9,109 results match your criteria Thrombolytic Therapy in Stroke


Analysis of the Association Between Polymorphisms within PAI-1 and ACE genes and Ischemic Stroke Outcome After rt-PA Therapy.

J Pharm Pharm Sci 2019 ;22(1):142-149

Institute of Human Genetics, Faculty of Medicine, University of Belgrade, Serbia.

Purpose: Treatment of Ischemic stroke (IS) in acute phase is based on the use of thrombolytic rt-PA therapy. We aimed to determine whether different alleles and genotypes of I/D ACE gene and 4G/5G PAI-1 gene polymorphisms may influence outcome of rt-PA therapy in patients with IS and the occurrence of haemorrhagic transformation (HT).

Methods: Our study included 94 consecutive patients with IS treated with rt-PA. Read More

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http://dx.doi.org/10.18433/jpps30339DOI Listing
January 2019

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain.

Eur Stroke J 2017 Sep 1;2(3):272-284. Epub 2017 Aug 1.

Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

Introduction: To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain.

Materials And Methods: Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). Read More

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http://dx.doi.org/10.1177/2396987317721865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454829PMC
September 2017

Theophylline as an add-on to thrombolytic therapy in acute ischaemic stroke (TEA-Stroke): A randomized, double-blinded, placebo-controlled, two-centre phase II study.

Eur Stroke J 2016 Dec 14;1(4):248-254. Epub 2016 Oct 14.

Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.

Introduction: Early reperfusion of brain tissue at risk of injury (penumbra salvage) is crucial in treating acute ischaemic stroke. Neuroprotective agents may extend the time window for the reperfusion. The vasoactive agent theophylline redistributes the perfusion to ischaemic brain tissue and thus reduces brain damage, brain tissue oedema and mortality in animal stroke models. Read More

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http://dx.doi.org/10.1177/2396987316674542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301252PMC
December 2016

Study of Ischemia Modified Albumin as a Biomarker in Acute Ischaemic Stroke.

Ann Neurosci 2018 Dec 28;25(4):187-190. Epub 2018 Jun 28.

Narayana Medical College and Hospitals, Nellore, India.

Background And Purpose: Stroke is one of the leading causes of mortality and long-term disability. Prompt diagnosis and treatment of stroke are crucial for a better outcome. A blood test, which serves as a biomarker in rural areas will help in immediately transferring patients to a hospital for thrombolytic therapy. Read More

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http://dx.doi.org/10.1159/000488188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470340PMC
December 2018

Protease-independent action of tissue plasminogen activator in brain plasticity and neurological recovery after ischemic stroke.

Proc Natl Acad Sci U S A 2019 Apr 17. Epub 2019 Apr 17.

Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh, Pittsburgh, PA 15213;

Emerging evidence suggests that tissue plasminogen activator (tPA), currently the only FDA-approved medication for ischemic stroke, exerts important biological actions on the CNS besides its well-known thrombolytic effect. In this study, we investigated the role of tPA on primary neurons in culture and on brain recovery and plasticity after ischemic stroke in mice. Treatment with recombinant tPA stimulated axonal growth in culture, an effect independent of its protease activity and achieved through epidermal growth factor receptor (EGFR) signaling. Read More

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http://dx.doi.org/10.1073/pnas.1821979116DOI Listing
April 2019
1 Read

The association between early neurological deterioration and whole blood purine concentration during acute stroke.

Biomark Res 2019 3;7. Epub 2019 Apr 3.

1NIHR Newcastle Biomedical Research Centre and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.

Background: Early neurological deterioration (END) is common after stroke. Prediction could identify patients requiring additional monitoring and intervention. Purines, breakdown products of adenosine triphosphate which accumulate during acute hypoxia, may reflect the subclinical presence of vulnerable tissue. Read More

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http://dx.doi.org/10.1186/s40364-019-0158-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448300PMC

Clinical application value of brain CT perfusion imaging in the treatment of acute ischemic stroke thrombolytic therapy.

Exp Ther Med 2019 May 22;17(5):3971-3976. Epub 2019 Mar 22.

Department of Imaging, Liaocheng Brain Hospital, Liaocheng, Shandong 252000, P.R. China.

Clinical application value of CT perfusion (CTP) imaging in the treatment of acute ischemic stroke (AIS) thrombolytic therapy was investigated. Retrospective analysis of 185 suspected AIS patients in Liaocheng Brain Hospital from April 2012 to December 2017 were involved. We observed the non-contrast CT (NCCT) and CTP in the diagnosis of AIS patients, and recorded as well as compared CTP parameters of AIS patients. Read More

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http://dx.doi.org/10.3892/etm.2019.7431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447903PMC
May 2019
1 Read

t-PA Suppresses the Immune Response and Aggravates Neurological Deficit in a Murine Model of Ischemic Stroke.

Front Immunol 2019 27;10:591. Epub 2019 Mar 27.

Molecular Neurotrauma and Haemostasis, Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia.

Acute ischemic stroke (AIS) is a potent trigger of immunosuppression, resulting in increased infection risk. While thrombolytic therapy with tissue-type plasminogen activator (t-PA) is still the only pharmacological treatment for AIS, plasmin, the effector protease, has been reported to suppress dendritic cells (DCs), known for their potent antigen-presenting capacity. Accordingly, in the major group of thrombolyzed AIS patients who fail to reanalyze (>60%), t-PA might trigger unintended and potentially harmful immunosuppressive consequences instead of beneficial reperfusion. Read More

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http://dx.doi.org/10.3389/fimmu.2019.00591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445967PMC
March 2019
1 Read

Synergistic role of susceptibility-weighted imaging with diffusion-weighted imaging and magnetic resonance angiography in the evaluation of acute arterial stroke.

J Int Med Res 2019 Apr 10:300060519840909. Epub 2019 Apr 10.

3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Objective: This study was performed to investigate whether diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are more effective than conventional imaging modalities for evaluation of stroke and selection of candidates for thrombolytic therapy.

Methods: Eighty patients who presented within 12 hours of onset of symptoms of brain ischemia underwent 1.5T magnetic resonance imaging. Read More

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http://dx.doi.org/10.1177/0300060519840909DOI Listing
April 2019
1 Read

Post-Stroke Blood-Brain Barrier Disruption and Poor Functional Outcome in Patients Receiving Thrombolytic Therapy.

Cerebrovasc Dis 2019 Apr 10:1-8. Epub 2019 Apr 10.

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA,

Background And Purpose: The role played by post-stroke inflammation after an ischemic event in limiting functional recovery remains unclear. One component of post-stroke inflammation is disruption of the blood-brain barrier (BBB). This study examines the relationship between post-stroke BBB disruption and functional outcome. Read More

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http://dx.doi.org/10.1159/000499666DOI Listing
April 2019
2 Reads

Accuracy of laboratory tests collected at referring hospitals versus tertiary care hospitals for acute stroke patients.

PLoS One 2019 10;14(4):e0214874. Epub 2019 Apr 10.

Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: The standard treatment of acute ischemic stroke patients is thrombolytic therapy within 60 minutes of a patient's arrival in stroke center hospitals. Based on the policy of the Lampang Referral System Committee, blood samples of suspected stroke patients need to be collected before transfer to the stroke center (Lampang Hospital). It was still questionable as to whether these blood samples are valid for clinical use and the present study aimed to confirm or deny their validity. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214874PLOS
April 2019
6 Reads

Therapeutic strategy against ischemic stroke with the concept of neurovascular unit.

Neurochem Int 2019 Jun 1;126:246-251. Epub 2019 Apr 1.

Department of Neurosurgery, Graduate School of Medicine, Osaka University, Japan.

Stroke is one of the leading causes of death and disability globally. Although thrombolytic therapy by t-PA and mechanical thrombectomy have improved outcomes of ischemic stroke patients, both of these approaches are applicable to limited numbers of patients owing to their time constraints. Therefore, development of other treatment approaches such as developing neuroprotective drugs and nerve regeneration therapy is required to overcome ischemic stroke. Read More

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http://dx.doi.org/10.1016/j.neuint.2019.03.022DOI Listing

Comparative efficacy and safety of bridging strategies with direct mechanical thrombectomy in large vessel occlusion: A systematic review and meta-analysis.

Medicine (Baltimore) 2019 Apr;98(14):e14956

Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China.

Background: Whether bridging strategies[intravenous thrombolysis (IVT) + mechanical thrombectomy (MT)] are superior to mechanical thrombectomy alone for large vessel occlusion(LVO) is still uncertain. A systematic review and meta-analysis was conducted to investigate and evaluate comparative efficacy and safety of bridging strategies vs direct MT in patients with LVO.

Methods: The PubMed, EMBASE and Cochrane library databases were searched to evaluate the efficacy and safety of bridging strategies with direct MT in LVO. Read More

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http://dx.doi.org/10.1097/MD.0000000000014956DOI Listing
April 2019
1 Read
5.723 Impact Factor

Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke: Case report and review.

Am J Emerg Med 2019 Mar 27. Epub 2019 Mar 27.

Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address:

The frequency of stroke mimics among stroke patients has been reported to be up to 30%, and that in patients who receive thrombolytic therapy ranges between 1% and 16%. Atlantoaxial dislocation with myelopathy mimicking stroke is extremely rare. An 83-year-old man with a history of old cerebellar infarction presented to the emergency department with acute left hemiplegia after a chiropractic manipulation of the neck and back several hours before symptom onset. Read More

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http://dx.doi.org/10.1016/j.ajem.2019.03.044DOI Listing
March 2019
2 Reads

Thrombolytic Therapy for Acute Ischemic Stroke: Past and Future.

Curr Pharm Des 2019 Mar 18. Epub 2019 Mar 18.

Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy. Japan.

Background: Thromboembolic ischemic stroke, which is mainly caused by hypertension, as well as plasma dyslipidemia, arterial fibrillation and diabetes, is a leading cause of death in the US and other countries. Numerous clinical trials for thrombolytic drugs, which aimed to pharmacologically dissolve thrombi, were conducted from the 1950s, when the first thrombolytic therapy was performed.

Method: We will summarize the pathophysiologic features of ischemic stroke, and the history of thrombolytic therapy, and discuss the recent progress that has been made in the ongoing development of thrombolytic drugs. Read More

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http://dx.doi.org/10.2174/1381612825666190319115018DOI Listing
March 2019
1 Read

Features of Childhood Arterial Ischemic Stroke in China.

Fetal Pediatr Pathol 2019 Mar 19:1-9. Epub 2019 Mar 19.

a Shengjing Hospital of China Medical University , Shenyang , China.

Objective: The aim of this study was to identify the features and risk factors for arterial ischemic stroke (AIS) in children.

Methods: We retrospectively analyzed the initial symptoms, clinical manifestations, risk factors, neuroradiological findings, and treatment data of 75 Chinese children aged between 1 month and 14 years (median 5.7 years) who were diagnosed with AIS in our hospital between 2013 and 2018. Read More

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https://www.tandfonline.com/doi/full/10.1080/15513815.2019.1
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http://dx.doi.org/10.1080/15513815.2019.1588438DOI Listing
March 2019
3 Reads
0.398 Impact Factor

The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis.

Clin Interv Aging 2019 27;14:493-503. Epub 2019 Feb 27.

Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland,

Purpose: The role of biomarkers in the prediction of acute ischemic stroke (AIS) outcome or response to thrombolytic therapy (with recombinant tissue plasminogen activator [rt-PA]) remains limited. The aim of this study was to evaluate whether mean platelet volume (MPV) could predict short-term functional outcome in patients with AIS following rt-PA treatment.

Patients And Methods: This was a retrospective analysis of 237 AIS patients (mean age 71. Read More

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http://dx.doi.org/10.2147/CIA.S195451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398411PMC
February 2019
3 Reads

Mathematical Modelling of Intravenous Thrombolysis in Acute Ischaemic stroke: Effects of Dose Regimens on Levels of Fibrinolytic Proteins and Clot Lysis Time.

Pharmaceutics 2019 Mar 7;11(3). Epub 2019 Mar 7.

Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.

Thrombolytic therapy is one of the medical procedures in the treatment of acute ischaemic stroke (AIS), whereby the tissue plasminogen activator (tPA) is intravenously administered to dissolve the obstructive blood clot. The treatment of AIS by thrombolysis can sometimes be ineffective and it can cause serious complications, such as intracranial haemorrhage (ICH). In this study, we propose an efficient mathematical modelling approach that can be used to evaluate the therapeutic efficacy and safety of thrombolysis in various clinically relevant scenarios. Read More

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http://dx.doi.org/10.3390/pharmaceutics11030111DOI Listing

Thrombolytic Therapy in Cocaine Users with Ischemic Stroke: A Review of Current Practice.

Psychopharmacol Bull 2019 Feb;49(1):70-79

Siniscalchi, MD, Pisani, Department of Neurology, "Annunziata" Hospital, Cosenza, Italy. De Sarro, Gallelli, Department of Health Science, School of Medicine, University of Catanzaro Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy. Pacifici, National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, Rome. Italy. Sanguigni, Department of Neurology, Madonna del Soccorso Hospital, S Benedetto del Tronto, Italy.

Alteplase is the main pharmacological treatment available for intravenous thrombolysis in patients with acute ischemic stroke. Endovascular treatment alone or add-on to intravenous thrombolysis is a valid approach in acute ischemic stroke with cerebral large vessel disease. The most common serious adverse reaction related to alteplase is the development of spontaneous intracerebral hemorrhage and the presence of cerebral small vessel disease may increase this risk, particularly in cocaine users, even if only few data have been published on this topic. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386426PMC
February 2019
1 Read

Management of Blood Pressure During and After Recanalization Therapy for Acute Ischemic Stroke.

Front Neurol 2019 21;10:138. Epub 2019 Feb 21.

Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.

Ischemic stroke is a common neurologic condition and can lead to significant long term disability and death. Observational studies have demonstrated worse outcomes in patients presenting with the extremes of blood pressure as well as with hemodynamic variability. Despite these associations, optimal hemodynamic management in the immediate period of ischemic stroke remains an unresolved issue, particularly in the modern era of revascularization therapies. Read More

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http://dx.doi.org/10.3389/fneur.2019.00138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394277PMC
February 2019
2 Reads

Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke.

Stroke 2019 Apr;50(4):1013-1016

From the China National Clinical Research Center for Neurological Diseases (H.-Q.G., X.Y., C.-J.W., Y.-L.W., C.-Y.W., H.L., Z.-X.L., Y.-J.W.), Beijing Tiantan Hospital, Capital Medical University, China.

Background and Purpose- Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods- We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates' balance assessments. Read More

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http://dx.doi.org/10.1161/STROKEAHA.118.024232DOI Listing
April 2019
2 Reads

Therapeutic Advances in Emergency Cardiology: Acute Pulmonary Embolism.

Am J Ther 2019 Mar/Apr;26(2):e248-e256

County Emergency Hospital, Baia Mare, Romania.

Background: Acute pulmonary embolism (PE) requires rapid diagnosis and early and appropriate treatment, often under conditions of hemodynamic instability. The therapeutic strategy should optimally integrate the therapeutic arsenal in a multidisciplinary but unitary approach.

Areas Of Uncertainty: The short list of the major uncertainties associated with acute PE should include limited general public awareness on venous thromboembolism, acute hemodynamic support not based on evidence from randomized clinical trials, with few updates lately, mainly linked to extracorporeal membrane oxygenation, thrombolytic therapy having firm indications only in high-risk PE, without clear strategies for particular clinical situations (ie, stroke, tumors, thrombi in transit, and cardiac arrest), using old therapeutic agents with old administration regimens, lack of evidence from large-volume trials on the optimal interventional approach, and relatively imprecise indications for surgical treatment. Read More

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http://Insights.ovid.com/crossref?an=00045391-201904000-0000
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http://dx.doi.org/10.1097/MJT.0000000000000917DOI Listing
March 2019
11 Reads
1.127 Impact Factor

Current Perspectives in Facilitated Angioplasty.

Am J Ther 2019 Mar/Apr;26(2):e208-e212

Cardiology Department, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.

Background: Ischemic heart disease represents the most important cause of mortality worldwide, and the management of patients with ST-elevation myocardial infarction (STEMI) still remains a great challenge. For a great number of patients who do not have immediate access to primary percutaneous coronary intervention (PCI), facilitated angioplasty may be a reasonable therapeutic option.

Areas Of Uncertainty: The goal of reperfusion therapy is achieving repermeabilization of the infarct-related artery. Read More

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http://dx.doi.org/10.1097/MJT.0000000000000914DOI Listing
March 2019
6 Reads
1.127 Impact Factor

Applications of Liposomal Drug Delivery Systems to Develop Neuroprotective Agents for the Treatment of Ischemic Stroke.

Biol Pharm Bull 2019 ;42(3):319-326

Department of Medical Biochemistry, School of Pharmaceutical Sciences, University of Shizuoka.

Ischemic stroke is one of the leading causes of severe disability and death. In clinical settings, tissue plasminogen activator (t-PA) for thrombolytic therapy is the only globally approved drug for the treatment of ischemic stroke. However, the proportion of patients who receive t-PA therapy is extremely limited due to its narrow therapeutic time window (TTW) and the risk of cerebral hemorrhage. Read More

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http://dx.doi.org/10.1248/bpb.b18-00683DOI Listing
January 2019
1 Read

Thrombolysis in an acute ischemic stroke patient with rivaroxaban anticoagulation: A case report.

Medicine (Baltimore) 2019 Feb;98(8):e14560

Department of Neurology, Taipei Medical University, Shuang Ho Hospital.

Rationale: Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial.

Patient Concerns: A 76-year-old woman with nonvalvular atrial fibrillation, who had been receiving 15 mg rivaroxaban once daily, was brought to the emergency department with right-side hemiparesis and aphasia. The onset of neurological deficits occurred 8 hours after the last dose of rivaroxaban administration. Read More

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http://dx.doi.org/10.1097/MD.0000000000014560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408142PMC
February 2019
2 Reads

Dasatinib Re-initiation after Post-stroke Thrombolysis Associated with Symptomatic Intracerebral Hemorrhage.

World Neurosurg 2019 Feb 21. Epub 2019 Feb 21.

Department of Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address:

Background: Dasatinib, a tyrosine kinase inhibitor commonly used in treatment of acute lymphoblastic leukemia and chronic myelogenous leukemia (CML), is often associated with hemorrhagic complications. Safety of Dasatinib after thrombolytic therapy in acute ischemic stroke (AIS) is unknown.

Case Description: 63-year-old man with multiple vascular risk factors and CML (in molecular remission) on Dasatinib presented with signs and symptoms of right hemispheric stroke due to acute intracranial internal carotid artery occlusion that was treated with intravenous thrombolysis and mechanical thrombectomy resulting in near complete resolution of stroke symptoms. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S18788750193043
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http://dx.doi.org/10.1016/j.wneu.2019.02.026DOI Listing
February 2019
6 Reads

Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study.

J Neurol Sci 2019 Apr 29;399:76-81. Epub 2019 Jan 29.

School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background And Purpose: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0. Read More

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http://dx.doi.org/10.1016/j.jns.2019.01.047DOI Listing
April 2019
1 Read

Mechanical thrombectomy and the future of acute stroke treatment.

Eur J Radiol 2019 Mar 29;112:214-221. Epub 2019 Jan 29.

Departments of Medical Imaging & Neurosurgery, University of Toronto, Toronto, Ontario, Canada.

After being staggered by numerous negative trials in 2013, the interventional stroke community saw four years of vindication for mechanical thrombectomy showing efficacy and safety, even beyond a hopeful 6-8 hour window out to 24 h. A landmark set of five trials in 2015 provided a foundation upon which years of incremental follow-ups, meta-analyses and new breakthroughs would be built. With optimized devices for thrombectomy and image analysis, the neurointerventional community has turned to workflow and systemization in this new era of acute ischemic stroke treatment. Read More

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http://dx.doi.org/10.1016/j.ejrad.2019.01.029DOI Listing
March 2019
2.369 Impact Factor

Comparison of myocardial microcirculatory perfusion after catheter-administered intracoronary thrombolysis with anisodamine versus standard thrombus aspiration in patients with ST-elevation myocardial infarction.

Catheter Cardiovasc Interv 2019 Feb 17;93(S1):839-845. Epub 2019 Feb 17.

Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

Objective: To evaluate efficacy, safety and feasibility of targeted intracoronary injection using pro-urokinase combined with anisodamine (TCA) versus thrombus aspiration (TA) in ST-elevation myocardial infarction (STEMI) patients with high thrombus loads.

Background: The best method of avoiding thrombus detachment and stroke in PCI patients with high thrombus loads has not yet been established.

Methods: STEMI patients receiving coronary artery angiography or percutaneous coronary intervention (CAG/PCI) with thrombus grade ≥ 3 from January 1, 2017 to June 30, 2018 were randomly assigned to targeted intracoronary thrombolysis (pro-urokinase and anisodamine via catheter (TCA) group), or the TA group which followed the standard thrombus aspiration procedure. Read More

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http://dx.doi.org/10.1002/ccd.28112DOI Listing
February 2019
2 Reads

Atypical Thrombotic Thrombocytopenic Purpura Presenting as Stroke.

Case Rep Hematol 2019 14;2019:7425320. Epub 2019 Jan 14.

Division of Hematology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6411 Fannin Street, Houston 77030, USA.

Here we report a case of atypical thrombotic thrombocytopenic purpura that presented as an ischemic cerebrovascular accident. A 56-year-old man with multiple cardiovascular risk factors presented with sudden left-sided weakness, slurred speech, and left facial droop. He showed mild improvement when he was treated with thrombolytic therapy according to the hospital stroke protocol. Read More

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http://dx.doi.org/10.1155/2019/7425320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350572PMC
January 2019
5 Reads

Time Is Brain.

Stroke 2019 Mar;50(3):552-553

From the Institute and Policlinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.

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http://dx.doi.org/10.1161/STROKEAHA.118.024214DOI Listing

Thrombolysis in Acute Ischemic Stroke after Idarucizumab for Dabigatran Etexilate Reversal in Elderly: A Case Report.

J Vasc Interv Neurol 2018 Nov;10(2):15-17

Stroke Unit, Department of Neuroscience, AOU Sassari, Italy.

Introduction: Dabigatran is one of the nonvitamin K antagonist oral anticoagulants. Thrombolytic treatment with intravenous recombinant tissue plasminogen activator is contraindicated in patients taking a DOAC. Idarucizumab was recently approved for dabigatran-activity reversing in severe bleeding, emergency surgery, or urgent procedures, but many attempts have been made to use idarucizumab in patients presenting with acute ischemic stroke in order to be eligible for thrombolysis. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350876PMC
November 2018
8 Reads

Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial.

Lancet 2019 03 7;393(10174):877-888. Epub 2019 Feb 7.

Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, UK.

Background: Systolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intravenous alteplase in patients with acute ischaemic stroke, but the target systolic blood pressure for optimal outcome is uncertain. We assessed intensive blood pressure lowering compared with guideline-recommended blood pressure lowering in patients treated with alteplase for acute ischaemic stroke.

Methods: We did an international, partial-factorial, open-label, blinded-endpoint trial of thrombolysis-eligible patients (age ≥18 years) with acute ischaemic stroke and systolic blood pressure 150 mm Hg or more, who were screened at 110 sites in 15 countries. Read More

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http://dx.doi.org/10.1016/S0140-6736(19)30038-8DOI Listing
March 2019
5 Reads

Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis.

J Stroke 2019 Jan 31;21(1):78-90. Epub 2019 Jan 31.

Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Background And Purpose: Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes.

Methods: Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0-1) and 3-month functional independence (mRS scores of 0-2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. Read More

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http://dx.doi.org/10.5853/jos.2018.02369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372893PMC
January 2019
2 Reads

Visualizing the Distribution of Matrix Metalloproteinases in Ischemic Brain Using In Vivo F-Magnetic Resonance Spectroscopic Imaging.

Contrast Media Mol Imaging 2019 6;2019:8908943. Epub 2019 Jan 6.

Center for Integrated Human Brain Science, Brain Research Institute, University of Niigata, Niigata, Japan.

Matrix metalloproteinases (MMPs) damage the neurovascular unit, promote the blood-brain barrier (BBB) disruption following ischemic stroke, and play essential roles in hemorrhagic transformation (HT), which is one of the most severe side effects of thrombolytic therapy. However, no biomarkers have presently been identified that can be used to track changes in the distribution of MMPs in the brain. Here, we developed a new F-molecular ligand, TGF-019, for visualizing the distribution of MMPs in vivo using F-magnetic resonance spectroscopic imaging (F-MRSI). Read More

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http://dx.doi.org/10.1155/2019/8908943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339703PMC
January 2019
2 Reads

Combined application of hypothermia and medical gases in cerebrovascular diseases.

Med Gas Res 2018 Oct-Dec;8(4):172-175. Epub 2019 Jan 9.

Department of Neurosurgery & Brain and Nerve Research Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.

Cerebrovascular diseases have a heavy burden on society and the family. At present, in the treatment of cerebrovascular diseases, the recognized effective treatment method is a thrombolytic therapy after cerebral infarction, but limited to the time window problem, many patients cannot benefit. Other treatments for cerebrovascular disease are still in the exploration stage. Read More

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http://dx.doi.org/10.4103/2045-9912.248269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352567PMC
January 2019
3 Reads

Timing of Anticoagulation in Atrial Fibrillation Status Post Cardioembolic Stroke.

J Pharm Pract 2019 Jan 31:897190019825577. Epub 2019 Jan 31.

2 Pharmacy Practice Department, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA.

Background:: Anticoagulation is the mainstay of secondary stroke prevention in patients with atrial fibrillation; however, few studies have assessed the optimal timing for initiation of anticoagulation post cardioembolic stroke. In the 2 weeks following an acute cardioembolic stroke, the risk of recurrent stroke is as high as 8%, but this risk must be balanced against the risk of hemorrhagic transformation with early initiation of anticoagulation.

Purpose:: This study described the time to initiation of anticoagulation and evaluated the in-hospital incidence of hemorrhagic and ischemic complications in 106 patients with atrial fibrillation post an acute cardioembolic stroke. Read More

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http://dx.doi.org/10.1177/0897190019825577DOI Listing
January 2019
17 Reads

[Reperfusion therapy in patients with minor or mild ischemic stroke].

Authors:
Junpei Koge

Rinsho Shinkeigaku 2019 Feb 31;59(2):84-92. Epub 2019 Jan 31.

Division of Neurology, Saiseikai Fukuoka General Hospital.

A significant number of patients with minor or mild stroke symptoms on initial presentation subsequently develop neurological deterioration and poor clinical outcomes at hospital discharge. The presence of an underlying large vessel occlusion is a strong predictor of both clinical worsening and poor outcome. Although patients with a low baseline National Institutes of Health Stroke Scale (NIHSS) could have been included in some randomized controlled trials, the benefits of the mechanical thrombectomy for patients with a low NIHSS score are unknown. Read More

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http://dx.doi.org/10.5692/clinicalneurol.cn-001255DOI Listing
February 2019
3 Reads

The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage.

Braz J Med Biol Res 2019 Jan 24;52(2):e7739. Epub 2019 Jan 24.

Department of Neurology, The Second Hospital of Shandong University, Jinan, Shandong, China.

Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Read More

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http://dx.doi.org/10.1590/1414-431X20187739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345357PMC
January 2019
1 Read

Effects of thrombolysis within 6 hours on acute cerebral infarction in an improved rat embolic middle cerebral artery occlusion model for ischaemic stroke.

J Cell Mol Med 2019 Apr 29;23(4):2468-2474. Epub 2019 Jan 29.

Department of Neurology, Shandong Provincial Qianfoshan Hospital, Affiliated to Shandong University, Jinan, Shandong, China.

Recombinant tissue plasminogen activator (rt-PA) is the first-line drug for revascularization in acute cerebral infarction (ACI) treatment. In this study, an improved rat embolic middle cerebral artery occlusion model for ischaemic stroke was used and the rats were killed on the first, third and seventh day after model establishment. Increases in infarct volume were significantly less in the thrombolytic group than in the conventional group at every time-point. Read More

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http://doi.wiley.com/10.1111/jcmm.14120
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http://dx.doi.org/10.1111/jcmm.14120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433693PMC
April 2019
7 Reads

Fast-tracking acute stroke care in China: Shenzhen Stroke Emergency Map.

Postgrad Med J 2019 Jan 29;95(1119):46-47. Epub 2019 Jan 29.

Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China

China has the largest stroke population and at-risk population in the world. However, it has a lower thrombolytic therapy rate and longer onset-to-needle time/door-to-needle time for patients who had an acute stroke compared with developed countries, which might be due to redundant procedures or inefficient systems. Things are changing due to some new initiatives. Read More

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http://pmj.bmj.com/lookup/doi/10.1136/postgradmedj-2018-1361
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http://dx.doi.org/10.1136/postgradmedj-2018-136192DOI Listing
January 2019
16 Reads

Acute alcohol intoxication may cause delay in stroke treatment - case reports.

BMC Neurol 2019 Jan 29;19(1):14. Epub 2019 Jan 29.

Department of Neurology, Faculty of Medicine, University of Debrecen, Moricz Zs. krt 22, Debrecen, 4032, Hungary.

Background: The signs and symptoms of acute alcohol intoxication resemble those of vertebrobasilar stroke. Due to their shared symptoms including double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication and vertebrobasilar stroke may pose a challenge. Moreover, if alcohol intoxication and stroke occur simultaneously, the signs and symptoms of stroke may be attributed to the effects of alcohol, leading to delayed stroke diagnosis and failure to perform reperfusion therapy. Read More

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http://dx.doi.org/10.1186/s12883-019-1241-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350361PMC
January 2019
2 Reads

Innovations in Acute Stroke Reperfusion Strategies.

Ann Indian Acad Neurol 2019 Jan-Mar;22(1):6-12

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Vascular neurology is witnessing unprecedented innovations in the management of acute ischemic stroke, especially in reperfusion strategies. The emergence of mechanical thrombectomy with new generation devices has revolutionized the treatment of acute ischemic stroke with large vessel occlusion. The reperfusion strategies are evolving with the extension of the window period for thrombolysis and endovascular therapy through the concept of "tissue clock" in addition to the established "time clock. Read More

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http://dx.doi.org/10.4103/aian.AIAN_263_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327700PMC
January 2019
3 Reads

Hemorrhagic conversion after alteplase administration in a patient with vasculitis and acute ischemic stroke.

Am J Health Syst Pharm 2019 Feb;76(4):211-213

Department of Pharmacy, Wesley Medical Center, Wichita, KS.

Purpose: A case of alteplase administration to a patient with vasculitis and acute ischemic stroke (AIS) is reported.

Summary: A 38-year-old woman with a recent diagnosis of granulomatosis with polyangiitis (GPA) received alteplase for AIS and developed symptomatic hemorrhagic conversion. Published reports regarding the safety of thrombolytic therapy in patients with a high inflammatory burden are inconsistent. Read More

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http://dx.doi.org/10.1093/ajhp/zxy048DOI Listing
February 2019
2 Reads

Efficacy of Sonothrombolysis Using Microbubbles Produced by a Catheter-Based Microfluidic Device in a Rat Model of Ischemic Stroke.

Ann Biomed Eng 2019 Apr 28;47(4):1012-1022. Epub 2019 Jan 28.

Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.

Limitations of existing thrombolytic therapies for acute ischemic stroke have motivated the development of catheter-based approaches that utilize no or low doses of thrombolytic drugs combined with a mechanical action to either dissolve or extract the thrombus. Sonothrombolysis accelerates thrombus dissolution via the application of ultrasound combined with microbubble contrast agents and low doses of thrombolytics to mechanically disrupt the fibrin mesh. In this work, we studied the efficacy of catheter-directed sonothrombolysis in a rat model of ischemic stroke. Read More

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http://dx.doi.org/10.1007/s10439-019-02209-0DOI Listing
April 2019
4 Reads
3.195 Impact Factor

Dynamic Detection of Thrombolysis in Embolic Stroke Rats by Synchrotron Radiation Angiography.

Transl Stroke Res 2019 Jan 24. Epub 2019 Jan 24.

Department of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.

A rodent model of embolic middle cerebral artery occlusion is used to mimic cerebral embolism in clinical patients. Thrombolytic therapy is the effective treatment for this ischemic injury. However, it is difficult to detect thrombolysis dynamically in living animals. Read More

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http://dx.doi.org/10.1007/s12975-019-0687-6DOI Listing
January 2019
4 Reads

A Puzzling Case of Cryptogenic Stroke.

J Stroke Cerebrovasc Dis 2019 Apr 17;28(4):e33-e35. Epub 2019 Jan 17.

UOC Neurologia, Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address:

Background: Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover.

Material And Methods: A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.001DOI Listing
April 2019
4 Reads

Catastrophic Secondary Infarctions with Onset Seizure Following Tissue Plasminogen Activator Therapy.

J Stroke Cerebrovasc Dis 2019 Apr 14;28(4):e24-e26. Epub 2019 Jan 14.

Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.

Fatalities following intravenous recombinant tissue-type plasminogen activator therapy have been reported. Major fatal complications following intravenous recombinant tissue-type plasminogen activator therapy include intracranial hemorrhage, aortic dissection, and extracranial bleeding. However, the possibility that intravenous recombinant tissue-type plasminogen activator therapy itself paradoxically induces synchronized multiple cerebral novel infarctions has never been considered. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10523057183074
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.045DOI Listing
April 2019
13 Reads