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Combination of hand-crafted and unsupervised learned features for ischemic stroke lesion detection from Magnetic Resonance Images
Publication date: Available online 14 February 2019Source: Biocybernetics and Biomedical EngineeringAuthor(s): G.B. Praveen, Anita Agrawal, Ponraj Sundaram, Sanjay SardesaiAbstractDetection of ischemic stroke lesions plays a vital role in the assessment of stroke treatments such as thrombolytic therapy and embolectomy. Manual detection and quantification of stroke lesions is a time-consuming and cumbersome process. In this paper, we present a novel automatic method to detect acute ischemic stroke lesions from Magnetic Resonance Image (MRI) volumes using textural and unsupervised learned features. The proposed method profic...
Source: Biocybernetics and Biomedical Engineering - February 15, 2019 Category: Biomedical Engineering Source Type: research

Deep Venous Thrombosis with Decreased Cerebral Blood Flow to the Thalamus was Completely Restored by Factor Xa Inhibitor
Background: Cerebral venous thrombosis is rare and an uncommon cause of stroke and has diverse etiologies and varied clinical presentations. Here, we report 2 cases of deep cerebral venous thrombosis. Case Description: A 64-year-old woman presented with cerebral venous thrombosis due to a hypercoagulable state associated with ovarian tumor. On initial fluid-attenuated inversion recovery and diffusion-weighted imaging, there was a diffuse high-intensity lesion in the bilateral thalamus. Computed tomography angiography showed occlusion of the straight sinus, vein of Galen, and internal cerebral vein.
Source: Journal of Stroke and Cerebrovascular Diseases - February 14, 2019 Category: Neurology Authors: Yu Shimizu, Katsuhiro Tsuchiya, Hironori Fujisawa Tags: Case Report Source Type: research

Atrial Fibrillation and Stroke in Patients with Hypertrophic Cardiomyopathy: Important New Insights.
Abstract PMID: 30759487 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - February 13, 2019 Category: Hematology Authors: Borer JS, Atar D, Marciniak T, Kim MH, Serebruany V Tags: Thromb Haemost Source Type: research

Interatrial block in prediction of all-cause mortality after first-ever ischemic stroke
Interatrial block (IAB) is an ECG indicator of atrial fibrosis related to atrial remodeling and thrombus formation thus leading to embolic stroke and increasing mortality. We aimed to assess weather IAB predic...
Source: BMC Cardiovascular Disorders - February 11, 2019 Category: Cardiology Authors: M. A. Baturova, A. Lindgren, Y. V. Shubik, J. Carlson and P. G. Platonov Tags: Research article Source Type: research

Acute Ischemic Stroke in a Child Successfully Treated with Thrombolytic Therapy and Mechanical Thrombectomy
We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was perfo...
Source: Case Reports in Neurology - February 8, 2019 Category: Neurology Source Type: research

Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial
Publication date: Available online 7 February 2019Source: The LancetAuthor(s): Craig S Anderson, Yining Huang, Richard I Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Qiang Li, Laurent Billot, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Alice C Durham, Pablo M Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O Martins, Veronica V Olavarria, Jeyaraj D PandianSummaryBackgroundSystolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intravenous alteplase in patients with acute ischaemic stroke, but the target systolic blood pressu...
Source: The Lancet - February 8, 2019 Category: General Medicine Source Type: research

Hemorrhagic Transformation of Arterial Ischemic and Venous Stroke in Children
Hemorrhagic transformation can complicate both arterial ischemic stroke (AIS) and cerebral sinus venous thrombosis (CSVT). Risk factors for hemorrhagic transformation after adult AIS include larger infarct volume, cardioembolic stroke, and anticoagulation in the acute period. Large hemorrhagic transformation in adults is associated with poor outcome. Therefore, hemorrhagic transformation is used as a safety endpoint of most AIS acute treatment and secondary prevention trials. Up to 30% of children with AIS have hemorrhagic transformation, most of which is petechial.
Source: Pediatric Neurology - February 7, 2019 Category: Neurology Authors: Melissa L. Hutchinson, Lauren A. Beslow Tags: Topical Review Source Type: research

Association of platelet-derived microvesicles and their phenotypes with carotid atherosclerosis and recurrent vascular events in patients after ischemic stroke
Platelet-derived microvesicles (pMVs) exhibit procoagulant and proinflammatory properties and play a role in the development and progression of atherosclerosis. The study examined the association between the total number of pMVs and their phenotypes with carotid atherosclerosis and recurrent vascular events (VEs) in patients in the convalescent phase of ischemic stroke (IS).
Source: Thrombosis Research - February 2, 2019 Category: Hematology Authors: Justyna Rosi ńska, Wojciech Ambrosius, Joanna Maciejewska, Robert Narożny, Wojciech Kozubski, Maria Łukasik Tags: Full Length Article Source Type: research

Hormone therapy in postmenopausal women associated with risk of stroke and venous thromboembolism: a population-based cohort study in Taiwan
Conclusions: In postmenopausal Taiwanese women, HT may be associated with an increased risk of cardiovascular disease. Although the women in our population receiving HT were near menopausal age, their risk of cardiovascular disease was still higher than in the non-HT group.
Source: Menopause - January 29, 2019 Category: OBGYN Tags: Original Articles Source Type: research

Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study
The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6  mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients.
Source: Journal of the Neurological Sciences - January 29, 2019 Category: Neurology Authors: A-Ching Chao, Ke Han, Sheng-Feng Lin, Ruey-Tay Lin, Chih-Hung Chen, Lung Chan, Huey-Juan Lin, Yu Sun, Yung-Yang Lin, Po-Lin Chen, Shinn-Kuang Lin, Cheng-Yu Wei, Yu-Te Lin, Jiunn-Tay Lee, Han-Hwa Hu, Chyi-Huey Bai, On behalf of the Taiwan Thrombolytic Ther Source Type: research

Efficacy of Sonothrombolysis Using Microbubbles Produced by a Catheter-Based Microfluidic Device in a Rat Model of Ischemic Stroke.
Abstract Limitations of existing thrombolytic therapies for acute ischemic stroke have motivated the development of catheter-based approaches that utilize no or low doses of thrombolytic drugs combined with a mechanical action to either dissolve or extract the thrombus. Sonothrombolysis accelerates thrombus dissolution via the application of ultrasound combined with microbubble contrast agents and low doses of thrombolytics to mechanically disrupt the fibrin mesh. In this work, we studied the efficacy of catheter-directed sonothrombolysis in a rat model of ischemic stroke. Microbubbles of 10-20 µm diameter with ...
Source: Annals of Biomedical Engineering - January 28, 2019 Category: Biomedical Engineering Authors: Dixon AJ, Li J, Rickel JR, Klibanov AL, Zuo Z, Hossack JA Tags: Ann Biomed Eng Source Type: research

Risk Assessment of Stroke in Patients with Atrial Fibrillation: Current Shortcomings and Future Directions
AbstractAtrial fibrillation is a well-known risk factor for cardioembolic stroke; a number of risk stratification scoring systems have been developed to help differentiate which patients would stand to benefit from anticoagulation. However, these scoring systems cannot be utilized in patients whose atrial fibrillation has not been diagnosed. As implantable cardiac monitors become more prevalent, it becomes possible to identify occult, subclinical atrial fibrillation. With this data, it is also possible to examine the relationship between episodes of paroxysmal atrial fibrillation and thromboembolism and the total burden of...
Source: Cardiovascular Drugs and Therapy - January 25, 2019 Category: Cardiology Source Type: research

Cardiac papillary fibroelastoma and stroke during pregnancy: Case report.
We report the case of a woman with severe headache associated with visual disturbances, without hypertension or proteinuria at 32 weeks of pregnancy. MRI revealed multiple recent cerebral vascular accidents. An echocardiogram detected a papillary fibroelastoma of 5mm. Maternal fetal experts determined it safe to continue the pregnancy. Childbirth at 39 weeks was normal uneventful for the newborn and mother. In the postpartum, despite the theoretical operative indication to resect the small residual papillary fibroelastoma, the patient was followed expectantly because of the stable neuro-cardiologic state. A fibroelastoma c...
Source: Annales de Cardiologie et d'Angeiologie - January 24, 2019 Category: Cardiology Authors: Binhas M, Zakine C, Khelil N, Mekacher L, Wafo E, Lebonhomme JJ, Iung B Tags: Ann Cardiol Angeiol (Paris) Source Type: research

The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage.
Abstract Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effe...
Source: Braz J Med Biol Res - January 24, 2019 Category: Research Authors: Zhao GJ, Wang ZR, Lin FZ, Cui YS, Xu SL Tags: Braz J Med Biol Res Source Type: research

Cerebral Arterial Stiffness as A New Marker of Early Stage Atherosclerosis of The Cerebral Large Artery in Acute Stroke.
CONCLUSIONS: Cerebral arterial stiffness has the potential to be a new marker of early stage atherosclerosis of the cerebral large artery. This finding may help us prevent the occurrence of stroke and decrease the burden of society from stroke patients. PMID: 30662019 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - January 23, 2019 Category: Cardiology Tags: J Atheroscler Thromb Source Type: research

“Blueprinting” thrombogenicity and antithrombotic drug response at the bedside in patients presenting emergently with symptoms of acute stroke
AbstractEarly assessment of thrombogenicity and antithrombotic drug effects may be important for therapeutic decision making in patients presenting with acute stroke. In this prospective, single center, pilot study, a bedside thrombelastography assay (TEG6s) was used to measure thrombogenicity and antithrombotic drug response in serial patients presenting emergently with symptoms of acute stroke (n  = 90). TEG6s measures were compared against diagnosis obtained by NIH Stroke Scale/Score and imaging. Acute ischemic stroke (AIS) was diagnosed in 30 patients, intracerebral hemorrhage (ICH) in 19, transient ischemic attack...
Source: Journal of Thrombosis and Thrombolysis - January 23, 2019 Category: Hematology Source Type: research

Hemorrhagic conversion after alteplase administration in a patient with vasculitis and acute ischemic stroke.
Conclusion: More data regarding alteplase treatment in patients with GPA are needed to further establish the safety of this therapy. PMID: 30689698 [PubMed - as supplied by publisher]
Source: American Journal of Health-System Pharmacy : AJHP - January 19, 2019 Category: Drugs & Pharmacology Authors: Gilbert BW, Dhakal L, Lacy A, Huffman JB Tags: Am J Health Syst Pharm Source Type: research

Bridging Therapy Versus Direct Mechanical Thrombectomy in Patients with Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: A Clinical-Histological Analysis of Retrieved Thrombi.
In conclusion, there was no difference in the functional outcomes between the direct MT and bridging therapy groups. However, randomized trials are needed to elucidate the high ratio of cardioembolism subtype in our group of patients. The histological MCA thrombus composition differed between cardioembolism and large-artery atherosclerosis, and this finding provides valuable information on the underlying pathogenesis and thrombus origin. PMID: 30654640 [PubMed - as supplied by publisher]
Source: Cell Transplantation - January 18, 2019 Category: Cytology Authors: Gong L, Zheng X, Feng L, Zhang X, Dong Q, Zhou X, Wang H, Zhang X, Shu Z, Zhao Y, Liu X Tags: Cell Transplant Source Type: research

The relationship between the prognosis of children with acute arterial stroke and polymorphisms of CDKN2B, HDAC9, NINJ2, NAA25 genes
AbstractIschemic stroke is a significant health condition, whose frequency in childhood is increasing day by day. Although many factors are effective in development of the stroke, it has been showed that individuals having risk factors have a genetic predisposition. The aim of the study is to determine whether distinct genetic mutations are risk factors for children with history of ischemic stroke. Our sample data is taken from 58 patients (29 male and 29 female) who applied our hospital between 2012 and 2016 with diagnosis of acute or chronic arterial stroke and from 70 healthy children (32 male and 38 female) with simila...
Source: Journal of Thrombosis and Thrombolysis - January 17, 2019 Category: Hematology Source Type: research

The role of endogenous tissue-type plasminogen activator in neuronal survival after ischemic stroke: friend or foe?
Abstract Endogenous protease tissue-type plasminogen activator (tPA) has highly efficient fibrinolytic activity and its recombinant variants alteplase and tenecteplase are established as highly effective thrombolytic drugs for ischemic stroke. Endogenous tPA is constituted of five functional domains through which it interacts with a variety of substrates, binding proteins and receptors, thus having enzymatic and cytokine-like effects to act on all cell types of the brain. In the past 2 decades, numerous studies have explored the clinical relevance of endogenous tPA in neurological diseases, especially in ischemic...
Source: Cellular and Molecular Life Sciences : CMLS - January 17, 2019 Category: Cytology Authors: Zhu J, Wan Y, Xu H, Wu Y, Hu B, Jin H Tags: Cell Mol Life Sci Source Type: research

Thrombus Enhancement Is a Predictor of Clinical Outcome in Acute Ischemic Stroke after Mechanical Thrombectomy
Conclusions: CE of thrombi – especially in a range from over 18.4 to 40.35 Hounsfield Units – is an independent predictor of poor clinical outcome in patients undergoing MT due to acute middle cerebral artery occlusion.Cerebrovasc Dis 2018;46:270 –278
Source: Cerebrovascular Diseases - January 16, 2019 Category: Neurology Source Type: research

Nucleic Acid Therapies for Ischemic Stroke
AbstractStroke remains a leading cause of disability and death worldwide despite significant scientific and therapeutic advances. Therefore, there is a critical need to improve stroke prevention and treatment. In this review, we describe several examples that leverage nucleic acid therapeutics to improve stroke care through prevention, acute treatment, and recovery. Aptamer systems are under development to increase the safety and efficacy of antithrombotic and thrombolytic treatment, which represent the mainstay of medical stroke therapy. Antisense oligonucleotide therapy has shown some promise in treating stroke causes th...
Source: Neurotherapeutics - January 11, 2019 Category: Neurology Source Type: research

Radiomics-Based Intracranial Thrombus Features on CT and CTA Predict Recanalization with Intravenous Alteplase in Patients with Acute Ischemic Stroke FUNCTIONAL
CONCLUSIONS: Thrombus radiomics features derived from NCCT and CTA are more predictive of recanalization with IV alteplase in patients with acute ischemic stroke with proximal occlusion than previously known thrombus imaging features such as length, volume, and permeability.
Source: American Journal of Neuroradiology - January 11, 2019 Category: Radiology Authors: Qiu, W., Kuang, H., Nair, J., Assis, Z., Najm, M., McDougall, C., McDougall, B., Chung, K., Wilson, A. T., Goyal, M., Hill, M. D., Demchuk, A. M., Menon, B. K. Tags: FUNCTIONAL Source Type: research

Internal Carotid Artery Occlusion Causing Acute Cranial Neuropathies
A 54-year-old male with a history of left posterior parietal ischemic stroke, epilepsy, tobacco and marijuana smoking, and alcohol abuse, presented with acute left visual loss and diplopia. On examination, he had reduced left visual acuity and a left oculomotor nerve palsy. CT angiogram from aortic arch to circle of Willis identified extensive thrombus occluding the left common and internal carotid arteries, extending to the left ophthalmic artery. This case demonstrates acute visual loss from ophthalmic artery occlusion, and left oculomotor nerve palsy from occlusion of the inferolateral trunk of the internal carotid arte...
Source: Journal of Stroke and Cerebrovascular Diseases - January 9, 2019 Category: Neurology Authors: Stephen R. Duma, Samer Ghattas, Florence C.F. Chang Tags: Case Report Source Type: research

Treatment With Intravenous Alteplase for Acute Ischemic Stroke After Reversal of Dabigatran With Idarucizumab: A Case Study
Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentat...
Source: Journal of Neuroscience Nursing - January 8, 2019 Category: Neuroscience Tags: Case Study Source Type: research

Interaction of cardiac implantable electronic device and patent foramen ovale in ischemic stroke: A case ‐only study
ConclusionAmong admitted ischemic stroke patients, we did not find a higher prevalence of CIED in patients with PFO compared to controls. Therefore, in the underlying source population, the presence of CIED did not increase the PFO ‐associated ischemic stroke risk.This article is protected by copyright. All rights reserved
Source: Pacing and Clinical Electrophysiology : PACE - January 8, 2019 Category: Cardiology Authors: Kolade M. Agboola, Jin ‐Moo Lee, Xiaoyan Liu, Eric Novak, Phillip S. Cuculich, Daniel H. Cooper, Amit Noheria Tags: DEVICES Source Type: research

Safety of Intra-Arterial Tirofiban Administration in Ischemic Stroke Patients after Unsuccessful Mechanical Thrombectomy
ConclusionsLow-dose IA tirofiban administration may be relatively safe in patients with ischemic stroke after unsuccessful recanalization.
Source: Journal of Vascular and Interventional Radiology - January 3, 2019 Category: Radiology Source Type: research

Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation: Prevalence and Associated Stroke Risks in a Nationwide Cohort Study.
CONCLUSION:  Among all NVAF patients, 1.1% of patient has HCM. The risk of stroke in NVAF with HCM without any CHA2DS2-VASc stroke risk factors was similar to that of those patients without HCM with CHA2DS2-VASc score of 3. Despite this, the actual use of OACs among NVAF patients with HCM was sub-optimal, relative to their high stroke risk. PMID: 30602200 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - January 2, 2019 Category: Hematology Authors: Jung H, Yang PS, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Lip GYH, Joung B Tags: Thromb Haemost Source Type: research

Impact of atrial fibrillation on in-hospital mortality of ischemic stroke patients and identification of promoting factors of atrial thrombi – Results from the German nationwide inpatient sample and a single-center retrospective cohort
Ischemic stroke is one of the leading causes of death and disability. Atrial fibrillation (AF) is a well-recognized risk factor for ischemic stroke. We aimed to investigate the impact of AF on in-hospital mortality of ischemic stroke patients and to identify parameters associated with intra-cardiac thrombogenic material. Patients were selected by screening the nationwide sample for ischemic stroke by ICD-Code (I63), stratified for AF. In this cohort, the association between in-hospital deaths and AF was investigated. In a second study, we performed a retrospective analysis of patients who underwent transesophageal echoc...
Source: Medicine - January 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Are Plasma Levels of Vascular Adhesion Protein-1 Associated Both with Cerebral Microbleeds in Multiple Sclerosis and Intracerebral Haemorrhages in Stroke?
Abstract PMID: 30597511 [PubMed - in process]
Source: Thrombosis and Haemostasis - January 1, 2019 Category: Hematology Authors: Ziliotto N, Zivadinov R, Jakimovski D, Bergsland N, Ramasamy DP, Weinstock-Guttman B, Ramanathan M, Marchetti G, Bernardi F Tags: Thromb Haemost Source Type: research

Optimal treatment modality for coexisting acute myocardial infarction and ischemic stroke
We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy.
Source: The American Journal of Emergency Medicine - December 31, 2018 Category: Emergency Medicine Authors: Fatih Gungoren, Feyzullah Besli, Zulkif Tanriverdi, Ozcan Kocaturk Source Type: research

Innovations in acute stroke reperfusion strategies
Venugopalan Y Vishnu, MV Padma SrivastavaAnnals of Indian Academy of Neurology 2019 22(1):6-12 Vascular neurology is witnessing unprecedented innovations in the management of acute ischemic stroke, especially in reperfusion strategies. The emergence of mechanical thrombectomy with new generation devices has revolutionized the treatment of acute ischemic stroke with large vessel occlusion. The reperfusion strategies are evolving with the extension of the window period for thrombolysis and endovascular therapy through the concept of “tissue clock” in addition to the established “time c...
Source: Annals of Indian Academy of Neurology - December 26, 2018 Category: Neurology Authors: Venugopalan Y Vishnu MV Padma Srivastava Source Type: research

Cholesterol and Inflammation in Stroke Recurrence.
Authors: Yagita Y PMID: 30568078 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - December 22, 2018 Category: Cardiology Tags: J Atheroscler Thromb Source Type: research

Gadolinium to the rescue for mechanical thrombectomy in acute ischemic stroke.
CONCLUSION: Gadolinium-based contrast agents could be effective alternatives for cerebral DSA in patients undergoing mechanical thrombectomy for AIS who have a history of anaphylactic reaction to ICs. PMID: 30567455 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - December 22, 2018 Category: Radiology Tags: Interv Neuroradiol Source Type: research

Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion
We read with interest the recently published article1 and commentaries2,3 on the stroke risk and acute management of patients with central retinal artery occlusion (CRAO). As emphasized by Lavin and associates,1 CRAO patients have a high risk of stroke and cardiovascular events. In Lavin and associates' series of 103 patients with acute CRAO seen within 7  days of onset of visual loss, 37.3% of the 67 patients with brain magnetic resonance imaging had coincident acute strokes, 36.7% of patients had severe carotid disease (greater than 70% stenosis, dissection, or intra-arterial thrombus), 33% presented with hypertensive...
Source: American Journal of Ophthalmology - December 19, 2018 Category: Opthalmology Authors: Valerie Biousse, Nancy J. Newman Tags: Correspondence Source Type: research

Refining the prediction of stroke in atrial fibrillation: An elusive endeavor
Atrial fibrillation (AF), the most common sustained arrhythmia, is responsible for>20% of all strokes.1 AF-associated strokes are more severe, causing significantly greater long-term disability, accounting for greater resource utilization, and resulting in significantly higher mortality compared to non-AF strokes.2 –4 Oral anticoagulants (OACs) are the standard of care for the prevention of AF-associated stroke and systemic thromboembolism. To date, OACs are the only therapeutic intervention that has been consistently and definitively shown to improve survival in the AF population.
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Jason G. Andrade, Laurent Macle Tags: Editorial Commentary Source Type: research

Refining the Prediction of Stroke in Atrial Fibrillation. An elusive endeavor
Atrial fibrillation (AF), the most common sustained arrhythmia, is responsible for>20% of all strokes.1 AF-associated strokes are more severe, causing significantly greater long-term disability, accounting for greater resource utilization, and result in significantly higher mortality when compared to non-AF strokes.2-4 Oral anticoagulants (OACs) are the standard of care for the prevention of AF-associated stroke and systemic thromboembolism. To date OACs are the only therapeutic intervention that has been consistently and definitively shown to improve survival in the AF population.
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Jason G. Andrade, Laurent Macle Source Type: research

Enhancing Base Excision Repair of Mitochondrial DNA to Reduce Ischemic Injury Following Reperfusion
AbstractWe hypothesize that enhancing mitochondrial base excision repair (BER) capability in brain will reduce reperfusion-associated ischemic brain injury. Post-stroke reperfusion was modeled in mice via transient filament occlusion of the middle cerebral artery (60  min) (transient MCAO). Administration of a TAT-modified form of a DNA glycosylase (EndoIII) following reperfusion of the brain reduced resultant brain infarct volume. Protection was dose-dependent, BER enzyme specific, and regionally specific (more effective via the jugular vein). EndoIII is compa tible with tissue plasminogen activator (tPA). The time windo...
Source: Translational Stroke Research - December 8, 2018 Category: Neurology Source Type: research

Efficacy of SMTP ‐7, a small‐molecule anti‐inflammatory thrombolytic, in embolic stroke in monkeys
In conclusion, SMTP‐7 is effective in treating severe embolic stroke in monkeys under conditions where t‐PA treatment tends to cause hemorrhagic infarct‐associated premature death.
Source: Pharmacology Research and Perspectives - December 5, 2018 Category: Drugs & Pharmacology Authors: Eriko Suzuki, Naoko Nishimura, Tetsuya Yoshikawa, Yudai Kunikiyo, Keiko Hasegawa, Keiji Hasumi Tags: ORIGINAL ARTICLE Source Type: research

Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials
Conclusions: Among patients who presented with ischemic stroke/TIA, short-course clopidog rel plus aspirin immediately following the index event appears to be more effective than and as safe as monotherapy for secondary stroke prevention.
Source: Journal of Thrombosis and Thrombolysis - December 3, 2018 Category: Hematology Source Type: research

A case report of left atrial myxoma-induced acute myocardial infarction and successive stroke
Rationale: Left atrial myxoma is a common primary cardiac tumor, however, due to poor image quality or atypical myxoma images, it is often misdiagnosed by echocardiograph. A case of left atrial myxoma being misdiagnosed as a thrombus, which successively caused acute myocardial infarction (AMI) and stroke, is very rare. Contrast-enhanced echocardiography can play an important role in definitive diagnosis. Patient concerns: A 44-year-old woman was diagnosed AMI because of chest pain with no significant stenosis in the coronary arteries. One month later, the patient was suddenly found unconscious, magnetic resonance imag...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke: A case report
We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches. Patient concerns: A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block). Diagnoses: The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion. ...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatets
In patients who receive intravenous thrombolytic therapy for ischemic stroke, prior use of dual antiplatelet therapy has been linked to high rates of adverse effects from tissue plasminogen activator (tPA). Specifically, increased rates of symptomatic intracranial hemorrhage have been reported. It is unclear if this is due to the antiplatelet therapy itself or due to other comorbidities present in patients typically prescribed dual antiplatelet therapy.
Source: The Journal of Emergency Medicine - December 1, 2018 Category: Emergency Medicine Authors: Lesley Catherine Pepin Source Type: research

Endovascular Stroke Therapy with a Novel 6-French Aspiration Catheter
ConclusionEndovascular stroke therapy using the AXS Catalyst catheter seems safe and effective, with similar performance than other reperfusion catheters.
Source: CardioVascular and Interventional Radiology - November 29, 2018 Category: Radiology Source Type: research

Paradoxical Thromboembolic Ischemic Stroke and Pulmonary Embolism after Uterine Fibroid Embolization
We report a case of acute paradoxical ischemic stroke after UFE in a patient with an inherited thrombophilia, who was successfully treated with endovascular clot retrieval. Institutional review board approval was not required.
Source: Journal of Vascular and Interventional Radiology : JVIR - November 29, 2018 Category: Radiology Authors: Matthew Boyko, Eric Herget, Youri Kaitoukov, Philippe Couillard Tags: Letter to the Editor Source Type: research

Potential molecular targets of peroxynitrite in mediating blood-brain barrier damage and haemorrhagic transformation in acute ischaemic stroke with delayed tissue plasminogen activator treatment.
Authors: Chen H, Chen X, Luo Y, Shen J Abstract Tissue plasminogen activator (t-PA) remains to be the only FDA-approved drug for ischaemic stroke, but it has a restrictive therapeutic window with 4.5 hours. Beyond the golden time window, thrombolytic treatment carries the risk of haemorrhagic transformation (HT). The blood-brain barrier (BBB) disruption is a critical step in the t-PA-mediated HT. Although large efforts are made to explore the mechanisms of the BBB disruption and HT, the underlying mechanisms are largely unknown. Thrombolytic treatment for recanalization could produce reactive oxygen species (ROS)...
Source: Free Radical Research - November 25, 2018 Category: Research Tags: Free Radic Res Source Type: research

Stroke due to Paradoxical Embolization Related to Fibroid Uterus Enlargement Compressing the Right Common Iliac Vein
We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus.Case Rep Neurol 2018;10:328 –331
Source: Case Reports in Neurology - November 23, 2018 Category: Neurology Source Type: research

Direct oral anticoagulants in the early phase of non valvular atrial fibrillation-related acute ischemic stroke: focus on real life studies
AbstractStrong evidence for the use of direct oral anticoagulants (DOACs) in the early phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) is lacking, because this kind of patients were excluded from phase III randomized clinical trials (RCT) and ad hoc RCTs are ongoing. In the latest years a lot of real life studies on this topic have been published. The aim of our review was to focus on these. We reviewed the PubMed databases searching articles reporting on DOACs starting time within 2 weeks from AIS onset. We selected fifteen studies, eight with retrospective, six with prospective observ...
Source: Journal of Thrombosis and Thrombolysis - November 23, 2018 Category: Hematology Source Type: research

Stroke in Pregnancy
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States. Other conditions associated with obstetric stroke include post...
Source: Neurologic Clinics - November 21, 2018 Category: Neurology Authors: Erica C. Camargo, Steven K. Feske, Aneesh B. Singhal Source Type: research

Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis
Conclusions: Our results suggest that inherited thrombophilias including FVL, PTM, PCD, and PSD are associated with an increased risk of arterial ischemic stroke, particularly in young patients. The association with FVL and PTM is stronger in the homozygous than in the heterozygous state, suggesting a potential dose-response relationship and causal role for inherited thrombophilias. The implications of these findings with respect to the evaluation and management of patients with ischemic stroke require further investigation.DisclosuresCrowther: Alnylam: Equity Ownership; Daiichi Sankyo: Membership on an entity's Board of D...
Source: Blood - November 21, 2018 Category: Hematology Authors: Chiasakul, T., De Jesus, E., Tong, J., Chen, Y., Crowther, M., Garcia, D. A., Chai-Adisaksopha, C., Messe, S. R., Cuker, A. Tags: 331. Pathophysiology of Thrombosis: Poster II Source Type: research