9,833 results match your criteria Thrombolytic Therapy in Stroke


Acute ischemic stroke management in Lebanon: obstacles and solutions.

Funct Neurol 2019 Jul/Sep;34(3):167-176

Management of acute stroke varies greatly within and between different countries. This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Read More

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Expansion of the dimensions in the current management of acute ischemic stroke.

J Neurol 2020 May 20. Epub 2020 May 20.

Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Stroke is the fifth leading cause of death in the United States with a huge burden on health care. Acute ischemic stroke (AIS) accounts for 87% of all stroke. The use of thrombolytic agents in AIS treatment is well known since 1950 but no FDA approval until 1996, due to lack of strong evidence showing benefits outweigh the risk of intracranial hemorrhage. Read More

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http://dx.doi.org/10.1007/s00415-020-09873-6DOI Listing

Factors Associated with Pre-Hospital Delay and Intravenous Thrombolysis in China.

J Stroke Cerebrovasc Dis 2020 May 16:104897. Epub 2020 May 16.

Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China. Electronic address:

Background: Pre-hospital delay was a critical factor affecting stroke patients receiving intravenous thrombolytic therapy. The aim of this study was to explore the factors associated with pre-hospital delay and thrombolysis in China.

Methods: Patient data were obtained from emergency department (ED), and the factors of patient pre-hospital delay were recorded through a well-designed form. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104897DOI Listing

Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy.

BMC Neurol 2020 May 19;20(1):197. Epub 2020 May 19.

University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA.

Background: Acute ischemic stroke attack with and without a recent TIA may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 h preceding ischemic stroke (recent-TIA) as compared to those without recent TIA or non-TIA > 24 h and less than 1 month (past-TIA).

Methods: A retrospective hospital-based analysis was conducted on 6315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 h prior to ischemic stroke. Read More

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http://dx.doi.org/10.1186/s12883-020-01782-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236928PMC

A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients.

J Neurosci Nurs 2020 May 14. Epub 2020 May 14.

Questions or comments about this article may be directed to Carol J. Droegemueller, MS APRN CNS OCNS CNRN, at C.J.D. is Stroke Program Coordinator, Regions Hospital Comprehensive Stroke Center, St Paul, MN. Bhavani Kashyap, PhD MBBS, is Research Associate, HealthPartners Neuroscience Center, HealthPartners Institute, Bloomington, MN. Roberta L. Huna Wagner, DNP APRN CNS AGCNS-BC PCCN, is Clinical Nurse Specialist, Regions Hospital Comprehensive Stroke Center, St Paul, MN. Hannah Shibeshi, BAN RN CNRN CCRN, is Registered Nurse, Regions Hospital Comprehensive Stroke Center, St Paul, MN. Mitchell W. Clayton, BS, is Student Intern, HealthPartners Neuroscience Center, St Paul, MN. Mary W. Fennig, BA, is Student Intern, HealthPartners Neuroscience Center, St Paul, MN. Haitham M. Hussein, MD MSc FAHA FAAN, is Medical Director, Regions Hospital Comprehensive Stroke Center, HealthPartners Neuroscience Center, HealthPartners Institute, Bloomington, MN.

Background: The incidence rate of stroke in hospitalized patients ranges between 2% and 17% of all strokes-a higher rate than in the community. Delays in recognition and management of stroke in hospitalized patients lead to worse outcomes. At our hospital, the existing in-hospital stroke (IHS) code showed low usage and effectiveness. Read More

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http://dx.doi.org/10.1097/JNN.0000000000000517DOI Listing

Effects of protective controlled coronary reperfusion on left ventricular remodeling in dogs with acute myocardial infarction: A pilot study.

Cardiovasc Revasc Med 2020 May 6. Epub 2020 May 6.

InVatin Technologies, Ltd., Kazrin, Israel; Applicative Cardiovascular Research Center (ACRC) and Department of Cardiology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Background: Coronary artery obstruction causes ischemia of cardiac tissue, leading to acute myocardial infarction (AMI). The treatment of choice for reducing acute myocardial ischemic injury is early, effective vascular reperfusion using thrombolytic therapy or primary percutaneous coronary intervention. However, reperfusion can cause cardiomyocyte injury. Read More

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http://dx.doi.org/10.1016/j.carrev.2020.05.001DOI Listing

Low-Frequency Vibrations Enhance Thrombolytic Therapy and Improve Stroke Outcomes.

Stroke 2020 Jun 13;51(6):1855-1861. Epub 2020 May 13.

Department of Neurology, Carver College of Medicine (E.C.L.), University of Iowa.

Background and Purpose- We aim to determine the potential impact on stroke thrombolysis of drip-and-ship helicopter flights and specifically of their low-frequency vibrations (LFVs). Methods- Mice with a middle cerebral artery autologous thromboembolic occlusion were randomized to receive rtPA (recombinant tissue-type plasminogen activator; or saline) 90 minutes later in 3 different settings: (1) a motion platform simulator that reproduced the LFV signature of the helicopter, (2) a standardized actual helicopter flight, and (3) a ground control. Results- Mice assigned to the LFV simulation while receiving tPA had smaller infarctions (31. Read More

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http://dx.doi.org/10.1161/STROKEAHA.120.029405DOI Listing
June 2020
5.723 Impact Factor

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients.

Lipids Health Dis 2020 May 6;19(1):84. Epub 2020 May 6.

University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA.

Background: Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated.

Methods: Retrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Read More

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http://dx.doi.org/10.1186/s12944-020-01270-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201805PMC

Thrombolysis before Thrombectomy - To Be or DIRECT-MT?

Authors:
Gregory W Albers

N Engl J Med 2020 05 6;382(21):2045-2046. Epub 2020 May 6.

From the Stanford Stroke Center, Palo Alto, CA.

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http://dx.doi.org/10.1056/NEJMe2004550DOI Listing

Effects of Baseline Systolic Blood Pressure on Outcome in Ischemic Stroke Patients With Intravenous Thrombolysis Therapy: A Systematic Review and Meta-Analysis.

Neurologist 2020 May;25(3):62-69

Department of Neurology, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen.

Background: Baseline systolic blood pressure (SBP) is an important parameter that can significantly influence the outcome in ischemic stroke patients who received intravenous thrombolysis, but the target baseline SBP for optimal outcome is uncertain. This study aimed to assess the relationship between baseline SBP and outcome.

Materials And Methods: Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. Read More

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http://dx.doi.org/10.1097/NRL.0000000000000267DOI Listing

Biomaterials to Neuroprotect the Stroke Brain: A Large Opportunity for Narrow Time Windows.

Cells 2020 Apr 26;9(5). Epub 2020 Apr 26.

Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain.

Ischemic stroke represents one of the most prevalent pathologies in humans and is a leading cause of death and disability. Anti-thrombolytic therapy with tissue plasminogen activator (t-PA) and surgical thrombectomy are the primary treatments to recanalize occluded vessels and normalize the blood flow in ischemic and peri-ischemic regions. A large majority of stroke patients are refractory to treatment or are not eligible due to the narrow time window of therapeutic efficacy. Read More

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http://dx.doi.org/10.3390/cells9051074DOI Listing

Changing the strategy and culture of stroke awareness education in China: implementing Stroke 1-2-0.

Stroke Vasc Neurol 2020 Apr 28. Epub 2020 Apr 28.

Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

This project implemented the Stroke 1-2-0 stroke awareness programme across China and investigated its impact over a 2-year period. We initiated the Stroke 1-2-0 educational campaign and Stroke 1-2-0 special task forces (STF) across the nation. Massive media coverage, community-based educational sessions with videos and other related materials and induction of Stroke 1-2-0 STF were the major means of promotion. Read More

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http://dx.doi.org/10.1136/svn-2019-000324DOI Listing

Limited Efficacy of Thrombolytics for Pump Thrombosis in Durable Left Ventricular Assist Devices.

Ann Thorac Surg 2020 Apr 26. Epub 2020 Apr 26.

Division of Cardiac Surgery,; Heart and Vascular Institute,. Electronic address:

Background: This study reports a single center experience with thrombolytics for left ventricular assist device (LVAD) pump thrombosis.

Methods: Adults undergoing continuous-flow LVAD implantation between 2004-2018 at a single center were reviewed and those with pump thrombosis identified. Primary outcomes included 1-year survival and success rates of thrombolytic therapy. Read More

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http://dx.doi.org/10.1016/j.athoracsur.2020.03.061DOI Listing

Messenger RNA/polymeric carrier nanoparticles for delivery of heme oxygenase-1 gene in the post-ischemic brain.

Biomater Sci 2020 Apr 29. Epub 2020 Apr 29.

Department of Bioengineering, College of Engineering, Hanyang University, Seoul, 04763, Korea.

Ischemic stroke is a cerebrovascular disease caused by narrowed cerebral arteries. Thrombolytic agents such as tissue-plasminogen activators have been used for recanalization of the blood supply into the ischemic region. However, ischemia-reperfusion damage continues to increase the infarction volume. Read More

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http://dx.doi.org/10.1039/d0bm00076kDOI Listing

[Acute stroke treatment in old age].

Authors:
Frank Erbguth

Med Klin Intensivmed Notfmed 2020 May;115(4):351-366

Universitätsklinik für Neurologie, Klinikum Nürnberg Süd, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland.

In patients over 80 years old, 4 of the 5 evidence-based acute treatments of ischemic stroke, i.e. stroke unit treatment, antiplatelet therapy, intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are effective but with a higher morbidity than in younger patients. Read More

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http://dx.doi.org/10.1007/s00063-020-00684-1DOI Listing

Optimized mouse model of embolic MCAO: From cerebral blood flow to neurological outcomes.

J Cereb Blood Flow Metab 2020 Apr 20:271678X20917625. Epub 2020 Apr 20.

Pittsburgh Institute of Brain Disorders & Recovery and UPMC Stroke Institute, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1177/0271678X20917625DOI Listing

Letter by Nicholson et al Regarding Article, "Thrombolytic Therapy for Acute Central Retinal Artery Occlusion".

Stroke 2020 May 17;51(5):e95. Epub 2020 Apr 17.

Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Canada.

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http://dx.doi.org/10.1161/STROKEAHA.120.029552DOI Listing

Response by Mac Grory et al to Letter Regarding Article, "Thrombolytic Therapy for Acute Central Retinal Artery Occlusion".

Stroke 2020 May 17;51(5):e96. Epub 2020 Apr 17.

Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN.

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http://dx.doi.org/10.1161/STROKEAHA.120.029609DOI Listing

Preparation of Peptide and Recombinant Tissue Plasminogen Activator Conjugated Poly(Lactic-Co-Glycolic Acid) (PLGA) Magnetic Nanoparticles for Dual Targeted Thrombolytic Therapy.

Int J Mol Sci 2020 Apr 13;21(8). Epub 2020 Apr 13.

Department of Chemical and Materials and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.

Recombinant tissue plasminogen activator (rtPA) is the only thrombolytic agent that has been approved by the FDA for treatment of ischemic stroke. However, a high dose intravenous infusion is required to maintain effective drug concentration, owing to the short half-life of the thrombolytic drug, whereas a momentous limitation is the risk of bleeding. We envision a dual targeted strategy for rtPA delivery will be feasible to minimize the required dose of rtPA for treatment. Read More

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http://dx.doi.org/10.3390/ijms21082690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215398PMC

Complement-Dependent Synaptic Uptake and Cognitive Decline after Stroke and Reperfusion Therapy.

J Neurosci 2020 May 14;40(20):4042-4058. Epub 2020 Apr 14.

Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina 29425

Despite the success of reperfusion therapy in significantly reducing the extent of infarct expansion after stroke, the effect of revascularization on poststroke neuroinflammation and the role of anti-inflammatory strategies in postreperfusion era are yet to be explored. Here, we investigate whether the neuroinflammatory response may still contribute to neurologic deficits after reperfused stroke by using targeted complement inhibition to suppress poststroke neuroinflammation in mice with or without concurrent reperfusion therapy. Complement inhibition was achieved using B4Crry, an injury site-targeted inhibitor of C3 activation. Read More

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http://dx.doi.org/10.1523/JNEUROSCI.2462-19.2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219298PMC

[Argentine Presidential Medical Unit. Survey of the Argentine hospital network and resources for golden hour pathologies.]

Rev Fac Cien Med Univ Nac Cordoba 2020 03 12;77(1):10-14. Epub 2020 Mar 12.

Presidencia de La Nación Argentina. Unidad Médica Presidencial Argentina.

Introduction: Presidential medical units are intended to protect the dignitary's health in multiple aspects and work in close relationship with security. There are three central areas of coverage: myocardial infarction, stroke and trauma. By 2016 we had not found information about the resources on medical centers in Argentina and their integration into healthcare networks. Read More

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http://dx.doi.org/10.31053/1853.0605.v77.n1.26779DOI Listing

Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding.

Eur Stroke J 2020 Mar 28;5(1):47-55. Epub 2019 Aug 28.

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.

Background: There are limited data on the safety of intravenous recombinant tissue plasminogen activator (rtPA) for treating acute ischemic stroke in patients with gastrointestinal malignancy or recent gastrointestinal bleeding within 21 days of their index stroke.

Aims: To evaluate clinical outcomes in patients treated with rtPA for acute ischemic stroke who had gastrointestinal malignancy or recent gastrointestinal bleeding.

Methods: We identified patients who were treated with rtPA for acute ischemic stroke between 2/2009 and 12/2015 from the Get With The Guidelines-Stroke linked to Medicare claims data. Read More

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http://dx.doi.org/10.1177/2396987319871784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092738PMC

Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case.

Radiol Oncol 2020 Mar 26;54(2):144-148. Epub 2020 Mar 26.

Department for Vascular Neurology and Intensive Neurological Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Background Acute bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion is extremely rare and associated with poor clinical outcomes. There are only a few reports in the literature about mechanical thrombectomy being performed for acute bilateral occlusions. The treatment strategies and prognoses (clinical outcomes) are therefore unclear. Read More

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http://dx.doi.org/10.2478/raon-2020-0017DOI Listing

Safety of urgent carotid endarterectomy following thrombolysis.

J Cardiovasc Surg (Torino) 2020 Apr;61(2):149-158

Section of Vascular Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA.

Introduction: Acute ischemic stroke is a leading cause of morbidity and mortality worldwide, and the incidence of ischemic stroke is predicted to increase in coming years. Carotid atherosclerotic occlusive disease accounts for up to 20% of all ischemic strokes, and mounting evidence suggests that, in the setting of an acute ischemic stroke due to carotid disease, earlier treatment with carotid intervention results in better outcomes. In patients with acute ischemic stroke, systemic or intravenous thrombolysis (IVT) has revolutionized ischemic stroke therapy, and intravenous tissue plasminogen activator (tPA) has become the principal treatment for acute ischemic stroke when administered within 3 to 4. Read More

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http://dx.doi.org/10.23736/S0021-9509.20.11179-0DOI Listing

Intracranial Aneurysms After Intravenous Thrombolysis in Patient with Atrial Myxoma: A Case Study.

J Stroke Cerebrovasc Dis 2020 Jun 24;29(6):104796. Epub 2020 Mar 24.

Department of Neurology, Yangpu Hospital Tongji University School of Medicine, Shanghai, China. Electronic address:

We administered intravenous thrombolytic therapy to a 51-year-old female patient with a 101-min stroke onset. The patient was unconscious during the manifestation of symptoms. Computed tomography angiography examination of the intracranial artery at the time of admission suggested that the left middle cerebral artery was occluded. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104796DOI Listing

Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature.

J Neurol 2020 Mar 21. Epub 2020 Mar 21.

Department of Neurology, The Canberra Hospital, Canberra, Australia.

Background/aims: This review examined factors that delay thrombolysis and what management strategies are currently employed to minimise this delay, with the aim of suggesting future directions to overcome bottlenecks in treatment delivery.

Methods: A systematic review was performed according to PRISMA guidelines. The search strategy included a combination of synonyms and controlled vocabularies from Medical Subject Headings (MeSH) and EmTree covering brain ischemia, cerebrovascular accident, fibrinolytic therapy and Alteplase. Read More

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http://dx.doi.org/10.1007/s00415-020-09803-6DOI Listing
March 2020
3.377 Impact Factor

A Case Report: An Acute Spinal Epidural Hematoma after Acupuncture Mimicking Stroke.

J Emerg Med 2020 Mar 20. Epub 2020 Mar 20.

Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Dementia and Parkinson's Disease Integrated Center, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.

Background: Spinal epidural hematoma (SEH) after acupuncture is rare and may present with acute or subacute onset and varied symptoms, making it difficult to diagnose. This condition can mimic acute stroke, so it is vital to establish a clear diagnosis before considering thrombolytic therapy, which could be disastrous if applied inappropriately.

Case Report: We describe a 52-year-old man who presented to our emergency department (ED) with acute onset of unilateral weakness of the limbs for 3. Read More

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http://dx.doi.org/10.1016/j.jemermed.2020.01.009DOI Listing

[Effect of acupuncture on neurological function, cerebral infarction volume, thrombolysis time window and cerebral cell apoptosis signaling pathway in cerebral infarction rats].

Zhen Ci Yan Jiu 2020 Mar;45(3):209-14

College of Acupuncture-moxibustion and Tuina, Nanjing University of Chinese Medicine, Nanjing 210046, China.

Objective: To observe the effect of acupuncture (Acupunct) on cerebral infarction volume and expression of poly ADP ribose polymerase 1 (PARP1), apoptosis-inducing factor (AIF) and endonuclease G (Endo-G) in the cerebral cortex tissue at different time-points after cerebral ischemia (CI) in acute cerebral infarction rats, so as to explore its underlying mechanisms in prolonging time window of thrombolysis.

Methods: Forty-eight SD rats were randomly divided into sham operation, model, intravenous thrombolysis (IVT)-4.5 h, IVT-6 h, IVT-9 h, Acupunct+IVT-4. Read More

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http://dx.doi.org/10.13702/j.1000-0607.190635DOI Listing

Lessons of the month 2: FAST is not always FAST.

Clin Med (Lond) 2020 Mar;20(2):219-220

Hertford County Hospital, Hertford, UK.

Thrombolytic treatment with tissue plasminogen activator is an established therapy for selected patients with ischaemic stroke within a narrow time window of 3 hours from the onset of symptoms. However, severe complications and poor outcomes are likely to ensue if a patient with acute aortic dissection is inadvertently treated with thrombolytic agents.We describe a patient presenting as facial droop, arm weakness, speech disturbance and time to call emergency services (FAST) positive (clinical picture of ischaemic stroke) who received thrombolysis and in whom the underlying diagnosis of acute thoracic aortic dissection was made by a combination of chance and a high clinical suspicion. Read More

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http://dx.doi.org/10.7861/clinmed.2019-0465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081796PMC

White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke.

AJNR Am J Neuroradiol 2020 Apr 12;41(4):639-644. Epub 2020 Mar 12.

From the Departments of Neurology (E.A.M., M.S.) and.

Background And Purpose: The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear.

Materials And Methods: In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. Read More

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http://dx.doi.org/10.3174/ajnr.A6478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144640PMC

Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study.

J Clin Med 2020 Mar 6;9(3). Epub 2020 Mar 6.

Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea.

We investigated whether there was an annual change in outcomes in patients who received the thrombolytic therapy or endovascular treatment (EVT) in Korea. This analysis was performed using data from a nationwide multicenter registry for exploring the selection criteria of patients who would benefit from reperfusion therapies in Korea. We compared the annual changes in the modified Rankin scale (mRS) at discharge and after 90 days and the achievement of successful recanalization from 2012 to 2017. Read More

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http://dx.doi.org/10.3390/jcm9030717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141338PMC

Is intravenous thrombolysis safe for acute ischemic stroke patients taking warfarin with INR 1.9?: A case report.

Medicine (Baltimore) 2020 Mar;99(10):e19358

Department of Neurology.

Introduction: Intravenous thrombolysis is not suitable for patients undergoing oral anticoagulants therapy, with INR > 1.7 or PT > 15 s. We described a case of intravenous thrombolysis in a patient with INR 1. Read More

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http://dx.doi.org/10.1097/MD.0000000000019358DOI Listing

Assessment of recombinant tissue plasminogen activator (rtPA) toxicity in cultured neural cells and subsequent treatment with poly-arginine peptide R18D.

Neurochem Res 2020 May 5;45(5):1215-1229. Epub 2020 Mar 5.

Perron Institute for Neurological and Translational Science, RR Block, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.

Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) in ischaemic stroke has been associated with neurotoxicity, blood brain barrier (BBB) disruption and intra-cerebral hemorrhage. To examine rtPA cellular toxicity we investigated the effects of rtPA on cell viability in neuronal, astrocyte and brain endothelial cell (bEnd.3) cultures with and without prior exposure to oxygen-glucose deprivation (OGD). Read More

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http://dx.doi.org/10.1007/s11064-020-03004-3DOI Listing

Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke.

Neurologist 2020 Mar;25(2):28-32

Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Background: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient.

Objective: To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset. Read More

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http://dx.doi.org/10.1097/NRL.0000000000000261DOI Listing

Thrombolysis for Acute Ischemic Stroke Following Transcatheter Aortic Valve Replacement: Case Report and Literature Review.

Neurologist 2020 Mar;25(2):26-27

Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Introduction: Intravenous thrombolytic therapy with recombinant tissue type plasminogen activator (IV-tPA) is the first-line treatment option for acute ischemic stroke (AIS). The tPA exclusion criteria, defined decades ago, require updates as new technologies emerge. Transcatheter aortic valve replacement (TAVR), which has begun to replace open surgery, poses a risk for acute stroke and falls outside of prior tPA guidelines. Read More

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http://dx.doi.org/10.1097/NRL.0000000000000260DOI Listing

Efficacy and Safety of Thrombolytic Therapy for Stroke with Unknown Time of Onset: A Meta-Analysis of Observational Studies.

J Stroke Cerebrovasc Dis 2020 May 29;29(5):104742. Epub 2020 Feb 29.

Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Hefei, China; Department of Medical Psychology, Anhui Medical University, Hefei, China. Electronic address:

Background: Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies available for patients with known-onset stroke (KOS). Whether rt-PA treatment would improve functional outcomes in patients with stroke with unknown time of onset (UTOS) is undetermined, we aimed to systematically assess the efficacy and safety of thrombolysis for UTOS patients in this meta-analysis.

Methods: A systematic literature search of Medline, Embase, and Cochrane Library was conducted. Read More

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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104742DOI Listing

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome.

Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620906867

University of South Carolina School of Medicine, Greenville, SC, USA.

Background: Specific clinical risk factors linked to transient ischemic attack (TIA) could affect functional ambulatory outcome following thrombolytic therapy in patients having ischemic stroke with a prior TIA (TIA-ischemic stroke). This issue was investigated in this study.

Methods: We retrospectively analyzed data from 6379 ischemic stroke patients of which 1387 presented with an antecedent TIA prior to onset of stroke. Read More

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http://dx.doi.org/10.1177/1076029620906867DOI Listing

Thrombolytic treatment in stroke mimic, inevitable but fortunately safe: An observational study from Iran.

Iran J Neurol 2019 Oct;18(4):172-175

Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center's SM (Firoozgar Hospital) among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036043PMC
October 2019

Women and In-hospital Stroke Code Activation: Age, Ethnicity, and Unique Symptoms Matter.

Authors:
Renee Colsch

J Cardiovasc Nurs 2020 Feb 26. Epub 2020 Feb 26.

Renee Colsch, PhD, RN Assistant Professor, College for Women, Henrietta Schmoll School of Health, Department of Nursing, St. Catherine University.

Background: Women have worse stroke outcomes than men, and almost 17% of all stroke cases have symptom onset when admitted to the hospital for a separate condition.

Objective: The aim of this study was to investigate the distinctive factors that impact the activation of an in-hospital stroke code and outcomes in women who have a stroke while admitted to the hospital for a separate condition.

Methods: A retrospective observational propensity score study guided by the model for nursing effectiveness was used. Read More

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http://dx.doi.org/10.1097/JCN.0000000000000663DOI Listing
February 2020

Recent strategies on targeted delivery of thrombolytics.

Asian J Pharm Sci 2019 May 4;14(3):233-247. Epub 2019 Feb 4.

College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China.

Thrombus formed in blood vessel is a progressive process, which would lead to life-threatening thrombotic diseases such as ischemic stroke. Unlike other diseases, the recognition of thrombus is usually in the late stage where blood vessels are largely blocked. So acute thrombotic diseases have a narrow therapeutic window, and remain leading causes of morbidity and mortality, whereas current thrombolysis therapy has limited therapeutic effects and bleeding complications. Read More

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http://dx.doi.org/10.1016/j.ajps.2018.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032080PMC

Measuring Outcome After Stroke: More Lessons Learned Again.

Authors:
Patrick D Lyden

Stroke 2020 Apr 27;51(4):1053-1054. Epub 2020 Feb 27.

From the Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.

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http://dx.doi.org/10.1161/STROKEAHA.119.028214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093244PMC

Stroke following successful PTMC in a patient with severe mitral stenosis: A case report and presenting a simple stepwise approach to PTMC-related stroke.

Cardiovasc Hematol Disord Drug Targets 2020 Feb 20. Epub 2020 Feb 20.

School of Medicine, Tehran University of Medical Sciences, Iran.

Stroke following percutaneous trans-septal mitral commissurotomy (PTMC) is a striking complication that could significantly affect quality of life of the patients, particularly the young and active ones. We present a middle-aged woman who experienced stroke following PTMC and successfully treated with thrombolytic therapy regarding the potential adverse effects of this type of therapy. Also, we present a simple novel stepwise clinical approach for PTMC-related stroke. Read More

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http://dx.doi.org/10.2174/1871529X20666200220125123DOI Listing
February 2020

Management of acute ischemic stroke.

BMJ 2020 Feb 13;368:l6983. Epub 2020 Feb 13.

Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.

Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Read More

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http://dx.doi.org/10.1136/bmj.l6983DOI Listing
February 2020

Can Emergency Medical Services (EMS) Shorten the Time to Stroke Team Activation, Computed Tomography (CT), and the Time to Receiving Antithrombotic Therapy? A Prospective Cohort Study.

Prehosp Disaster Med 2020 Apr 14;35(2):148-151. Epub 2020 Feb 14.

Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Introduction: Stroke is a major emergency that can cause a significant morbidity and mortality. Advancement in stroke management in recent years has allowed more patients to be diagnosed and treated by stroke teams; however, stroke is a time-sensitive emergency that requires a high level of coordination, particularly within the prehospital phase. This research is to determine whether patients received by Emergency Medical Services (EMS) at a tertiary health care facility had shorter stroke team activation, time to computed tomography (CT), or time to receive intravenous thrombolytics. Read More

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http://dx.doi.org/10.1017/S1049023X20000126DOI Listing

Blood-brain barrier integrity of stroke patients presenting in an extended time window.

BMC Neurol 2020 Feb 13;20(1):54. Epub 2020 Feb 13.

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, MD, 20892, USA.

Background: Current guidelines limit thrombolytic treatment of stroke to those patients who present within 4.5 h to minimize the risk of hemorrhagic complications. Risk of hemorrhage increases with increasing blood-brain barrier (BBB) disruption. Read More

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http://dx.doi.org/10.1186/s12883-020-01634-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017520PMC
February 2020

Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous thrombolysis: A meta-analysis.

Medicine (Baltimore) 2020 Feb;99(7):e18995

Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu, Sichuan Province, P.R. China.

Aim: To determine the risk factors related to hemorrhagic transformation in Chinese patients with acute ischemic stroke treated with intravenous thrombolysis.

Methods: Studies published in different languages were retrieved by systematically searching PubMed, EMBASE, Vip, CNKI, and WanFang Data from the establishment of the library to December 31, 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered risk factors. Read More

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http://dx.doi.org/10.1097/MD.0000000000018995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035114PMC
February 2020

Accuracy and Reliability of the Recommendation for IV Thrombolysis in Acute Ischemic Stroke Based on Interpretation of Head CT on a Smartphone or a Laptop.

AJR Am J Roentgenol 2020 04 11;214(4):877-884. Epub 2020 Feb 11.

Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia.

The objective of this study was to assess the accuracy and reliability of IV thrombolysis recommendations made after interpretation of head CT images of patients with symptoms of acute stroke displayed on smartphone or laptop reading systems compared with those made after interpretation of images displayed on a medical workstation monitor. This retrospective study was institutional review board-approved, and the requirement for informed consent was waived. We used a factorial design including 2256 interpretations (188 patients, four neuroradiologists, and three reading systems). Read More

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http://dx.doi.org/10.2214/AJR.19.21896DOI Listing

Centralising acute stroke care within clinical practice in the Netherlands: lower bounds of the causal impact.

BMC Health Serv Res 2020 Feb 10;20(1):103. Epub 2020 Feb 10.

Unit Patient Centred Health Technology Assessment, Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

Background: Authors in previous studies demonstrated that centralising acute stroke care is associated with an increased chance of timely Intra-Venous Thrombolysis (IVT) and lower costs compared to care at community hospitals. In this study we estimated the lower bound of the causal impact of centralising IVT on health and cost outcomes within clinical practice in the Northern Netherlands.

Methods: We used observational data from 267 and 780 patients in a centralised and decentralised system, respectively. Read More

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http://dx.doi.org/10.1186/s12913-020-4959-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011566PMC
February 2020

Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals.

Front Neurol 2019 22;10:1396. Epub 2020 Jan 22.

Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.

Primary stroke center (PSC) certification is associated with improvements in stroke care and outcome. However, these improvements may reflect a higher baseline level of care delivery in hospitals eventually achieving certification. This study examines whether advancements in acute stroke care at PSCs are due to certification or factors intrinsic to the hospital. Read More

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http://dx.doi.org/10.3389/fneur.2019.01396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987385PMC
January 2020

Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke.

J Stroke 2020 Jan 31;22(1):64-75. Epub 2020 Jan 31.

Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.

Recent advances in endovascular thrombectomy have enabled the histopathologic analysis of fresh thrombi in patients with acute stroke. Histologic analysis has shown that the thrombus composition is very heterogeneous between patients. However, the distribution pattern of each thrombus component often differs between patients with cardiac thrombi and those with arterial thrombi, and the efficacy of endovascular thrombectomy is different according to the thrombus composition. Read More

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http://dx.doi.org/10.5853/jos.2019.03440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005358PMC
January 2020