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Isolated Anisocoria as a Presenting Stroke Code Symptom is Unlikely to Result in Alteplase Administration
Acute stroke codes may be activated for anisocoria, but how often these codes lead to a final stroke diagnosis or alteplase treatment is unknown. The purpose of this study was to assess the frequency of anisocoria in stroke codes that ultimately resulted in alteplase administration.
Source: Journal of Stroke and Cerebrovascular Diseases - October 13, 2018 Category: Neurology Authors: Victoria A. Chang, Dawn M. Meyer, Brett C. Meyer Source Type: research

Safety and Efficacy of Repeated Thrombolysis with Alteplase in Early Recurrent Ischemic Stroke: A Systematic Review
Background and Aim: The current American Heart Association guidelines for the management of acute ischemic stroke advise against the use of intravenous (IV) alteplase in patients with recurrent stroke occurring within 90 days of their index event. Following these guidelines strictly, patients having early recurrent ischemic stroke would be unable to avail of this reperfusion strategy that has been proven to confer superior clinical outcomes. While some registry-based studies have demonstrated the safety of IV alteplase in this subgroup of patients, data on the repeated use of the drug are lacking.
Source: Journal of Stroke and Cerebrovascular Diseases - July 28, 2019 Category: Neurology Authors: Robert Joseph Cruz Sarmiento, Jose Danilo Bengzon Diestro, Adrian Isidoro Espiritu, Maria Cristina Zarsadias San Jose Source Type: research

Utilization of Intravenous Tissue Plasminogen Activator and Reasons for Nonuse in Acute Ischemic Stroke in Saudi Arabia
Background: Recombinant tissue plasminogen activator (rt-PA, alteplase) within 4.5 hours of symptom onset decreases the rate of disability after acute ischemic stroke (AIS). Due to various reasons, alteplase remains underutilized in certain regions ( ∼3% in low- and middle-income countries). Aims: We aimed to estimate the alteplase utilization rate and identify the reasons for nonuse in Saudi Arabia. Methods: We retrospectively reviewed all patients admitted with suspected stroke in the past 24 hours to the stroke unit at King Abdulaziz Medica l City, Riyadh, Saudi Arabia from February 2016 to July 2018.
Source: Journal of Stroke and Cerebrovascular Diseases - March 11, 2020 Category: Neurology Authors: Ali M. Al Khathaami, Bayan Al Bdah, Maisoun Tarawneh, Mohammed Alskaini, Faris Alotaibi, Abdulaziz Alshalan, Mohammed Almuhraj, Daham Aldaham, Nasser Alotaibi Source Type: research

Association Between Dispatch Complaint and Critical Prehospital Time Intervals in Suspected Stroke 911 Activations in the National Emergency Medical Services Information System, 2012 –2016
Stroke, one of the leading causes of death and disability in the United States (US), is a time sensitive emergency.1 Receiving timely treatment is associated with increased survival and better outcomes.2 –5 For every minute that treatment is delayed, a patient with stroke may lose an estimated 1.9 million neurons, leading to irreversible brain tissue damage long term disability, or death.6 Several studies have demonstrated that treatment with intravenous recombinant tissue-type plasminogen activat or (IV alteplase) can positively affect clinical outcomes when administered within a critical timeframe after ischemic stroke symptom onset.
Source: Journal of Stroke and Cerebrovascular Diseases - December 24, 2021 Category: Neurology Authors: Amena Y. Abbas, Erika C. Odom, Isaac Nwaise Source Type: research

Guidelines for the Intravenous Application of Recombinant Tissue-type Plasminogen Activator (Alteplase), the Second Edition, October 2012: A Guideline From the Japan Stroke Society
In Japan, intravenous alteplase, a recombinant tissue-type plasminogen activator (rt-PA), was approved for an indication of ischemic stroke in 2005 on the basis of the results of a clinical trial with a unique dose of the drug (0.6 mg/kg). The Japan Stroke Society published the guidelines for intravenous application of rt-PA and organized training sessions for proper use all over Japan in an effort to promote the safe, widespread use of intravenous alteplase. Seven years following its approval, clinical experience with intravenous alteplase has accumulated, additional evidence of intravenous alteplase has been found in Jap...
Source: Journal of Stroke and Cerebrovascular Diseases - June 3, 2013 Category: Neurology Authors: Kazuo Minematsu, Kazunori Toyoda, Teruyuki Hirano, Kazumi Kimura, Rei Kondo, Etsuro Mori, Jyoji Nakagawara, Nobuyuki Sakai, Yoshiaki Shiokawa, Norio Tanahashi, Masahiro Yasaka, Yasuo Katayama, Susumu Miyamoto, Akira Ogawa, Makoto Sasaki, Sadao Suga, Taken Tags: Original Articles Source Type: research

Safety and Efficacy of Mechanical Thrombectomy in Acute Ischemic Stroke of Anticoagulated Patients—A Prospective Observational Study
Anticoagulated patients (APs) are excluded from the acute stroke management with alteplase in Europe, not in the United States. They could benefit from mechanical thrombectomy (MT), which was not undoubtedly proven. There are scarce data about its results in such patients. The authors' aim is to analyze the efficacy and safety of MT in APs presenting with an acute stroke in our institution.
Source: Journal of Stroke and Cerebrovascular Diseases - June 30, 2016 Category: Neurology Authors: Lorena Benavente, Davinia Larrosa, Carmen García-Cabo, Ángel I. Pérez, María Rico, Pedro Vega, Eduardo Murias, Sergio Calleja Source Type: research

Safety and Efficacy of Mechanical Thrombectomy in Acute Ischemic Stroke of Anticoagulated Patients —A Prospective Observational Study
Anticoagulated patients (APs) are excluded from the acute stroke management with alteplase in Europe, not in the United States. They could benefit from mechanical thrombectomy (MT), which was not undoubtedly proven. There are scarce data about its results in such patients. The authors' aim is to analyze the efficacy and safety of MT in APs presenting with an acute stroke in our institution.
Source: Journal of Stroke and Cerebrovascular Diseases - June 30, 2016 Category: Neurology Authors: Lorena Benavente, Davinia Larrosa, Carmen Garc ía-Cabo, Ángel I. Pérez, María Rico, Pedro Vega, Eduardo Murias, Sergio Calleja Source Type: research

Sequential Multiple Assignment Randomized Trials: An Opportunity for Improved Design of Stroke Reperfusion Trials
Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and “rescue” endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice.
Source: Journal of Stroke and Cerebrovascular Diseases - January 13, 2017 Category: Neurology Authors: William J. Meurer, Nicholas J. Seewald, Kelley Kidwell Source Type: research

Impact of Tissue Plasminogen Activator Dosing on Patients Weighing More Than 100  kg on 3-Month Outcomes in Acute Ischemic Stroke
The landmark National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator (tPA) trial established the effectiveness and dosing of intravenous tPA for acute ischemic stroke (AIS) at .9  mg/kg with a maximum dose of 90 mg. Since the publication of the NINDS trial in 1995, there has been a drastic increase in the amount of obesity and the average weight of adults in the United States, which has caused an increase in the number of patients receiving 90 mg of alteplase for AIS.
Source: Journal of Stroke and Cerebrovascular Diseases - January 23, 2017 Category: Neurology Authors: Jeffrey Garavaglia, Jay Sherman, Hannah Yetzer, Michael Regier, Matthew Smith Source Type: research

Thrombolysis with tPA 3-4.5  h after acute ischemic stroke in 5 hospital groups in Japan
Clinical data from Japan on the safety and realworld outcomes of alteplase (tPA) thrombolysis in the extended therapeutic window are lacking. The aim of this study was to assess the safety and real-world outcomes of tPA administered within 3-4.5  h of stroke onset. The study comprised consecutive acute ischemic stroke patients (n = 177) admitted across five hospitals between September 2012 and August 2014. Patients received intravenous tPA within
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Ryuta Morihara, Syoichiro Kono, Toru Yamashita, Kentaro Deguchi, Yasuhiro Manabe, Takako Yoshiki, Kenichi Kashihara, Satoshi Inoue, Hideki Kiriyama, Koji Abe Source Type: research

Myocardial Infarction Following Intravenous Thrombolysis for Acute Ischemic Stroke: Case Report and Literature Review
We describe a case of early anterior myocardial infarction during intravenous thrombolysis for stroke and review the current literature.
Source: Journal of Stroke and Cerebrovascular Diseases - April 20, 2017 Category: Neurology Authors: Marina Mannino, Salvatore Asciutto, Valeria Terruso, Matilde Gammino, Melchiorre Gilberto Cellura, Serena Monaco Tags: Case Studies Source Type: research

Incidental Thrombotic Thrombocytopenic Purpura during Acute Ischemic Stroke and Thrombolytic Treatment
In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented.
Source: Journal of Stroke and Cerebrovascular Diseases - November 28, 2017 Category: Neurology Authors: İbrahim Acır, Hacı Ali Erdoğan, Vildan Yayla, Nilay Taşdemir, Murat Çabalar Tags: Case Report Source Type: research

Stroke Thrombolysis in Patients Taking Ticagrelor –Two Successful Cases and a Review of the Literature
Ticagrelor is a novel antiplatelet agent that is frequently used for secondary prevention in coronary artery disease and has emerging evidence in stroke after the recent results of SOCRATES and THALES trials. The use of intravenous thrombolysis with alteplase in acute ischemic stroke (AIS) patients on ticagrelor is a topic of debate as the safety profile of ticagrelor in this setting is not well established.
Source: Journal of Stroke and Cerebrovascular Diseases - December 11, 2020 Category: Neurology Authors: David R. Landzberg, Stephen English, Michael Frankel, Digvijaya Navalkele Source Type: research

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