10,505 results match your criteria Thrombolytic Therapy in Stroke


Foix-Chavany-Marie Syndrome as a Manifestation of Unilateral Opercular Stroke.

Eur J Case Rep Intern Med 2021 6;8(4):002462. Epub 2021 Apr 6.

Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.

Introduction: Foix-Chavany-Marie syndrome (FCMS) is a type of pseudobulbar palsy that affects facio-pharyngo-glosso-masticatory muscles.

Materials And Methods: A 62-year-old man was admitted to the emergency department after 9 hours of acute dysarthria and dysphagia. MRI showed restricted diffusion in the right operculum on diffusion-weighted imaging (DWI). Read More

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[Delayed administration of thrombolytic therapy in minor stroke].

Rev Neurol 2021 May;72(10):352-356

Hospital Universitario Virgen Macarena, 41003 Sevilla, España.

Introduction: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. Read More

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Potential accuracy of prehospital NIHSS-based triage for selection of candidates for acute endovascular stroke therapy.

J Am Coll Emerg Physicians Open 2021 Jun 1;2(3):e12441. Epub 2021 May 1.

Department of Neurology Kaiser Permanente, Northern California Walnut Creek California USA.

Objective: Whether patients with acute stroke and large vessel occlusion (LVO) benefit from prehospital identification and diversion by emergency medical services (EMS) to an endovascular stroke therapy (EST)-capable center is controversial. We sought to estimate the accuracy of field-based identification of potential EST candidates in a hypothetical best-of-all-worlds situation.

Methods: In Kaiser Permanente Northern California, all acute stroke patients arriving at its 21 stroke centers between 7:00 am and midnight from January 2016 to December 2019 were evaluated by teleneurologists on arrival. Read More

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2,5TT genotype of the MMP-9-1562C/T polymorphism may be a risk factor for thrombolytic therapy-induced hemorrhagic complications after acute ischemic stroke.

Pharmacotherapy 2021 May 4. Epub 2021 May 4.

St. Sava Hospital, Belgrade, Serbia.

Introduction: Levels of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) influence recombinant tissue plasminogen activator (rtPA) therapy response in patients with acute ischemic stroke (AIS). Serum levels of MMPs and TIMPs along with the expression of genes coding these proteins are related to the recovery and appearance of adverse effects (AE) after AIS. Consequently, it is important to explore whether polymorphisms in regulatory sequences of MMPs and TIMPs are associated with rtPA response in AIS patients. Read More

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Safety and efficacy of intravenous thrombolytic treatment in wake-up stroke: Experiences from a single center.

Authors:
Adam Wiśniewski

Brain Behav 2021 May 3:e02152. Epub 2021 May 3.

Department of Neurology, Faculty of Medicine, Collegium Medium in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.

Objectives: Wake-up stroke is an important clinical problem that may account for a quarter of all ischemic strokes. This study aimed to establish the safety and efficacy of intravenous thrombolytic treatment of wake-up strokes by comparing it to the standard thrombolysis treatment in strokes with clear onsets and wake-up strokes that did not receive reperfusion therapy.

Methods: This retrospective study enrolled 95 patients with ischemic strokes who underwent thrombolytic treatment with alteplase, including nine patients with wake-up strokes. Read More

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Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke.

PLoS One 2021 30;16(4):e0251077. Epub 2021 Apr 30.

Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China.

Background: Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline "clinical-CT mismatch" may also predict the responses to thrombolytic therapy. Read More

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2020 Guideline for Prehospital Management, Emergency Evaluation and Treatment of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the Taiwan Society of Emergency Medicine and Taiwan Stroke Society.

J Acute Med 2021 Mar;11(1):12-17

National Taiwan University Hospital Stroke Center and Department of Neurology Taipei Taiwan.

To improve the clinical outcomes of patients with acute ischemic stroke, the public, pre-hospital care system, and hospitals should cooperate to achieve quick assessment and management for such patients and to start treatment as soon as possible. To reach the goal, the Consensus Group, including emergency physicians and neurologists in the Taiwan Society of Emergency Medicine and Taiwan Stroke Society, performed an updated review and discussion for the local guidelines. The guidelines consist of 12 parts, including public education program, evaluation and management in the emergency medical system, emergency medical system, assessment of stroke care capability of the hospital by independent parties, stroke team of the hospital, telemedicine, organization, and multifaceted integration, improvement of quality of care process of stroke system, initial clinical and imaging evaluations after arriving at the hospital, imaging evaluation for indications of intravenous thrombolysis, imaging evaluation for indications of endovascular thrombectomy, and other diagnostics. Read More

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Sex-Related Disparities in the Incidence and Outcomes of Ischemic Stroke among Type 2 Diabetes Patients. A Matched-Pair Analysis Using the Spanish National Hospital Discharge Database for Years 2016-2018.

Int J Environ Res Public Health 2021 Apr 1;18(7). Epub 2021 Apr 1.

Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain.

Background: To analyze the incidence, use of therapeutic procedures, and in-hospital outcomes among patients suffering an ischemic stroke (IS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016-2018) and to assess the existence of sex differences.

Methods: Matched-pair analysis using the Spanish National Hospital discharge.

Results: IS was coded in 92,524 men and 79,731 women (29. Read More

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[Intravenous thrombolytic therapy with Revelisa of ischemic stroke in real-world clinical practice: interim results of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R].

Zh Nevrol Psikhiatr Im S S Korsakova 2021 ;121(3. Vyp. 2):33-37

Institute of Cerebrovascular Pathology and Stroke, Federal Center for Brain and Neurotechnology of the Federal Medical and Biological Agency, Moscow, Russia.

Objective: To assess the safety and efficacy of Revelisa in patients with ischemic stroke in real-world clinical practice.

Material And Methods: The interim analysis of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R included 223 patients (50.2% women and 49. Read More

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[Screening of intravenous thrombolysis for eligible patients with ischemic stroke].

Authors:
H Q Qin Y J Wang

Zhonghua Nei Ke Za Zhi 2021 May;60(5):476-482

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.

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Stroke-unit care for stroke patients in China: the results from Bigdata Observatory platform for Stroke of China.

J Neurol 2021 Apr 22. Epub 2021 Apr 22.

The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China.

Background: To assess whether stroke patients admitted to stroke units (SU) have a better short-term outcome than those treated in conventional wards (CW).

Methods: A total of 20 hospitals from 16 provinces in China were initially selected in this study. Finally, 24,090 consecutive admissions in 2013-2015 treated in CW and 21,332 consecutive entries in 2017-2019 treated in SU were included. Read More

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Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men.

JAMA Netw Open 2021 04 1;4(4):e217498. Epub 2021 Apr 1.

Division of Neurology, Department of Medicine, National University Health System, Singapore.

Importance: Acute ischemic stroke (AIS) is a known neurological complication in patients with respiratory symptoms of COVID-19 infection. However, AIS has not been described as a late sequelae in patients without respiratory symptoms of COVID-19.

Objective: To assess AIS experienced by adults 50 years or younger in the convalescent phase of asymptomatic COVID-19 infection. Read More

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Neutrophil extracellular traps promote tPA-induced brain hemorrhage via cGAS in mice with stroke.

Blood 2021 Feb 24. Epub 2021 Feb 24.

Fudan University, Shanghai, China.

Intracerebral hemorrhage associated with thrombolytic therapy with tissue plasminogen activator (tPA) in acute ischemic stroke continues to present a major clinical problem. Here, we report that infusion of tPA resulted in a significant increase in markers of neutrophil extracellular traps (NETs) in the ischemic cortex and plasma of mice subjected to photothrombotic middle cerebral artery occlusion. Peptidylarginine deiminase 4 (PAD4), a critical enzyme for NET formation, is also significantly upregulated in the ischemic brains in tPA-treated mice. Read More

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February 2021

Management of an acute cerebral embolic infarct with thrombolysis and mechanical thrombectomy in the presence of an aortic arch floating thrombus.

BMJ Case Rep 2021 Apr 20;14(4). Epub 2021 Apr 20.

Department of Stroke Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK.

An aortic arch floating thrombus is a rare cause of embolic ischaemic cerebral infarction. Previously, thrombolysis or mechanical thrombectomy has been used to treat acute cerebral infarction in this context; however, combination therapy using both modalities is yet to be published. The optimal management of aortic arch floating thrombi is debated. Read More

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Large Cerebellar Stroke in a Young COVID-19-Positive Patient: Case Report.

J Emerg Med 2021 Feb 9. Epub 2021 Feb 9.

UC San Diego Health Sciences, UC San Diego Medical Center, San Diego, California.

Background: Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most frequently presents with respiratory symptoms, such as fever, dyspnea, shortness of breath, cough, or myalgias. There is now a growing body of evidence that demonstrates that severe SARS-CoV-2 infections can develop clinically significant coagulopathy, inflammation, and cardiomyopathy, which have been implicated in COVID-19-associated cerebrovascular accidents (CVAs).

Case Report: We report an uncommon presentation of a 32-year-old man who sustained a large vessel cerebellar stroke associated with a severe COVID-19 infection. Read More

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February 2021

A first trimester pregnancy with cerebrovascular accident treated with thrombolytic therapy: A case report.

Am J Emerg Med 2021 Apr 13. Epub 2021 Apr 13.

Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.

Pregnant patients are at increased risk of cerebrovascular accident due to the prothrombotic state of pregnancy. This risk is highest in those with pre-eclampsia and eclampsia as well as those of Asian descent. Despite this increased risk, pregnancy was an exclusion criterion for major stroke intervention trials. Read More

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Thrombolytic therapy for pulmonary embolism.

Cochrane Database Syst Rev 2021 04 15;4:CD004437. Epub 2021 Apr 15.

The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.

Background: Thrombolytic therapy is usually reserved for people with clinically serious or massive pulmonary embolism (PE). Evidence suggests that thrombolytic agents may dissolve blood clots more rapidly than heparin and may reduce the death rate associated with PE. However, there are still concerns about the possible risk of adverse effects of thrombolytic therapy, such as major or minor haemorrhage. Read More

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Intravenous Thrombolysis for Acute Ischemic Stroke Due to Cardiac Myxoma.

Basic Clin Neurosci 2020 Nov-Dec;11(6):855-859. Epub 2020 Nov 1.

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

Background: Myxoma may cause systemic embolization and frequently presents as ischemic stroke.

Case Presentation: There have been debates about whether it is safe to use recombinant tissue plasminogen activator (rt-PA) in patients with cardiac myxoma who referred with ischemic stroke to the hospital's emergency.

Results: The patient was a young case of atrial myxoma with initial presentation of acute cerebral infarction symptoms who was treated with intravenous rt-PA with no complications. Read More

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November 2020

Verapamil as an Adjunct Therapy to Reduce tPA Toxicity in Hyperglycemic Stroke: Implication of TXNIP/NLRP3 Inflammasome.

Mol Neurobiol 2021 Apr 13. Epub 2021 Apr 13.

Department of Anatomy and Neurobiology, College of Medicine, The University of Tennessee Health Science Center, 875 Monroe Avenue, Wittenborg Bldg, Room-231, Memphis, TN, 38163, USA.

Thrombolytic therapy has remained quite challenging in hyperglycemic patients for its association with poor prognosis and increased hemorrhagic conversions. We recently showed that tissue plasminogen activator (tPA)-induced cerebrovascular damage is associated with thioredoxin-interacting protein (TXNIP) upregulation, which has an established role in the detrimental effects of hyperglycemia. In the present work, we investigated whether verapamil, an established TXNIP inhibitor, may provide protection against hyperglycemic stroke and tPA-induced blood-brain barrier (BBB) disruption. Read More

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A case of acute cerebral infarction with a favorable prognosis after rt-PA administration by a general physician with telestroke support.

J Rural Med 2021 Apr 1;16(2):119-122. Epub 2021 Apr 1.

Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Japan.

Herein, we report a patient with acute cerebral infarction with a favorable prognosis after being managed by a general physician with support from the telestroke program. An 85-year-old man was transferred to a regional hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or neurologists were available in that hospital or area, the patient was examined by a general physician who diagnosed him with cardioembolic stroke on the left middle cerebral artery territory. Read More

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Decade-Long Nationwide Trends and Disparities in Use of Comfort Care Interventions for Patients With Ischemic Stroke.

J Am Heart Assoc 2021 Apr 7;10(8):e019785. Epub 2021 Apr 7.

Center for Outcomes Research Houston Methodist Houston TX.

Background Stroke remains one of the leading causes of disability and death in the United States. We characterized 10-year nationwide trends in use of comfort care interventions (CCIs) among patients with ischemic stroke, particularly pertaining to acute thrombolytic therapy with intravenous tissue-type plasminogen activator and endovascular thrombectomy, and describe in-hospital outcomes and costs. Methods and Results We analyzed the National Inpatient Sample from 2006 to 2015 and identified adult patients with ischemic stroke with or without thrombolytic therapy and CCIs using validated ( codes. Read More

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In imaging-selected ischemic stroke with unknown onset, alteplase increases favorable outcomes and death at 90 d.

Authors:
Michael D Hill

Ann Intern Med 2021 04 6;174(4):JC42. Epub 2021 Apr 6.

University of Calgary and Hotchkiss Brain Institute & Foothills Medical Centre, Calgary, Alberta, Canada (M.D.H.).

Source Citation: Thomalla G, Boutitie F, Ma H, et al. Lancet. 2020;396:1574-84. Read More

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Impact of COVID-19 on the rate of stroke cases at a tertiary hospital in Makkah, Saudi Arabia.

Neurosciences (Riyadh) 2021 Apr;26(2):158-162

From the Department of Neurology (Samkari, Alkhotani), King Abdullah Medical City, from the Department of Community Medicine (Siddiqui), and from the Department of Medicine (Alkhotani), Umm AlQura University, Makkah, Kingdom of Saudi Arabia.

Objectives: To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia.

Methods: This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020.

Results: Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. Read More

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Stroke Treatment With PAR-1 Agents to Decrease Hemorrhagic Transformation.

Front Neurol 2021 15;12:593582. Epub 2021 Mar 15.

Department of Physiology and Neuroscience, Keck School of Medicine, Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, United States.

Ischemic stroke is the most widespread cause of disability and a leading cause of death in developed countries. To date, the most potent approved treatment for acute stroke is recanalization therapy with thrombolytic drugs such as tissue plasminogen activator (rt-PA or tPA) or endovascular mechanical thrombectomy. Although tPA and thrombectomy are widely available in the United States, it is currently estimated that only 10-20% of stroke patients get tPA treatment, in part due to restrictive selection criteria. Read More

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Tube feeding predictors after ischemic hemispheric stroke during hospitalization.

Logoped Phoniatr Vocol 2021 Mar 29:1-6. Epub 2021 Mar 29.

Department of Health Sciences, Speech-Language Pathology Department, Universidade Federal de Santa Catarina, Florianopolis, Brazil.

Purpose: To verify the factors associated with the need of tube feeding (TF) during patients post-ischemic stroke hospitalization.

Method: This is a retrospective study with 70 adult post-ischemic hemispheric stroke adult patients hospitalized in the Neurology department at a tertiary public hospital in Santa Catarina, Brazil. We investigated associations between the need of a feeding tube during hospitalization and the variables age, gender, admission and discharge NIHSS and FOIS, length of hospital stay in days, presence of thrombolytic therapy, extensive stroke, hemisphere affected, prior stroke, pneumonia during hospitalization, presence of signs of laryngeal penetration and laryngotracheal aspiration and dysphagia in the first and last swallowing clinical evaluation. Read More

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Thrombolytic therapy for wake-up stroke: A systematic review and meta-analysis.

Eur J Neurol 2021 Mar 26. Epub 2021 Mar 26.

Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Background And Purpose: According to evidence-based clinical practice guidelines, patients presenting with disabling stroke symptoms should be treated with intravenous tissue plasminogen activator (IV tPA) within 4.5 h of time last known well. However, 25% of strokes are detected upon awakening (i. Read More

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Haemorrhagic transformation: A serious complication of massive ischemic stroke.

Med J Malaysia 2021 03;76(2):258-260

International Islamic University of Malaysia, Department of Medicine, Pahang, Malaysia.

Acute ischaemic stroke is a debilitating disease and may lead to haemorrhagic transformation associated with few factors such as high National Institute of Health Stroke Scale (NIHSS), low Modified Rankin Score (MRS), cardio-embolic clot and others.1 We report herein a 61 years old man whom presented with left sided weakness and diagnosed with acute right middle cerebral artery (MCA) infarction. Thrombolytic therapy was not offered due to low Alberta Stroke Program Early CT (ASPECT) score and hence managed conservatively. Read More

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Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence.

Ther Adv Neurol Disord 2021 26;14:1756286421997368. Epub 2021 Feb 26.

Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA.

Intravenous thrombolysis (IVT) represents the only systemic reperfusion therapy able to reverse neurological deficit in patients with acute ischemic stroke (AIS). Despite its effectiveness in patients with or without large vessel occlusion, it can be offered only to a minority of them, because of the short therapeutic window and additional contraindications derived from stringent but arbitrary inclusion and exclusion criteria used in landmark randomized controlled clinical trials. Many absolute or relative contraindications lead to disparities between the official drug label and guidelines or expert recommendations. Read More

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February 2021

Insight Into the Mechanisms and the Challenges on Stem Cell-Based Therapies for Cerebral Ischemic Stroke.

Front Cell Neurosci 2021 25;15:637210. Epub 2021 Feb 25.

Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Strokes are the most common types of cerebrovascular disease and remain a major cause of death and disability worldwide. Cerebral ischemic stroke is caused by a reduction in blood flow to the brain. In this disease, two major zones of injury are identified: the lesion core, in which cells rapidly progress toward death, and the ischemic penumbra (surrounding the lesion core), which is defined as hypoperfusion tissue where cells may remain viable and can be repaired. Read More

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February 2021