Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy

Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS). With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiably improved outcomes, but only a minority are able to achieve these highest grades. As such, one of the primary targets for improvement in MT is finding reliable means of achieving near-perfect reperfusion.
Source: JAMA Neurology - Category: Neurology Source Type: research

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AbstractWhile a number of studies have reported an association between apelin-13 and ischemic stroke, few have verified its clinical effect. We investigated the prognostic value of serum apelin-13 levels in patients with acute ischemic stroke (AIS). We prospectively recruited 244 AIS patients within 24  h after stroke onset, and 167 healthy controls. We assessed the serum apelin-13 levels using ELISA, and the severity of AIS using the National Institutes of Health Stroke Scale (NIHSS). The primary outcomes included death or major disability (modified Rankin Scale score, 3–6) and major disabilit y (modified Ranki...
Source: Translational Stroke Research - Category: Neurology Source Type: research
This article highlights the various agents which have tried in the past but failed to translate into stroke therapy along with key points that are responsible for lagging of experimental success to translational failure in stroke treatment. PMID: 31934841 [PubMed - as supplied by publisher]
Source: Current Neuropharmacology - Category: Drugs & Pharmacology Authors: Tags: Curr Neuropharmacol Source Type: research
In this study, we hypothesize that aging enhances the pro-inflammatory function of neutrophils, directly contributing to the poorer outcomes seen in aging patients. We utilized demographic data and biological specimens from ischemic stroke patients and an experimental mouse model to determine the correlation between age, neutrophil function and stroke outcomes. In ischemic stroke patients, age was associated with increased mortality and morbidity and higher levels of neutrophil-activating cytokines. In mice, aged animals had higher stroke mortality and morbidity, higher levels of neutrophil-activating cytokines and enhance...
Source: Aging - Category: Biomedical Science Authors: Tags: Aging (Albany NY) Source Type: research
AbstractPurposeThis review summarizes the current science underpinning the treatment of patients with ischemic stroke who awaken with stroke symptoms. This large subset of stroke patients has historically been precluded from treatment with disability-limiting reperfusion therapies such as intravenous thrombolysis. Recent advances in neuroimaging have shifted the paradigm of treatment based upon rigid time-based criteria to treatment guided by evidence of salvageable ischemic penumbra on advanced imaging.Recent FindingsSeveral recent randomized controlled trials provide evidence that imaging-guided treatment of wake-up and ...
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research
Publication date: Available online 7 January 2020Source: The Lancet Diabetes &EndocrinologyAuthor(s): Hertzel C Gerstein, Robert Hart, Helen M Colhoun, Rafael Diaz, Mark Lakshmanan, Fady T Botros, Jeffrey Probstfield, Matthew C Riddle, Lars Rydén, Charles Messan Atisso, Leanne Dyal, Stephanie Hall, Alvaro Avezum, Jan Basile, Ignacio Conget, William C Cushman, Nicolae Hancu, Markolf Hanefeld, Petr Jansky, Matyas KeltaiSummaryBackgroundCardiovascular outcome trials have suggested that glucagon-like peptide 1 (GLP-1) receptor agonists might reduce strokes. We analysed the effect of dulaglutide on stroke within the ...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research
Abstract An important cause of acquired brain injury in children, pediatric ischemic stroke can cause sequelae across a wide range of cognitive domains, including verbal reasoning and processing speed. As a result, survivors are especially vulnerable to academic difficulties and face unique challenges compared to their peers. Despite this knowledge, pediatric stroke remains an understudied neurological condition, and its impact on school functioning poorly understood. The present clinical study addressed academic outcome in this population using a multifaceted approach. Patients were recruited for participation fr...
Source: Child Neuropsychology - Category: Child Development Authors: Tags: Child Neuropsychol Source Type: research
Background and Purpose: Inflammation plays a significant role in the pathogenesis of acute ischemic stroke (AIS). The role of β2-microglobulin (β2M) as a potential initiator of the inflammatory response in AIS is unclear. The purpose of this study was to analyze the relationship of serum β2M with the recurrence risk and 3-month outcome of AIS.Methods: A total of 205 patients with AIS were recruited, and their clinical and biochemical characteristics were collected. All patients were followed up for 3 months after stroke onset, and the occurrence of death or major disability at 3 months after onset was the ou...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion. . With the increase of spinal procedures, it is important to identify patients at risk for having an ischemic stroke and to optimize their comorbidities preoperatively. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization. Level of Evidence: 4
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research
In this study, we aim to explore the mechanism by which ANRIL exhibits protective effect. Middle cerebral artery occlusion mouse models were applied and infarction areas were assessed by TTC assay. The expression of ANRIL and miR-199a-5p were determined by qPCR. Oxygen and glucose deprivation treatment was applied to mimic in vitro ischemia injury in N-2a cells. The levels of BCL-2, BAX, MEK, ERK, CAV-1 were determined by western blot. Cell viability were assessed by MTT assay. The direct interaction among miR-199a-5p and ANRIL, miR-199a-5p and CAV-1 were demonstrated by dual Luciferase report assay. ANRIL and miR-199a-5p ...
Source: Neurochemical Research - Category: Neuroscience Authors: Tags: Neurochem Res Source Type: research
Publication date: Available online 28 December 2019Source: Microvascular ResearchAuthor(s): Edna Constanza Gómez Victoria, Eliana Cristina de Brito Toscano, Fabrício Marcus Silva Oliveira, Bárbara Andrade de Carvalho, Marcelo Vidigal Caliari, Antônio Lúcio Teixeira, Aline Silva de Miranda, Milene Alvarenga RachidAbstractIschemic stroke represents a major cause of adult death and severe neurological disability worldwide. Reperfusion following brain ischemia produces an inflammatory cascade that increases brain damage. In this context, matrix metalloproteinases (MMPs) play an important role ...
Source: Microvascular Research - Category: Biochemistry Source Type: research
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