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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

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

Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone Clinical Sciences
Conclusions— THERAPY did not achieve its primary end point in this underpowered sample. Directions of effect for all prespecified outcomes were both internally and externally consistent toward benefit. It is possible that an alternate method of thrombectomy, primary aspiration, will benefit selected patients harboring large vessel occlusions. Further study on this topic is indicated. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01429350.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Mocco, J., Zaidat, O. O., von Kummer, R., Yoo, A. J., Gupta, R., Lopes, D., Frei, D., Shownkeen, H., Budzik, R., Ajani, Z. A., Grossman, A., Altschul, D., McDougall, C., Blake, L., Fitzsimmons, B.-F., Yavagal, D., Terry, J., Farkas, J., Lee, S. K., Baxter Tags: 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

Coagulation and Fibrinolytic Activity of Tenecteplase and Alteplase in Acute Ischemic Stroke Brief Reports
Conclusions— In patients with acute ischemic stroke, alteplase 0.9 mg/kg caused significant disruption of the fibrinolytic system, whereas tenecteplase 0.25 mg/kg did not, consistent with the trend toward lower intracerebral hemorrhage incidence with tenecteplase in the ATTEST study. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Huang, X., Moreton, F. C., Kalladka, D., Cheripelli, B. K., MacIsaac, R., Tait, R. C., Muir, K. W. Tags: Treatment, Ischemic Stroke, Thrombosis Brief Reports Source Type: research

Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke Basic Sciences
Conclusions— Our data demonstrate that DMT is an early phenomenon initiated before recanalization. We further show that alteplase-dependent maintenance of downstream perfusion during MCAO improves acute ischemic stroke outcome through a fibrinogen-dependent platelet aggregation reduction. Our results indicate that early targeting of DMT represents a therapeutic strategy to improve the benefit of large artery recanalization in acute ischemic stroke.
Source: Stroke - October 26, 2015 Category: Neurology Authors: Desilles, J.-P., Loyau, S., Syvannarath, V., Gonzalez-Valcarcel, J., Cantier, M., Louedec, L., Lapergue, B., Amarenco, P., Ajzenberg, N., Jandrot-Perrus, M., Michel, J.-B., Ho-Tin-Noe, B., Mazighi, M. Tags: Fibrinolysis, Fibrinogen/fibrin, Acute Cerebral Infarction, Brain Circulation and Metabolism, Thrombolysis Basic Sciences Source Type: research

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials Understanding and Applying the Endovascular Trials
The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, 9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute strok...
Source: Stroke - May 22, 2015 Category: Neurology Authors: Toyoda, K., Koga, M., Hayakawa, M., Yamagami, H. Tags: Emergency treatment of Stroke, Anticoagulants, Thrombolysis, Angioplasty and Stenting Understanding and Applying the Endovascular Trials Source Type: research

Tenecteplase-Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion Clinical Sciences
Conclusions— Administration of TNK–tissue-type plasminogen activator in minor stroke with intracranial occlusion is both feasible and safe. A larger randomized controlled trial is needed to prove that this treatment is efficacious. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01654445.
Source: Stroke - February 23, 2015 Category: Neurology Authors: Coutts, S. B., Dubuc, V., Mandzia, J., Kenney, C., Demchuk, A. M., Smith, E. E., Subramaniam, S., Goyal, M., Patil, S., Menon, B. K., Barber, P. A., Dowlatshahi, D., Field, T., Asdaghi, N., Camden, M.-C., Hill, M. D., for the TEMPO-1 Investigators Tags: Computerized tomography and Magnetic Resonance Imaging, 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

Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke: Results From Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register Clinical Sciences
Conclusions— Frequency of thrombolytic treatment seems to follow the same circadian pattern of stroke incidence, whereas its correspondence to a weekly pattern is less clear. Time of treatment is an independent predictor of outcome.
Source: Stroke - December 23, 2013 Category: Neurology Authors: Lorenzano, S., Ahmed, N., Tatlisumak, T., Gomis, M., Davalos, A., Mikulik, R., Sevcik, P., Ollikainen, J., Wahlgren, N., Toni, D., for the SITS Investigators Tags: Acute Cerebral Infarction, Thrombolysis Clinical Sciences Source Type: research

Unequal Access to Treatment With Intravenous Alteplase for Women With Acute Ischemic Stroke Brief Reports
Conclusions— Fewer women present themselves within 4 hours from stroke onset than men and consequently less often receive thrombolytic treatment. This difference may be caused by the older age of women on average and consequently women more often living alone. Clinical Trial Registration— URL: http://www.controlled-trials.com. Unique identifier: ISRCTN20405426.
Source: Stroke - August 26, 2013 Category: Neurology Authors: de Ridder, I., Dirks, M., Niessen, L., Dippel, D., on behalf of the PRACTISE Investigators Tags: Acute Cerebral Infarction, Emergency treatment of Stroke, Thrombolysis Brief Reports Source Type: research