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'Last known well alone should not determine triage for patients with stroke and symptoms of large vessel occlusion
The term ‘last known well’ (LKW) is ingrained in the culture of stroke treatment. There are good reasons for this. Successful acute thrombolytic trials used LKW as an entry criterion to prove the efficacy of IV thrombolysis.1 2 Based on the results of those trials, treatment of acute stroke with IV thrombolysis is a class 1 recommendation for patients presenting with acute stroke symptoms within 3–4.5 h of LKW.3 Few vascular neurologists will recommend IV thrombolysis for patients outside the time window established by LKW, and hence this term represents a crucial time metric for thrombolytic therapy...
Source: Journal of NeuroInterventional Surgery - March 15, 2017 Category: Neurosurgery Authors: Heck, D. V., Grotta, J. C. Tags: Editorials Source Type: research

Different risk factors for poor outcome between patients with positive and negative susceptibility vessel sign
Conclusions The risk factors for clinical outcome after IVT in patients with negative SVS may differ from those with positive SVS.
Source: Journal of NeuroInterventional Surgery - September 12, 2016 Category: Neurosurgery Authors: Yan, S., Liu, K., Tong, L., Yu, Y., Zhang, S., Lou, M. Tags: Ischemic stroke Source Type: research

Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever
We present the case of a 22-month-old child with acute ischemic stroke due to basilar artery occlusion that was successfully treated with a stent retriever.
Source: Journal of NeuroInterventional Surgery - July 13, 2016 Category: Neurosurgery Authors: Savastano, L., Gemmete, J. J., Pandey, A. S., Roark, C., Chaudhary, N. Tags: Electronic pages Source Type: research

Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas.
Authors: Kageji T, Obata F, Oka H, Kanematsu Y, Tabata R, Tani K, Bando H, Nagahiro S Abstract There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Pref...
Source: Neurologia Medico-Chirurgica - June 25, 2016 Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research

Successful outcome after endovascular thrombolysis for acute ischemic stroke with basis on perfusion-diffusion mismatch after 24 h of symptoms onset.
CONCLUSIONS: We report the case of a successful thrombolytic therapy following AIS performed more than 24 h after the initial symptoms based on the presence of a perfusion-diffusion mismatch. This report is expected to stimulate the development of future prospective studies with special focus on the role of perfusion-diffusion mismatch in patient selection for treatment of AIS, especially in those presenting outside the traditional time window. PMID: 27313971 [PubMed]
Source: Surgical Neurology International - June 19, 2016 Category: Neurosurgery Tags: Surg Neurol Int Source Type: research

Multicenter clinical experience in over 125 patients with the Penumbra Separator 3D for mechanical thrombectomy in acute ischemic stroke
Conclusions The results suggest that the Separator 3D enables safe and effective revascularization of occluded large arteries in acute stroke intervention, leading to a high rate of functional independence at 90 days.
Source: Journal of NeuroInterventional Surgery - December 13, 2015 Category: Neurosurgery Authors: Behme, D., Kowoll, A., Mpotsaris, A., Hader, C., Hechelhammer, L., Weber, J., Weber, W. Tags: Ischemic stroke Source Type: research

Evaluation of Cerebral Perfusion in Patients Undergoing Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis.
Authors: Hirano T Abstract Currently, the indication for thrombolytic therapy using intravenous recombinant tissue plasminogen activator (rt-PA) is restricted strictly to patients with acute ischemic stroke within 4.5 h of onset. The effect of rt-PA declines over time; therefore, we need to minimize the time delay while generating imaging information. The use of cerebral blood flow imaging is not recommended within this time window. Conversely, the balance of efficacy and the risk of bleeding complications differ among patients > 4.5 h after onset. Several ongoing studies are using mismatch concepts to extend th...
Source: Neurologia Medico-Chirurgica - September 16, 2015 Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research

Emergency Superficial Temporal Artery to Middle Cerebral Artery Bypass After Intravenous Administration of Tissue Plasminogen Activator for Stroke.
We described three cases of emergency superficial temporal artery to middle cerebral artery bypass performed within 24 hours of IVtPA administration, and discussed the safety of such procedures. We believe that superficial temporal artery to middle cerebral artery bypass can be safely performed even within 24 hours after IVtPA administration. PMID: 26242342 [PubMed - in process]
Source: Turkish Neurosurgery - August 7, 2015 Category: Neurosurgery Authors: Takeuchi S, Wada K, Arimoto H, Kumagai K, Osada H, Otani N, Mori K Tags: Turk Neurosurg Source Type: research

Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke
Thrombolytic therapy generally improves clinical outcome after acute ischemic stroke, but the decision to administer thrombolytics may be challenging because of hemorrhagic complications and poor response in some patients [1–4]. Many models for risk stratification of thrombolytic treatment have been developed to support the clinician in this complex decision-making process.
Source: Clinical Neurology and Neurosurgery - August 14, 2014 Category: Neurosurgery Authors: Robbert-Jan Van Hooff, Koenraad Nieboer, Ann De Smedt, Maarten Moens, Peter Paul De Deyn, Jacques De Keyser, Raf Brouns Source Type: research

Thrombolytic therapy in total mismatch with severe stroke after acute MCA-occlusion and negative DWI
Total mismatch is a recently described magnetic resonance imaging (MRI) pattern in acute stroke patients with no signal changes in diffusion weighted images (DWI) and extensive hypoperfusion on perfusion weighted images (PWI). The prognostic value and importance for treatment decision based on this finding in MRI have recently been controversially discussed in patients with minor stroke . Here we report a case of a 98-year-old woman that presented with severe stroke and total mismatch in the left middle cerebral artery (MCA) territory in MRI scan and an occlusion of the proximal MCA (M1) in time-of flight MR angiography (T...
Source: Clinical Neurology and Neurosurgery - August 6, 2012 Category: Neurosurgery Authors: Lars Neeb, Frederik Geisler, Matthias Wendt, Andrea Rocco, Jochen B. Fiebach, Kersten Villringer Tags: Case reports Source Type: research

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