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Topographic Assessment of Acute Ischemic Changes for Prognostication of Anterior Circulation Stroke
CONCLUSIONSTopographic assessment of acute ischemic changes using the sASPECTS (including caudate, lentiform nucleus, insula, and M5) can predict disability/death in anterior circulation stroke as accurately as the ASPECTS; and may help predict response to treatment and risk of developing symptomatic ICH.
Source: Journal of Neuroimaging - August 31, 2016 Category: Radiology Authors: Seyedmehdi Payabvash, Siamak Noorbaloochi, Adnan I. Qureshi Tags: Clinical Investigative Study Source Type: research

Delayed Endovascular Thrombectomy in a Patient Suffering from Stroke in Progression after Intravenous Thrombolytic Therapy.
CONCLUSION: In LAO patients, directly proceeding EVT following IVT may not be hesitated. In addition, while LAO patients with incomplete IV-tPA treatment responses result in transient improvement of neurological symptoms but later reversed, EVT may be a potential rescue therapy in carefully selected patients. PMID: 30315557 [PubMed - in process]
Source: Acta Neurologica Taiwanica - October 15, 2018 Category: Neurology Tags: Acta Neurol Taiwan Source Type: research

Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil
ConclusionAcute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients.
Source: Frontiers in Neurology - July 10, 2023 Category: Neurology Source Type: research

Prehospital Thrombolysis for Stroke An Idea Whose Golden Hour Has Arrived
Soon after thrombolytic therapy was established as a therapy for ischemic stroke, our colleague Anthony Furlan, MD, famously circulated a cartoon of a computed tomographic (CT) scanner visible through the back doors of an ambulance, where a happy stroke physician had hung a bottle dripping tissue plasminogen activator (tPA) into the scanned patient’s arm. Because the time interval from stroke onset to initiation of thrombolysis after ischemic stroke is inversely related to the probability of disability-free recovery, prehospital initiation of thrombolytic therapy seemed a compelling and logical ambition, if one could rul...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research

Systems and Care Process Parameters as Determinants of Onset-to-Treatment Times in Acute Ischemic Stroke: A Simulation Study (P1.018)
CONCLUSIONS: We employed a realistic simulation of AIS care to explore performance characteristics of proposed AIS care process configurations during the narrow window of opportunity to deliver thrombolytic therapy. This simulation methodology provides a model for prototyping process reengineering, in which essential details and assumptions in AIS care are identified for critical review by stakeholders. Study Supported by: Genentech, Inc.Disclosure: Dr. Levy has received personal compensation for activities with Genentech. Dr. Norris has received personal compensation for activities with Genentech. Dr. Tayama has received ...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Levy, D., Norris, D., Tayama, D. Tags: Cerebrovascular Disease and Interventional Neurology I ePosters Source Type: research

DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis
Background: Lesion patterns may predict prognosis after acute ischemic stroke within the middle cerebral artery (MCA) territory; yet it remains unclear whether such imaging prognostic factors are related to patient outcome after intravenous thrombolysis. Aims: The aim of this study is to investigate the clinical outcome after intravenous thrombolysis in acute MCA ischemic strokes with respect to diffusion-weighted imaging (DWI) lesion patterns. Methods: Consecutive acute ischemic stroke cases of the MCA territory treated over a 7-year period were retrospectively analyzed. All acute MCA stroke patients underwent a MRI scan ...
Source: Cerebrovascular Diseases - October 30, 2015 Category: Neurology Source Type: research

Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke.
Conclusion. Our interventions significantly reduced DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered. PMID: 27478641 [PubMed]
Source: International Journal of Vascular Medicine - August 2, 2016 Category: Cardiology Tags: Int J Vasc Med Source Type: research

Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy.
Conclusions: The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable. PMID: 29998881 [PubMed - in process]
Source: Chinese Medical Journal - July 14, 2018 Category: General Medicine Authors: Liu MS, Liao Y, Li GQ Tags: Chin Med J (Engl) 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

Determining Stroke Onset Time Using Quantitative MRI: High Accuracy, Sensitivity and Specificity Obtained from Magnetic Resonance Relaxation Times
Many ischaemic stroke patients are ineligible for thrombolytic therapy due to unknown onset time. Quantitative MRI (qMRI) is a potential surrogate for stroke timing. Rats were subjected to permanent middle cerebral artery occlusion and qMRI parameters including hemispheric differences in apparent diffusion coefficient, T2-weighted signal intensities, T1 and T2 relaxation times (qT1, qT2) andf1,f2 andVoverlap were measured at hourly intervals at 4.7 or 9.4 T. Accuracy and sensitivity for identifying strokes scanned within and beyond 3 h of onset was determined. Accuracy forVoverlap,f2 and qT2 (>90%) was significantly higher...
Source: Cerebrovascular Diseases Extra - August 25, 2016 Category: Neurology Source Type: research

Mobile Stroke Unit Reduces Time to Image Acquisition and Reporting INTERVENTIONAL
SUMMARY: Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy.
Source: American Journal of Neuroradiology - July 9, 2018 Category: Radiology Authors: Nyberg, E. M., Cox, J. R., Kowalski, R. G., Vela-Duarte, D., Schimpf, B., Jones, W. J. Tags: INTERVENTIONAL Source Type: research

Efficacy of Rosuvastatin Combined with rt-PA Intravenous Thrombolytic Therapy for Elderly Acute Ischemic Stroke Patients
CONCLUSION: ROS combined with rt-PA ivTT can better enhance the therapeutic efficacy of elderly patients with AIS, improve their neurological function, and reduce serum inflammatory responses.PMID:35756414 | PMC:PMC9217586 | DOI:10.1155/2022/9403693
Source: Computational and Mathematical Methods in Medicine - June 27, 2022 Category: Statistics Authors: Jianzhong Zhu Shan Wang Zhenqiu Chen Qiqi Cheng Source Type: research

Stroke Care Within the Golden Hour
To the Editor We read with interest the article by Ebinger and colleagues in which they demonstrated that the number of stroke patients treated within the golden hour can be increased up to 6 times compared with a hospital-based approach through a mobile unit staffed with a stroke neurologist and technical personnel as well as a computed tomographic scanner and point-of-care laboratory. In an editorial, Warach questioned the generality of this pack-and-load approach, which was tested in Berlin, Germany, based on financial, logistical, and clinical issues. In the United States, less than one-third of patients receive door-t...
Source: JAMA Neurology - April 1, 2015 Category: Neurology Source Type: research

Impact of CT scanner location on door to imaging time for emergency department stroke evaluation
Stroke is a potentially serious condition commonly diagnosed in the ED. Time to diagnosis can be crucial to maximizing outcome in a majority of ischemic stroke cases amenable to thrombolytic therapy.
Source: The American Journal of Emergency Medicine - August 13, 2019 Category: Emergency Medicine Authors: William Bonadio Source Type: research

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