen Coupled to a Single-Chain Antibody Specific for Activated GPIIb/IIIa.
    J Am Heart Assoc 2017 Feb 3;6(2). Epub 2017 Feb 3.
    NanoBiotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
    Background: Thrombolytic therapy for acute thrombosis is limited by life-threatening side effects such as major bleeding and neurotoxicity. New treatment options with enhanced fibrinolytic potential are therefore required. Here, we report the development of a new thrombolytic molecule that exploits key features of thrombosis. Read More

    CT of the head for acute stroke: Diagnostic performance of a tablet computer prior to intravenous thrombolysis.
    J Med Imaging Radiat Oncol 2017 Feb 3. Epub 2017 Feb 3.
    Department of Radiology, Cork University Hospital, Cork, Ireland.
    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. Read More

    Towards best practice in acute stroke care in Ghana: a survey of hospital services.
    BMC Health Serv Res 2017 Feb 2;17(1):108. Epub 2017 Feb 2.
    School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
    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. Read More

    Sex Differences and Functional Outcome After Intravenous Thrombolysis Revision.
    Stroke 2017 Jan 31. Epub 2017 Jan 31.
    From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (F.H.S., S.M.Z., I.M.B., P.J.N.); Stroke Center and Department of Neurology, University Hospital Basel, Switzerland (H.G., A.P., C.T., S.T.E.); Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.R.); Department of Neurology, Helsinki University Central Hospital, Finland (S.C., N.M.-M., K.A.); Department of Neurology and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.); University Lille, Inserm, CHU Lille, U1171-Degenerative and Vascular Cognitive Disorders, France (D.L., A.H.); Department of Neurology, Clinical Centre of Serbia, Beograd (V.P.); Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.); Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.); Department of Neurology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland (P.M., O.B.); and Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Italy (A.Z.).
    Background And Purpose: Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. Read More

    Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function.
    Congenit Heart Dis 2017 Jan 31. Epub 2017 Jan 31.
    Rady Children's Hospital, San Diego, University of California, San Diego, California, USA.
    Objective: Neonatal coronary thrombosis is a rarely reported disorder, with variable outcomes described. This study assessed the feasibility and safety of an institutional protocol using tissue plasminogen activator (tPA) administration for the treatment of neonatal coronary artery thrombi.

    Methods: They reviewed the outcome of three neonates with clinical evidence of myocardial infarction secondary to coronary thrombosis. Read More

    Therapies for Hemorrhagic Transformation in Acute Ischemic Stroke.
    Curr Treat Options Neurol 2017 Jan;19(1)
    Department of Neurology, The Warren Alpert Medical School of Brown University, 353 Eddy Street APC 530, Providence, RI, 02903, USA.
    Opinion Statement: Hemorrhagic transformation occurs in about 10-15% of patients with acute ischemic stroke. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure. Future research should be directed on identifying indications to treat and use of appropriate homeostatic regimens to effectively reverse the different anticoagulants and thrombolytic agents in an attempt to improve outcomes of patients with hemorrhagic transformation. Read More

    Plasma kallikrein mediates brain hemorrhage and edema caused by tissue plasminogen activator therapy in mice after stroke.
    Blood 2017 Jan 27. Epub 2017 Jan 27.
    Research Division, Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
    Thrombolytic therapy using tissue plasminogen activator (tPA) in acute stroke is associated with increased risks of cerebral hemorrhagic transformation and angioedema. While plasma kallikrein (PKal) has been implicated in contributing to both hematoma expansion and thrombosis in stroke, its role in the complications associated with the therapeutic use of tPA in stroke is not yet available. We investigated the effects of tPA on plasma prekallikrein (PPK) activation and the role of PKal on cerebral outcomes in a murine thrombotic stroke model treated with tPA. Read More

    [Transmissible thrombus and submaximal pulmonary thromboembolism (PE) successfully treated with tenecteplase (TNK)].
    Gac Med Mex 2017 Jan-Feb;153(1):129-133
    UMAE, Hospital de Cardiología No. 34, Monterrey, Nuevo León, N.L., México.
    Right heart thrombus is a slightly detectable condition. In patients presenting with acute pulmonary embolism, the finding of thrombus in transit has been associated with high in-hospital mortality. We present a case of a 50-year-old male patient with acute pulmonary embolism and a thrombus in transit in the right atrium. Read More

    Catheter-directed interventions for pulmonary embolism.
    Cardiovasc Diagn Ther 2016 Dec;6(6):651-661
    Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
    Pulmonary embolism (PE), a potentially life-threatening entity, can be treated medically, surgically, and percutaneously. In patients with right ventricular dysfunction (RVD), anticoagulation alone may be insufficient to restore cardiac function. Because of the morbidity and mortality associated with surgical embolectomy, clinical interest in catheter-directed interventions (CDI) has resurged. Read More

    Minimally invasive treatments for venous compression syndromes.
    Cardiovasc Diagn Ther 2016 Dec;6(6):582-592
    Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
    The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods. We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. Read More

    The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion.
    Int J Biol Sci 2017 1;13(1):57-64. Epub 2017 Jan 1.
    Department of Neurology, xinqiao hospital affiliated Third Military Medical University, Chongqing 400037, China.
    In order to further optimize the treatment strategy for the patients with acute basilar artery occlusion, we were dedicated to study the therapeutic effects and influential factors in the process of treated basilar artery occlusion with thrombolytic combined vascular interventional therapy. 75 patients with acute basilar artery occlusion treated with arterial thrombolytic therapy were analyzed retrospectively. In accordance with the discharge records of patients, their short-term curative effect with 24-hour treatment and 14-days treatment were evaluated. Read More

    YAMATO Study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy).
    Stroke 2017 Jan 24. Epub 2017 Jan 24.
    From the Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (J.A., K.K.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A., K.K., T. Inoue); Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan (N. Morita); Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Japan (M.H.); Hirosaki Stroke and Rehabilitation Center, Japan (N. Metoki); Department of Neurology and Strokology, Nagasaki University Hospital, Japan (Y. Tateishi); Department of Neurology, Kobe City Medical Center General Hospital, Japan (K.T., H.Y.); Fukui-ken Saiseikai Hospital, Fukui, Japan (K.H.); Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University, Japan (Y. Terasawa, K.F., N.Y.); Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan (I.D., N.T.); Japanese Red Cross Okayama Hospital, Japan (T. Iwanaga); Okinawa Kyodo Hospital, Japan (N.K.); Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan (H.M., Y.I.); Shinko Hospital, Kobe, Japan (Y.U., Y.K.); Department of Neurology, Faculty of Medicine, Fukuoka University, Japan (T.O.); Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan (S.F.); Department of Neurology, Yokohama Sakae Kyosai Hospital, Japan (M.Y.); and Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan (S.N.).
    Background And Purpose: We investigated whether administration of edaravone, a free radical scavenger, before or during tissue-type plasminogen activator (tPA) can enhance early recanalization in a major arterial occlusion.

    Methods: The YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy) is an investigator-initiated, multicenter (17 hospitals in Japan), prospective, randomized, and open-label study. Patients with stroke secondary to occlusion of the M1 or M2 portion of the middle cerebral artery and within 4. Read More

    Use of Intravenous Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) Before Stroke.
    Circulation 2017 Jan 24. Epub 2017 Jan 24.
    Duke Clinical Research Institute, Durham, NC.
    Background: -Intravenous recombinant tissue plasminogen activator (rt-PA) is effective in improving outcomes in ischemic stroke; however, there are few data on use of rt-PA in patients who are receiving a non-vitamin K antagonist oral anticoagulant (NOAC).

    Methods: -Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we examined the outcomes of use of thrombolytic therapy in ischemic stroke patients receiving anticoagulation with NOACs versus those on warfarin (international normalized ratio <1.7) or not on anticoagulation from 1,289 registry hospitals between October 2012 and March 2015. Read More

    Translational initiatives in thrombolytic therapy.
    Front Med 2017 Jan 23. Epub 2017 Jan 23.
    Department of Internal Medicine, Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77054, USA.
    Once thrombi have formed as part of the pathology defining myocardial infarction, ischemic stroke, peripheral arterial disease, deep venous thrombosis or other embolic disorders, the only clinically meaningful thrombolytic agents available for reversing the thrombogenic process are various plasminogen activators. These agents are enzymes that reverse fibrin polymerization underlying the coagulation process by converting endogenous plasminogen to plasmin, which cleaves the fibrin network to form increasingly smaller protein fragments, a process known as fibrinolysis. For the most part, the major clinically used thrombolytics, tissue plasminogen activator, urokinase and streptokinase, as well as the experimentally investigated agent staphylokinase, are the products of recombinant DNA technology, which permits molecular optimization of clinical efficacy. Read More

    Thrombin Generation in Acute Ischaemic Stroke.
    Stroke Res Treat 2016 25;2016:7940680. Epub 2016 Dec 25.
    King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
    Introduction. Stroke remains a global leading cause of death and disability. Traditional description of plasma biology in the aftermath of acute ischaemic stroke favours development of hypercoagulability, resulting from complex interplay between plasma and endothelial factors. Read More

    Subcapsular liver hematoma after fibrinolytic therapy for acute myocardial infarction: a rare case report.
    Acta Biomed 2017 Jan 16;87(3):318-320. Epub 2017 Jan 16.
    Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran..
    Hemorrhagic complications of thrombolytic therapy are rare but also serious and sometimes life-threatening. Liver hematoma is a very uncommon complication following thrombolytic therapy. We present a rare case of sub-capsular liver hematoma following streptokinase therapy of acute myocardial infarction as a challenging condition. Read More

    Neuroprotective effects of adjunctive treatments for acute stroke thrombolysis: a review of clinical evidence.
    Int J Neurosci 2017 Jan 23:1-31. Epub 2017 Jan 23.
    a Department of Neurology , Zhujiang Hospital of Southern Medical University , Guangzhou , China.
    The narrow therapeutic time window and risk of intracranial hemorrhage largely restrict the clinical application of thrombolysis in acute ischemic stroke. Adjunctive treatments added to rt-PA may be beneficial to improve the capacity of neural cell to withstand ischemia, and to reduce the hemorrhage risk as well. This review aims to evaluate the neuroprotective effects of adjunctive treatments in combination with thrombolytic therapy for acute ischemic stroke. Read More

    PARK2-dependent mitophagy induced by acidic postconditioning protects against focal cerebral ischemia and extends the reperfusion window.
    Autophagy 2017 Jan 19. Epub 2017 Jan 19.
    a Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Department of Pharmacology, Key Laboratory of Medical Neurobiology of The Ministry of Health of China, Zhejiang Province Key Laboratory of Neurobiology , Zhejiang University , Hangzhou , 310058 , China.
    Prompt reperfusion after cerebral ischemia is critical for neuronal survival. Any strategies that extend the limited reperfusion window will be of great importance. Acidic postconditioning (APC) is a mild acidosis treatment that involves inhaling CO2 during reperfusion following ischemia. Read More

    [Pulmonary thromboembolism: Recent experience of 4 years at a cardiology hospital].
    Rev Med Inst Mex Seguro Soc 2017 Jan-Feb;55(1):52-62
    Servicio de Urgencias, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
    It comprised a series of cases over a period of 4 years, held at the Hospital of Cardiology of the Centro Médico Nacional Siglo XXI, IMSS. From 2008 to 2011, admitted to Emergency 184 patients with suspected pulmonary embolism, of which 41 were removed; of the 143 remaining cases, only 127 patients was diagnosed with PE. The other 16 patients had other diagnoses. Read More

    Efficacy and Safety of Thrombolytic Therapy in Acute Submassive Pulmonary Embolism: Follow-Up Study.
    J Clin Med Res 2017 Feb 31;9(2):163-169. Epub 2016 Dec 31.
    Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India.
    Background: Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding.

    Method: A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G. Read More

    Sequential Multiple Assignment Randomized Trials: An Opportunity for Improved Design of Stroke Reperfusion Trials.
    J Stroke Cerebrovasc Dis 2017 Jan 12. Epub 2017 Jan 12.
    Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
    Background: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice. Read More

    The association of blood urea nitrogen levels with mortality in acute pulmonary embolism.
    J Crit Care 2016 Dec 29. Epub 2016 Dec 29.
    Department of Cardiology, Dr. Siyami Ersek Cardiovascular Surgery Research and Training Hospital, Istanbul, 34773, Turkey.
    Background: The aim of this study was to investigate the association of BUN levels with in-hospital and long-term adverse clinical outcomes in acute pulmonary embolism (APE) patients treated with tissue-plasminogen activator (t-PA).

    Methods: This retrospective study included 252 consecutive confirmed APE patients treated with t-PA. An admission BUN of 34. Read More

    [Telemedical prenotification in acute stroke treatment : Experiences from the Stroke Angel initiative from 2004 until the present].
    Nervenarzt 2017 Feb;88(2):120-129
    Zentrum für Telemedizin Bad Kissingen, Sieboldstr. 7, 97688, Bad Kissingen, Deutschland.
    Objective: The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke.

    Material And Methods: Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhön-Grabfeld and Bad Kissingen since 2005. Read More

    [Telemedicine: Comprehensive coverage and quality - Not a contradiction : Practical experience from the stroke network with telemedicine in northern Bavaria (STENO)].
    Nervenarzt 2017 Feb;88(2):130-140
    Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland.
    Telemedicine is widely used in the field of stroke treatment. Following the pioneering and implementation phase, the quality of the whole stroke treatment process needs to be ensured in telemedically connected hospitals. This is particular important for telestroke hospitals without neurological expertise and can be achieved by integrating telemedicine into the stroke unit concept and stroke networks. Read More

    Combination therapy with liposomal neuroprotectants and tissue plasminogen activator for treatment of ischemic stroke.
    FASEB J 2017 Jan 12. Epub 2017 Jan 12.
    Department of Medical Biochemistry, School of Pharmaceutical Sciences, University of Shizuoka, Japan; and
    For ischemic stroke treatment, extension of the therapeutic time window (TTW) of thrombolytic therapy with tissue plasminogen activator (tPA) and amelioration of secondary ischemia/reperfusion (I/R) injury are most desirable. Our previous studies have indicated that liposomal delivery of neuroprotectants into an ischemic region is effective for stroke treatment. In the present study, for solving the above problems in the clinical setting, the usefulness of combination therapy with tPA and liposomal Fasudil (Fasudil-Lip) was investigated in ischemic stroke model rats with photochemically induced thrombosis, with clots that were dissolved by tPA. Read More

    Endovascular Management of Central Retinal Arterial Occlusion.
    Vasc Endovascular Surg 2016 Nov;50(8):579-581
    1 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
    Background And Importance: Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Read More

    Reactive nitrogen species as therapeutic targets for autophagy: implication for ischemic stroke.
    Expert Opin Ther Targets 2017 Mar 19;21(3):305-317. Epub 2017 Jan 19.
    a School of Chinese Medicine, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR , China.
    Introduction: Roles of autophagy/mitophagy activation in ischemic stroke remain controversial. To elucidate potential reasons, we analyze the factors responsible for divergent results in literatures. Reactive nitrogen species (RNS) are important cytotoxic factors in ischemic stroke. Read More

    Managing challenging patients with venous thromboembolism: a practical, case-based approach.
    Pol Arch Med Wewn 2017 Jan 4;127(1):41-46. Epub 2017 Jan 4.
    The management of patients with venous thromboembolism (VTE) is a common clinical scenario that, for the most part, involves well‑established, evidence‑based treatment pathways. However, important unanswered clinical questions remain that are the focus of ongoing research. The aim of this narrative review is to provide a practical, case‑based approach to the following clinical scenarios in which therapeutic management pathways are less well established: How long to administer anticoagulation to patients with a first unprovoked VTE? How to manage complex patients with cancer‑associated VTE? When and how to treat patients with splanchnic vein thrombosis? When to use thrombolytic therapy for deep vein thrombosis? Read More

    Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital.
    BMJ Qual Improv Rep 2016 19;5(1). Epub 2016 Dec 19.
    South Canterbury DHB, New Zealand.
    Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization service. Read More

    Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy for morbid obesity.
    BMJ Case Rep 2017 Jan 9;2017. Epub 2017 Jan 9.
    Department of Surgery, Mercy Catholic Medical Center, Darby, Pennsylvania, USA.
    Portomesenteric vein thrombosis (PMVT) is a rare, life-threatening pathology associated with increased prevalence in laparoscopic sleeve gastrectomy (LSG) versus other gastric bypass procedures. Gaining popularity, LSG is becoming the first choice of patients and physicians alike due to its low complication profile compared to the gastric bypass procedure. We present the case of a 34-year-old woman who underwent an uncomplicated LSG for the treatment of morbid obesity, and presented on postoperative day 13 with PMVT. Read More

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