Regarding “Meet Me in Computed Tomography Suite: Decreasing Tissue Plasminogen Activator Door-to-Needle Time for Acute Ischemic Stroke Patients”

As a manager of a large urban academic medical center, I have implemented multiple best practices related to improving tissue plasminogen activator (tPA) administration. For a comprehensive stroke center with multiple EMS providers, implementing multiple strategies to decrease door-to-needle times is important. I found the article “Meet Me in Computed Tomography Suite: Decreasing Tissue Plasminogen Activator Door-to-Needle Time for Acute Ischemic Stroke Patients” by Speirs and Mitchell1 to be thorough, comprehensive, and an overall excellent review.
Source: Journal of Emergency Nursing: JEN - Category: Nursing Tags: Letters Source Type: research

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AbstractThe Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used for the assessment of early ischemic changes (EICs) before thrombolysis. However, for symptomatic intracerebral hemorrhage (sICH) following intravenous recombinant tissue plasminogen activator (rt-PA), the prediction abilities of CT-ASPECTS, diffusion-weighted imaging (DWI)-ASPECTS, and DWI-ASPECTS including EICs in deep white matter (DWI-ASPECTS  + W) are unclear. We investigated associations between each score and sICH following intravenous rt-PA. Data from consecutive patients who received intravenous rt-PA for acut...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusions: DDAVP was associated with a decreased likelihood of intracranial hemorrhage expansion during the first 24 hours. DDAVP administration did not significantly affect serum sodium and thrombotic events during the study period.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research
Temporary middle cerebral artery occlusion (MCAO) in sheep allows modeling of acute large vessel occlusion stroke and subsequent vessel recanalization. However, rapid and precise imaging-based assessment of vessel occlusion and the resulting perfusion deficit during MCAO still represents an experimental challenge. Here, we tested feasibility and suitability of a strategy for MCAO verification and perfusion deficit assessment. We also compared the extent of the initial perfusion deficit and subsequent lesion size for different MCAO durations. The rete mirabile prevents reliable vascular imaging investigation of middle cereb...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
AbstractTime-consuming reconstruction of volumetric data by area-detector-computed tomography (ADCT) scanning and narrow coverage of small-row ADCT may hinder volumetric scanning in acute stroke stage. To design a practical protocol of volumetric scanning for thrombectomy using an 80-row ADCT. An imaging protocol that focuses on the middle cerebral arteries by tilting the gantry of an 80-row ADCT with 0.5-mm-thick detectors can shorten the reconstruction time by 1.0-mm thickness scanning without subtraction. The reconstruction time of small volumetric data was 69 second. This practical protocol is applicable before thrombe...
Source: Neuroradiology - Category: Radiology Source Type: research
To investigate whether contrast extravasation on dual-energy computed tomography (DECT) in patients with acute ischemic stroke (AIS) after endovascular therapy (EVT) are related to hemorrhagic transformation (HT) and poor short-term clinical outcomes.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
ConclusionsThe most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.ResumenIntroducciónLas hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las característi...
Source: Neurologia - Category: Neurology Source Type: research
Publication date: Available online 4 November 2019Source: Journal of Clinical NeuroscienceAuthor(s): Atilla Özcan Özdemir, Ezgi Sezer Eryıldız, Fatma Ger Akarsu, Zehra Uysal Kocabaş, Özlem AykaçAbstractThe Alberta Stroke Program Early Computed Tomography Score (ASPECTs) on noncontrast CT (NCCT) is widely used for the decision of endovascular therapy (ET) in randomized controlled trials. CT angiography source images (CTA-SI) is another method to evaluate ischemic brain damage. We aimed to evaluate the association between pretreatment ASPECTs on CTA-SI and post-treatment clinical and radiological out...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
A nationally recommended practice to accelerate thrombolytic therapy for acute ischemic stroke is to route emergency medical services (EMS)-transported stroke patients directly to the computed tomography (CT) scanner on arrival. We evaluated door-to-needle time with direct-to-CT routing versus emergency department (ED)-bed first routing.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.
Source: The Neurologist - Category: Neurology Tags: Case Report/Case Series Source Type: research
AbstractPurposeThe aim of this study was to develop an interactive deep learning-assisted identification of the hyperdense middle cerebral artery (MCA) sign (HMCAS) on non-contrast computed tomography (CT) among patients with acute ischemic stroke.Materials and methods35 HMCAS-positive and 39 HMCAS-negative samples extracted by 50-pixel-diameter circular regions of interest were obtained as training and validation datasets according to the consensus decisions of two experienced neuroradiologists. Data augmentation was performed to increase the number of training samples. A deep convolutional neural network (DCNN) (Xception...
Source: Japanese Journal of Radiology - Category: Radiology Source Type: research
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