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Total 1186 results found since Jan 2013.

Acute imaging for evidence-based treatment of ischemic stroke
Purpose of review Until recently, intravenous thrombolysis and mechanical thrombectomy for acute stroke treatment relied on reported information on the known time of symptom onset and was limited to treatment within a narrow time window. New trials have provided evidence for imaging-based effective reperfusion treatment in an extended time window and unknown-onset stroke. This review summarizes evidence from recent clinical trials and suggests a simple algorithm for the choice of imaging modalities to guide evidence-based reperfusion treatment of acute stroke. Recent findings Two trials have provided evidence for bene...
Source: Current Opinion in Neurology - June 27, 2019 Category: Neurology Tags: NEUROIMAGING: Edited by Stefan Klöppel Source Type: research

Current Smoking Does Not Modify the Treatment Effect of Intravenous Thrombolysis in Acute Ischemic Stroke Patients —A Post-hoc Analysis of the WAKE-UP Trial
Conclusions: In patients with mild to moderate MRI-proven AIS and unknown time of symptom onset with DWI-FLAIR mismatch, current smokers had worse functional outcome as compared to non-smokers. Current smoking did not modify the treatment effect of alteplase.Clinical Trial registration: Main trial (WAKE-UP): ClinicalTrials.gov, NCT01525290; and EudraCT, 2011-005906-32. Registered 02 February 2012.
Source: Frontiers in Neurology - November 21, 2019 Category: Neurology Source Type: research

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland.
CONCLUSIONS: Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis. PMID: 32469076 [PubMed - as supplied by publisher]
Source: Neurologia i Neurochirurgia Polska - May 28, 2020 Category: Neurology Authors: Wiszniewska M, Fryze W, Wiśniewska A, Karliński M, Sobolewski P, Krzykowski G, Członkowska A Tags: Neurol Neurochir Pol Source Type: research

Thrombolysis beyond 4.5  h in Acute Ischemic Stroke
AbstractPurpose of ReviewThe purpose of this article is to review the current approaches using neuroimaging techniques to expand eligibility for intravenous thrombolytic therapy in acute ischemic stroke patients with stroke of unknown symptom onset.Recent FindingsIn recent years, several randomized, placebo-controlled trials have shown neuroimaging-guided approaches to be feasible in determining eligibility for alteplase beyond 4.5  h from last known well, and efficacious for reducing disability. DWI-FLAIR mismatch on MRI is an effective tool to identify stroke lesions less than 4.5 h in onset in patients with stroke of ...
Source: Current Neurology and Neuroscience Reports - June 29, 2020 Category: Neuroscience Source Type: research

Stroke in the acute setting
Acute stroke and transient ischaemic attack (TIA) are focal neurological syndromes of vascular origin and should be treated as medical emergencies. Brain imaging with computed tomography or magnetic resonance imaging is required to distinguish ischaemic stroke from intracerebral haemorrhage, recognize non-stroke pathologies that mimic stroke, and guide investigation into the underlying mechanism. Acute interventions of benefit in ischaemic stroke include intravenous thrombolysis with alteplase, endovascular thrombectomy, with imaging permitting treatment in a wider range of patients, stroke unit care, aspirin, and combinat...
Source: Medicine - January 27, 2021 Category: Internal Medicine Authors: Keith W. Muir Tags: Acute medicine II Source Type: research

Silver Jubilee of Stroke Thrombolysis With Alteplase: Evolution of the Therapeutic Window
In 1995, the results of a landmark clinical trial by National Institute of Neurological Disorders and Stroke (NINDS) made a paradigm shift in managing acute cerebral ischemic stroke (AIS) patients at critical care centers. The study demonstrated the efficacy of tissue-type plasminogen activator (tPA), alteplase in improving neurological and functional outcome in AIS patients when administered within 3 h of stroke onset. After about 12 years of efforts and the results of the ECASS-III trial, it was possible to expand the therapeutic window to 4.5 h, which still represents a major logistic issue, depriving many AIS patients ...
Source: Frontiers in Neurology - March 1, 2021 Category: Neurology Source Type: research

E-011 Factors influencing thrombectomy decision-making for primary medium vessel occlusion stroke
ConclusionsMost physicians in this survey would treat MeVO stroke patients immediately with EVT, supporting the need for more robust clinical evidence.Disclosures P. Cimflova: None. M. Kappelhof: None. N. Singh: None. N. Kashani: None. J. Ospel: None. R. McDonough: None. A. Demchuk: None. B. Menon: None. N. Sakai: None. M. Chen: 2; C; Medtronic, Genentech, Stryker, Microvention, Cerenovus, Penumbra. J. Fiehler: 1; C; Acandis, Medtronic, Microvention, Stryker. 2; C; Acandis, Codman, Cerenovus, Microvention, Medtronic, Penumbra, Phenox, Stryker. M. Goyal: 2; C; Medtronic, Microvention, Stryker, GE Healthcare, Mentice.
Source: Journal of NeuroInterventional Surgery - July 26, 2021 Category: Neurosurgery Authors: Cimflova, P., Kappelhof, M., Singh, N., Kashani, N., Ospel, J., McDonough, R., Demchuk, A., Menon, B., Sakai, N., Chen, M., Fiehler, J., Goyal, M. Tags: Electronic poster abstracts Source Type: research

A Nursing Approach to Improving Critical Care Compliance With Vital Signs and Neurological Assessments in Post-IV-Alteplase Stroke Patients
Ischemic stroke represents 87% of all strokes. As global initiatives move forward with stroke care, health care providers and institutions will be called on to deliver the most current evidence-based care. The American Heart Association/American Stroke Association (AHA/ASA) estimates that 795 000 strokes occur each year; 610 000 are new strokes, and 185 000 are recurrent strokes. Eighty-seven percent are ischemic strokes; the overall mortality rate from stroke was 273 000, which makes stroke the fifth leading cause of death and the leading cause of disability in the United States. Stroke costs the United States an estimate...
Source: Critical Care Nursing Quarterly - August 23, 2022 Category: Nursing Tags: Original Articles Source Type: research

Effect of alteplase, benzodiazepines and beta-blocker on post-stroke pneumonia: Exploration of VISTA-Acute
by Thanh G. Phan, Richard Beare, Philip M. Bath, Svitlana Ievlieva, Stella Ho, John Ly, Amanda G. Thrift, Velandai K. Srikanth, Henry Ma, on behalf of the VISTA-Acute Collaborators BackgroundPost-stroke pneumonia is a frequent complication of stroke and is associated with high mortality. Investigators have described its associations with beta-blocker. However, there has been no evaluation of the role of recombinant tissue plasminogen activator (RTPA). We postulate that RTPA may modify the effect of stroke on pneumonia by reducing stroke disability. We explore this using data from neuroprotection trials in Virtual Internati...
Source: PLoS One - May 1, 2023 Category: Biomedical Science Authors: Thanh G. Phan Source Type: research

Femoral Access-Site Complications with Tenecteplase versus Alteplase before Mechanical Thrombectomy for Large-Vessel-Occlusion Stroke INTERVENTIONAL
CONCLUSIONS: Tenecteplase compared with alteplase before mechanical thrombectomy for large-vessel-occlusion stroke is not associated with an alteration in femoral access-site complication rates.
Source: American Journal of Neuroradiology - June 8, 2023 Category: Radiology Authors: Hendrix, P., Collins, M. K., Goren, O., Weiner, G. M., Dalal, S. S., Melamed, I., Kole, M. J., Griessenauer, C. J., Noto, A., Schirmer, C. M. Tags: INTERVENTIONAL Source Type: research

E-189 Outcomes of tenecteplase versus alteplase after mechanical thrombectomy in a multiethnic stroke consortium registry
ConclusionIn this prospective, multi-center stroke consortium study, IV TNK in comparison to tPA prior to MT for ischemic stroke resulted in non-inferior outcomes related to angiographic reperfusion and functional status at discharge. These findings compliment the current literature and include a large Hispanic US cohort. Further analysis will include expansion of contributing centers and use of propensity scoring.Abstract E-189 Table 1 and 2Disclosures M. Gaub: None. D. Ramaswamy: None. A. Cardentey: None. S. Bandela: None. G. Gealogo: None. J. Mascitelli: None. F. Al Saiegh: None. L. Birnbaum: 2; C; Rapid AI, Imperative Care.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Gaub, M., Ramaswamy, D., Cardentey, A., Bandela, S., Gealogo, G., Mascitelli, J., Al Saiegh, F., Birnbaum, L. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Review Streamlining of prehospital stroke management: the golden hour
Thrombolysis with alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment. We recommend that all links in the prehospital stroke rescue chain must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of s...
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Klaus Fassbender, Clotilde Balucani, Silke Walter, Steven R Levine, Anton Haass, James Grotta Tags: Review Source Type: research

Safe use of alteplase in a 10 months old infant with cardio-embolic stroke.
We present an infant with cardioembolic stroke treated with alteplase. He had hypoplastic left heart syndrome since birth. He underwent Norwood operation, followed by bidirectional cavopulmonary anastomosis at 3 months. On aspirin therapy he was well until heart failure developed at the age of 9 months with 2 thrombi in the right ventricle. During the course of enoxaparin therapy sudden acute left-sided haemiplegia occurred. The emergency brain CT scan was normal. Informed consent was obtained from parents after explaining the alteplase treatment protocol and possible complications. Alteplase was administered i.v. accordin...
Source: European Journal of Paediatric Neurology - April 19, 2013 Category: Neurology Authors: Rener-Primec Z, Svigelj V, Vesel S, Lovrič D, Skofljanec A Tags: Eur J Paediatr Neurol Source Type: research

Thrombolytic dosing in acute ischaemic stroke.
Abstract Thrombolysis treatment for acute ischaemic stroke is effective if it is administered within 4.5 hours of stroke onset. Alteplase is a licensed thrombolytic treatment for ischaemic stroke. The dose of alteplase is dependent on a patient's weight. The stroke team involved in the administration of the treatment usually estimates a patient's weight prior to the treatment in order to ensure the correct dosage. This paper highlights the reliability of body weight estimates in determining the accuracy of thrombolysis dosing and the implication of dosing errors to post-thrombolysed patients. PMID: 24121849 [PubMed - in process]
Source: British Journal of Nursing - October 9, 2013 Category: Nursing Authors: J Catangui E Tags: Br J Nurs Source Type: research

Thrombolytic Treatment of Cardiac Myxoma-Induced Ischemic Stroke: a Review.
Abstract Primary cardiac tumors are uncommon, with an autopsy frequency of 0.001%-0.28%: 75% of them are benign, and 50-75% of these are myxomas. Often the first neurological manifestations of a cardiac myxoma include transient ischemic attacks and ischemic strokes. Although thrombolytic therapy represents the gold standard for acute ischemic stroke treatment, its safety and effectiveness in stroke patients with myxoma is unknown. From the analysis of the literature on thrombolysis in ischemic stroke patients with myxoma we report clinical evidence supporting the use of thrombolytics, and the application of thromb...
Source: Current Drug Safety - January 10, 2014 Category: Drugs & Pharmacology Authors: Acampa M, Guideri F, Tassi R, D'Andrea P, Marotta G, Giudice GL, Martini G Tags: Curr Drug Saf Source Type: research