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Low Levels of Caveolin-1 Predict Symptomatic Bleeding After Thrombolytic Therapy in Patients With Acute Ischemic Stroke Brief Report
Background and Purpose—Experimental models of cerebral ischemia demonstrate that the decrease in the caveolin-1 membrane protein results in an increase in endothelial permeability. Because this phenomenon is responsible for hemorrhagic transformation (HT) after cerebral ischemia, we aimed to determine whether caveolin-1 levels may predict bleeding after recombinant tissue-type plasminogen activator (r-tPA) administration in patients with acute stroke.Methods—We studied 133 patients with a first hemispheric stroke treated with r-tPA within 4.5 hours of symptom onset. HT was evaluated and classified on cranial computed t...
Source: Stroke - May 25, 2018 Category: Neurology Authors: Mar Castellanos, Cecile van Eendenburg, Carme Gubern, Elisabet Kadar, Gemma Huguet, Josep Puig, Tomas Sobrino, Gerard Blasco, Joaquin Serena, Juan Manuel Sanchez Tags: Biomarkers, Endothelium/Vascular Type/Nitric Oxide, Blood-Brain Barrier, Ischemic Stroke Brief Reports Source Type: research

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association AHA/ASA Scientific Statement
Purpose—Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment.Methods—A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The documen...
Source: Stroke - November 27, 2017 Category: Neurology Authors: Shadi Yaghi, Joshua Z. Willey, Brett Cucchiara, Joshua N. Goldstein, Nicole R. Gonzales, Pooja Khatri, Louis J. Kim, Stephan A. Mayer, Kevin N. Sheth, Lee H. Schwamm Tags: Statements and Guidelines AHA/ASA Scientific Statement Source Type: research

Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke Clinical Sciences
Conclusions—Coexistent SCD had no significant impact on the safety or outcome of thrombolytic therapy in acute ischemic stroke. Although the sample size is relatively small, these data suggest that adults with SCD and acute ischemic stroke should be treated with thrombolysis, if they otherwise qualify. Addition studies, however, should track the intracranial hemorrhage rate and provide information on other SCD-related care such as transfusion.
Source: Stroke - February 26, 2017 Category: Neurology Authors: Robert J. Adams, Margueritte Cox, Shelly D. Ozark, Julie Kanter, Phillip J. Schulte, Ying Xian, Gregg C. Fonarow, Eric E. Smith, Lee H. Schwamm Tags: Ischemic Stroke, Transient Ischemic Attack (TIA) Original Contributions Source Type: research

Intravenous Thrombolysis in Unknown-Onset Stroke Clinical Sciences
Conclusions—Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window.
Source: Stroke - February 26, 2017 Category: Neurology Authors: Laura Dorado, Niaz Ahmed, Gotz Thomalla, Manuel Lozano, Branko Maloȷcic, Mushtaq Wani, Monica Millan, Ales Tomek, Antoni Davalos Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China Clinical Sciences
Conclusions—Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China.
Source: Stroke - October 23, 2016 Category: Neurology Authors: Li, Z., Wang, C., Zhao, X., Liu, L., , Li, H., Shen, H., Liang, L., Bettger, J., Yang, Q., Wang, D., Wang, A., Pan, Y., Jiang, Y., Yang, X., Zhang, C., Fonarow, G. C., Schwamm, L. H., Hu, B., Peterson, E. D., Xian, Y., Wang, Y., Tags: Clinical Studies, Health Services, Quality and Outcomes, Cerebrovascular Disease/Stroke Original Contributions Source Type: research

Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) Clinical Sciences
Conclusions— Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.
Source: Stroke - September 25, 2016 Category: Neurology Authors: Asdaghi, N., Romano, J. G., Wang, K., Ciliberti-Vargas, M. A., Koch, S., Gardener, H., Dong, C., Rose, D. Z., Waddy, S. P., Robichaux, M., Garcia, E. J., Gonzalez-Sanchez, J. A., Burgin, W. S., Sacco, R. L., Rundek, T. Tags: Secondary Prevention, Women, Quality and Outcomes, Ischemic Stroke Clinical Sciences Source Type: research

Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes: A Pooled Analysis of 9 Trials Clinical Sciences
Conclusions— Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Lees, K. R., Emberson, J., Blackwell, L., Bluhmki, E., Davis, S. M., Donnan, G. A., Grotta, J. C., Kaste, M., von Kummer, R., Lansberg, M. G., Lindley, R. I., Lyden, P., Murray, G. D., Sandercock, P. A. G., Toni, D., Toyoda, K., Wardlaw, J. M., Whiteley, Tags: Treatment, Cerebrovascular Disease/Stroke, Cerebrovascular Procedures, Ischemic Stroke Clinical Sciences Source Type: research

Identification of Reversible Disruption of the Human Blood-Brain Barrier Following Acute Ischemia Brief Reports
Conclusions— This study demonstrates that diffuse, mild BBB disruption in the acutely ischemic human brain is reversible with reperfusion. This study also confirms prior findings that focal severe BBB disruption confers an increased risk of hemorrhagic transformation in patients treated with intravenous tissue-type plasminogen activator.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Simpkins, A. N., Dias, C., Leigh, R., on behalf of the National Institutes of Health Natural History of Stroke Investigators, Benson, Hsia, Latour, Luby, Lynch, Merino, Nadareishvili, Warach Tags: Magnetic Resonance Imaging (MRI), Blood-Brain Barrier, Intracranial Hemorrhage, Ischemic Stroke Brief Reports Source Type: research

Intravenous Thrombolysis With Recombinant Tissue-Type Plasminogen Activator in a Stroke Patient Receiving Dabigatran Anticoagulant After Antagonization With Idarucizumab Brief Reports
Conclusions— This case represents a new therapeutic paradigm. It is further supported by in vitro data showing no nonspecific interactions of idarucizumab with recombinant tissue-type plasminogen activator–induced thrombolysis. Thus, patients effectively anticoagulated with dabigatran who were previously contraindicated for thrombolytic therapy in this situation may now receive treatment because of the ability to rapidly reverse the anticoagulant activity of dabigatran with idarucizumab.
Source: Stroke - June 26, 2016 Category: Neurology Authors: Berrouschot, J., Stoll, A., Hogh, T., Eschenfelder, C. C. Tags: Cerebrovascular Procedures, Ischemic Stroke Brief Reports Source Type: research

Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke: Systematic Review Clinical Sciences
Conclusions— This systematic review and meta-analysis suggest that greater systolic BPV, measured early from ischemic stroke or intracerebral hemorrhage onset, is associated with poor longer-term functional outcome. Future prospective studies should investigate how best to measure and define BPV in acute stroke, as well as to determine its prognostic significance.
Source: Stroke - August 24, 2015 Category: Neurology Authors: Manning, L. S., Rothwell, P. M., Potter, J. F., Robinson, T. G. Tags: Cerebrovascular disease/stroke, Acute Cerebral Hemorrhage, Acute Cerebral Infarction, Acute Stroke Syndromes Clinical Sciences Source Type: research

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry Clinical Sciences
Conclusions— These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke.
Source: Stroke - June 22, 2015 Category: Neurology Authors: Fukuda, K., Kai, H., Kamouchi, M., Hata, J., Ago, T., Nakane, H., Imaizumi, T., Kitazono, T., on behalf of the FSR Investigators, The steering committee of the Fukuoka Stroke Registry included, Ishitsuka, Fujimoto, Ibayashi, Kusuda, Arakawa, Irie, Fujii, Tags: Acute Cerebral Infarction Clinical Sciences Source Type: research

Validity of Shape as a Predictive Biomarker of Final Infarct Volume in Acute Ischemic Stroke Clinical Sciences
Conclusions— Our findings suggest that lesion shape contains important predictive information and reflects important environmental factors that might determine the progression of ischemia from the core.
Source: Stroke - March 23, 2015 Category: Neurology Authors: Frindel, C., Rouanet, A., Giacalone, M., Cho, T.-H., Ostergaard, L., Fiehler, J., Pedraza, S., Baron, J.-C., Wiart, M., Berthezene, Y., Nighoghossian, N., Rousseau, D. Tags: Acute Cerebral Infarction, Brain Circulation and Metabolism Clinical Sciences Source Type: research

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke: Use, Temporal Trends, and Outcomes Clinical Sciences
Conclusions— Drip and ship tPA is common, used in 1 in 4 patients treated with tPA in the United States. Modest differences in mortality and symptomatic intracranial hemorrhage may be because of patient selection bias, post-tPA care differences, or unmeasured confounding. The drip and ship paradigm may facilitate widespread tPA use in patients with acute stroke.
Source: Stroke - February 23, 2015 Category: Neurology Authors: Sheth, K. N., Smith, E. E., Grau-Sepulveda, M. V., Kleindorfer, D., Fonarow, G. C., Schwamm, L. H. Tags: Acute Cerebral Infarction, Acute Stroke Syndromes, Embolic stroke, Emergency treatment of Stroke, Thrombolysis Clinical Sciences Source Type: research

Initial Body Temperature in Ischemic Stroke: Nonpotentiation of Tissue-Type Plasminogen Activator Benefit and Inverse Association With Severity Clinical Sciences
Conclusions— In patients with hyperacute stroke, higher presenting temperatures are associated with less severe neurological deficits and reduced final infarct volumes. Presenting temperature does not modify the benefit of tPA on 3-month favorable outcome.
Source: Stroke - December 22, 2014 Category: Neurology Authors: Kim, S. H., Saver, J. L. Tags: Thrombolysis Clinical Sciences Source Type: research

Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial) Clinical Sciences
Conclusions— These exploratory analyses of the third International Stroke Trial (IST-3) trial support improving acute stroke patients’ access to earlier alteplase treatment, treatment of patients with poor prognosis, and further randomized controlled trials in minor stroke to replicate these findings. Clinical Trial Registration— URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25765518.
Source: Stroke - November 24, 2014 Category: Neurology Authors: Whiteley, W. N., Thompson, D., Murray, G., Cohen, G., Lindley, R. I., Wardlaw, J., Sandercock, P., on behalf of the IST-3 Collaborative Group Tags: Acute Cerebral Infarction, Thrombolysis Clinical Sciences Source Type: research

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