11,311 results match your criteria Thrombolytic Therapy in Stroke


Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis.

Neurol Sci 2022 May 17. Epub 2022 May 17.

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, 310014, Hangzhou, China.

Background/objective: Cardiac diseases are frequently accompanied by elevated levels of biomarkers, among which, troponin is commonly investigated. The levels of plasma cardiac troponin I (cTnI), which has been shown to predict short-term mortality, are elevated in patients with acute cerebral infarction (ACI). However, few studies have assessed the association between cTnI concentration and long-term mortality in patients with ACI following thrombolysis. Read More

View Article and Full-Text PDF

Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke.

Stroke 2022 May 17:101161STROKEAHA121037687. Epub 2022 May 17.

Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.).

Background: Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care.

Methods: This nationwide register-based cohort study included patients with ischemic stroke registered in the Danish Stroke Registry between 2015 and 2018. Read More

View Article and Full-Text PDF

Emergency Cervical Carotid Artery Stenting After Intravenous Thrombolysis in Patients With Hyperacute Ischemic Stroke.

J Korean Med Sci 2022 May 16;37(19):e156. Epub 2022 May 16.

Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.

Background: Intravenous recombinant tissue plasminogen activator (IV rtPA) is the mainstay of treatment for acute ischemic stroke to recanalize thrombosed intracranial vessels within 4.5 hours. Emergency carotid artery stenting for the treatment of acute stroke due to steno-occlusion of the proximal internal carotid artery (ICA) can improve symptoms, prevent neurological deterioration, and reduce recurrent stroke risk. Read More

View Article and Full-Text PDF

Thrombolytic tPA-Induced Hemorrhagic Transformation of Ischemic Stroke is Mediated by PKCβ phosphorylation of Occludin.

Blood 2022 May 16. Epub 2022 May 16.

University of Michigan, United States.

The current standard of care for moderate to severe ischemic stroke is thrombolytic therapy with tissue plasminogen activator (tPA). Treatment with tPA can significantly improve neurological outcomes; however, thrombolytic therapy is associated with an increased risk of intracerebral hemorrhage (ICH). The risk of hemorrhage significantly limits the use of thrombolytic therapy and identifying pathways induced by tPA that increase this risk could provide new therapeutic options to extend thrombolytic therapy to a wider patient population. Read More

View Article and Full-Text PDF

Impact of Medical Community Model on Intravenous Alteplase Door-to-Needle Times and Prognosis of Patients With Acute Ischemic Stroke.

Front Surg 2022 27;9:888015. Epub 2022 Apr 27.

Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China.

Objective: In this study, we retrospectively analyzed 795 AIS patients who received intravenous alteplase for thrombolytic therapy in one third-class hospital or three second-class hospitals in Dongyang City and sought to evaluate the effects of the medical community model on intravenous alteplase door-to-needle time (DNT) and prognosis of patients with acute ischemic stroke.

Methods: According to whether the medical community model is established or not, 303 AIS patients (204 cases from the third-class hospital and 99 cases from three second-class hospitals) were assigned to control group unavailable to the medical community model and 492 AIS patients (297 cases from the third-class hospital, and 195 cases from three second-class hospitals) into observational group available to the medical community model.

Results: A higher thrombolysis rate, a shorter DNT, more patients with DNT ≤ 60 min and DNT ≤ 45 min, a shorter ONT, lower National Institutes of Health Stroke Scale (NIHSS) scores at 24 h, 7 d, 14 d, and modified Rankin scale (mRS) scores at 3 months after thrombolytic therapy, a shorter length of hospital stay, and less hospitalization expense were found in the observational group than the control group. Read More

View Article and Full-Text PDF

Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis.

Front Neurol 2022 29;13:851910. Epub 2022 Apr 29.

Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China.

Introduction: The safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke.

Methods: We systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Read More

View Article and Full-Text PDF

An Optimal Animal Model of Ischemic Stroke Established by Digital Subtraction Angiography-Guided Autologous Thrombi in Cynomolgus Monkeys.

Front Neurol 2022 25;13:864954. Epub 2022 Apr 25.

Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China.

Objective: Ischemic stroke seriously threatens human health, characterized by the high rates of incidence, disability, and death. Developing a reliable animal model that mimics most of the features of stroke is critical for pathological studies and clinical research. In this study, we aimed to establish and examine a model of middle cerebral artery occlusion (MCAO) guided by digital subtraction angiography (DSA) in cynomolgus monkeys. Read More

View Article and Full-Text PDF

Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of <3 Hour Intravenous Alteplase.

Stroke 2022 May 11:101161STROKEAHA121038153. Epub 2022 May 11.

Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (K.T.M., D.S.L., J.L.S.).

Background: Cumulative fragility index (FI) analysis enables quantification of the evidential strength of intravenous alteplase's core indication-treatment of disabling acute ischemic stroke within 3 hours of onset.

Methods: Meta-analyses were performed (study level) or identified (individual participant level) for freedom-from-disability (modified Rankin Scale [mRS] score 0-1, primary efficacy), functional independence (mRS score 0-2, secondary efficacy), and mortality outcomes. Individual trial and cumulative FI analyses were serially conducted after each successive randomized controlled trial (RCT). Read More

View Article and Full-Text PDF

Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial.

Lancet Neurol 2022 Jun 4;21(6):520-527. Epub 2022 May 4.

Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

Background: Mobile stroke units (MSUs) equipped with a CT scanner reduce time to thrombolytic treatment and improve patient outcomes. We tested the hypothesis that tenecteplase administered in an MSU would result in superior reperfusion at hospital arrival, when compared with alteplase.

Methods: The TASTE-A trial is a phase 2, randomised, open-label trial at the Melbourne MSU and five tertiary hospitals in Melbourne, VIC, Australia. Read More

View Article and Full-Text PDF

Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial.

Lancet Neurol 2022 Jun 4;21(6):511-519. Epub 2022 May 4.

Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Background: Tenecteplase is a modified tissue plasminogen activator with pharmacological and practical advantages over alteplase-which is currently the only approved thrombolytic drug for ischaemic stroke. The NOR-TEST trial showed that 0·4 mg/kg tenecteplase had an efficacy and safety profile similar to that of a standard dose (0·9 mg/kg) of alteplase, albeit in a patient population with a high prevalence of minor stroke. The aim of NOR-TEST 2 was to establish the non-inferiority of tenecteplase 0·4 mg/kg to alteplase 0·9 mg/kg for patients with moderate or severe ischaemic stroke. Read More

View Article and Full-Text PDF

Tenecteplase for acute stroke: the thrombolysis puzzle.

Lancet Neurol 2022 Jun 4;21(6):496-497. Epub 2022 May 4.

Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

View Article and Full-Text PDF

MRI-guided thrombolysis for lenticulostriate artery stroke within 12 h of symptom onset.

Sci Rep 2022 May 6;12(1):7445. Epub 2022 May 6.

Department of Neurology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China.

Stroke thrombolysis treatment is generally administered within 4.5 h, but a greater time window may be permitted depending upon the ischemic penumbra on neuroimaging. This observational cohort study investigated the outcomes of thrombolysis given within 12 h after symptom onset of lenticulostriate artery stroke. Read More

View Article and Full-Text PDF

Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?

Surg Neurol Int 2022 29;13:177. Epub 2022 Apr 29.

Department of Neuroscience, Ascension St Mary's Hospital, Saginaw, Michigan, United States.

Background: Acute ischemic stroke (AIS) due to cervical internal carotid artery (cICA) occlusion is challenging to treat, with the lower revascularization rates, higher risk for complications, and poor response to thrombolytic therapy compared to isolated intracranial occlusions. While emergent revascularization through mechanical thrombectomy (MT) improves outcomes, the impact of tissue plasminogen activator (tPA) on outcomes in this subgroup of patients remains unclear. The objective of this study is to report our preliminary experience in treating AIS with cICA occlusions secondary to severe atherosclerotic stenosis and to establish the need for further clinical studies to determine the optimal intervention strategy for these lesions. Read More

View Article and Full-Text PDF

The End of Tissue-Type Plasminogen Activator's Reign?

Authors:
Imad Derraz

Stroke 2022 May 4:101161STROKEAHA122039287. Epub 2022 May 4.

Department of Neuroradiology, Hôpital Guide Chauliac, Montpellier University Medical Center, France.

Mechanical thrombectomy is a highly effective treatment for acute ischemic stroke caused by large-vessel occlusion in the anterior cerebral circulation, significantly increasing the likelihood of recovery to functional independence. Until recently, whether intravenous thrombolysis before mechanical thrombectomy provided additional benefits to patients with acute ischemic stroke-large-vessel occlusion remained unclear. Given that reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke-large-vessel occlusion and the efficacy of both intravenous thrombolysis and mechanical thrombectomy is time-dependent, achieving complete reperfusion with a single pass should be the primary angiographic goal. Read More

View Article and Full-Text PDF

Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke: A Phase IIa Randomized Clinical Trial.

Transl Stroke Res 2022 May 3. Epub 2022 May 3.

Department of Neurology, Xuanwu Hospital, Capital Medicine University, 45 Chang Chun St, Beijing, 100053, China.

Recombinant human prourokinase (rhPro-UK) is a novel thrombolytic that has been approved to treat patients with acute myocardial infarction. However, the safety and efficacy of intravenous rhPro-UK in patients with acute ischemic stroke (AIS) has not been well established. We aimed to investigate the safety and preliminary efficacy of rhPro-UK in patients with AIS in a multi-center phase IIa trial setting. Read More

View Article and Full-Text PDF

Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation Trial in the Ambulance (Mobile Stroke Unit-TASTE-A): protocol for a prospective randomised, open-label, blinded endpoint, phase II superiority trial of tenecteplase versus alteplase for ischaemic stroke patients presenting within 4.5 hours of symptom onset to the mobile stroke unit.

BMJ Open 2022 Apr 29;12(4):e056573. Epub 2022 Apr 29.

School of Medicine and Public Health, Department of Neurology Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia.

Introduction: Mobile stroke units (MSUs) equipped with a CT scanner are increasingly being used to assess and treat stroke patients' prehospital with thrombolysis and transfer them to the most appropriate hospital for ongoing stroke care and thrombectomy when indicated. The effect of MSUs in both reducing the time to reperfusion treatment and improving patient outcomes is now established. There is now an opportunity to improve the efficacy of treatment provided by the MSU. Read More

View Article and Full-Text PDF

Investigational drugs for ischemic stroke: what's in the clinical development pipeline for acute phase and prevention?

Expert Opin Investig Drugs 2022 May 13:1-23. Epub 2022 May 13.

Department of Medicine and Surgery, University of Insubria, Varese, Italy.

Introduction: Stroke is a leading cause of disability and mortality and its burden expected to increase. The only approved drug for acute ischemic stroke (IS) is the intravenous thrombolytic alteplase. The risk of bleeding complications is one of the reasons for the undertreatment of eligible patients. Read More

View Article and Full-Text PDF

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction.

Pak J Med Sci 2022 Mar-Apr;38(3Part-I):498-504

Guoqing Wang, Department of Neurology, Binzhou People's Hospital, Shandong 256610, China.

Objectives: To compare the efficacy and safety of intravenous thrombolysis with alteplase and intravenous thrombolysis with urokinase for patients with acute cerebral infarction.

Methods: This prospective study included 140 patients with acute cerebral infarction who were admitted to our hospital between June 2018 and June 2019. They were randomly divided into two groups. Read More

View Article and Full-Text PDF

Stroke outcome of early antiplatelet in post-thrombolysis haemorrhagic infarction.

J Neurol Neurosurg Psychiatry 2022 Apr 26. Epub 2022 Apr 26.

Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China

Background And Purpose: Initiation of early antiplatelet (EA) therapy after acute ischaemic stroke (AIS) is essential. We aimed to investigate the safety and effectiveness of EA therapy in patients who had an AIS with haemorrhagic infarction (HI) after intravenous thrombolysis (IVT).

Methods: Based on a multicentre stroke registry database, patients who had an AIS with post-thrombolysis HI at 24 hours were identified. Read More

View Article and Full-Text PDF

The Effect of Age and Sex on Ischemıc Stroke: A Sıngle-Centred Neuro-Intensıve Care Unıt Experıence.

Authors:
Seda Guzeldag

Acta Neurol Taiwan 2022 Dec;31(4):145-153

Department of Neuro-Intensive Care Unit, Kayseri City Hospital, Turkey.

Background: Age and sex are important determinants in the acute ischemic stroke (AIS). In this study, we examine the effects of age and sex on stroke survival and treatment in our clinic.

Methods: We reviewed 368 AIS patients' records between January 1, 2019, and January 1, 2020, and formed three groups of age; Group 1:18-64 years, Group 2:65-79 years, and Group 3:more than 80 years. Read More

View Article and Full-Text PDF
December 2022

Intravenous thrombolysis prior to mechanical thrombectomy does not affect clinical or procedural outcomes in patients with large vessel occlusion acute ischemic stroke.

J Clin Neurosci 2022 Jun 19;100:120-123. Epub 2022 Apr 19.

Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States; Clinical Neuroscience Institute, Premier Health, Dayton OH, United States. Electronic address:

Mechanical thrombectomy (MT) has revolutionized the care of large vessel occlusion acute ischemic strokes (LVOAIS). However, the benefit of intravenous thrombolysis prior to MT remains unproven. Two recent trials showed equivocal results regarding the benefits of pre-MT intravenous thrombolysis in predominantly Asian populations. Read More

View Article and Full-Text PDF

Negative correlation between early recovery and lipoprotein-associated phospholipase A2 levels after intravenous thrombolysis.

J Int Med Res 2022 Apr;50(4):3000605221093303

Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China.

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is considered a biomarker for systemic inflammation and the risk of myocardial infarction and stroke. However, little is known about the effect of acute vascular events on marker levels. The purpose of this study was to assess the potential association of early recovery with Lp-PLA2 levels in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). Read More

View Article and Full-Text PDF

Intravenous Administration of Scutellarin Nanoparticles Augments the Protective Effect against Cerebral Ischemia-Reperfusion Injury in Rats.

Mol Pharm 2022 05 20;19(5):1410-1421. Epub 2022 Apr 20.

School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom.

This study investigates the protective effect of poly(lactic--glycolic acid) (PLGA) nanoparticles (NPs) loaded with scutellarin (SCU), a flavone isolated from the traditional Chinese medicine (Vant.) Hand.-Mazz. Read More

View Article and Full-Text PDF

Urgent Demand of Network Access for Acute Ischemic Stroke Management in Taiwan.

Acta Neurol Taiwan 2022 Sep;31(3):84-90

Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Time is the major determinant in successful reperfusion therapy of acute ischemic stroke. The evolving diagnostic tools and treatment of acute stroke has made a great progress in the past 2 decades and is remolding current management practices. It demands a timely neurologic evaluation and a neuroimaging study to determine if stroke patients are appropriate candidates for reperfusion demands. Read More

View Article and Full-Text PDF
September 2022

Advances in Acute Ischemic Stroke Therapy.

Circ Res 2022 Apr 14;130(8):1230-1251. Epub 2022 Apr 14.

Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School' Boston' MA (M.F.).

The treatment of acute ischemic stroke continues to advance. The mainstay of treatment remains intravenous thrombolysis with alteplase. Recent studies demonstrated that later treatment with alteplase is beneficial in patients selected with advanced imaging techniques. Read More

View Article and Full-Text PDF

Estimation of treatment effects in observational stroke care data: comparison of statistical approaches.

BMC Med Res Methodol 2022 04 10;22(1):103. Epub 2022 Apr 10.

Department of Public Health, Erasmus University Medical Center, Erasmus MC, P.O. Box 2040, CA, Rotterdam, the Netherlands.

Introduction: Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data.

Patients And Methods: We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Read More

View Article and Full-Text PDF

How Frequent is the One-Hour tPA Infusion Interrupted or Delayed?

J Stroke Cerebrovasc Dis 2022 Jun 5;31(6):106471. Epub 2022 Apr 5.

Mobile Stroke Unit, Memorial Hermann Hospital, USA. Electronic address:

Background And Purpose: Tissue plasminogen activator (tPA) requires a one-hour infusion after the bolus. The frequency of delay or interruption of the tPA infusion may be useful in weighing the advantages of Tenecteplase (TNKase, TNK) which does not require an infusion.

Methods: Utilizing the Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services study database, we calculated the frequency and magnitude of tPA infusion delay or interruption. Read More

View Article and Full-Text PDF