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Total 1186 results found since Jan 2013.

The role of uric acid as a potential neuroprotectant in acute ischemic stroke: a review of literature
Abstract Uric acid (UA), a product of purine metabolism, is a kind of powerful endogenous antioxidant which may increase in many oxidative stress situations such as stroke. Some studies have found that UA is a predictor for stroke by mechanisms involved in development. There are some controversies about whether it is an independent effect of UA or an epiphenomenon. UA has been widely concerned for its neuroprotective effect as an antioxidant. In some experimental models of acute ischemic stroke, UA levels are associated with better functional recovery because of its synergistic effect with alteplase. In this re...
Source: Neurological Sciences - March 13, 2015 Category: Neurology Source Type: research

Editorial Thrombolysis for stroke: clinical judgment at its apogee
In the Correspondence section of today's Lancet, we publish a selection of letters challenging the report by Jonathan Emberson and colleagues on the effect of treatment delay, age, and stroke severity on the effects of thrombolysis with alteplase for acute ischaemic stroke. Emberson and colleagues concluded from their meta-analysis of 6756 patients that despite early increases in fatal intracranial haemorrhage, alteplase improves the overall likelihood of a good stroke outcome at 3–6 months when delivered within 4·5 h of the initial stroke symptoms, with earlier treatment increasing proportional benefit, irrespective of...
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research

Effect of Treatment Delay, Age, and Stroke Severity on the Effects of Intravenous Thrombolysis with Alteplase for Acute Ischaemic Stroke: A Meta-analysis of Individual Patient Data from Randomized Trials
Ischemic stroke is a common medical condition that carries significant morbidity and mortality. Treatment with alteplase is a controversial modality that comes with significant risks and benefits. The authors of this study sought to analyze effects of age, time to treatment, and severity of stroke on stroke outcomes in patients treated with alteplase. A meta-analysis was performed, with a total of 6756 patients from nine randomized trials comparing alteplase with placebo or open control. Positive stroke outcomes were defined by this study as no significant disability at 3–6 months, as defined by a modified Rankin Score of 0 or 1.
Source: The Journal of Emergency Medicine - May 1, 2015 Category: Emergency Medicine Authors: Graham Ingalsbe Tags: Abstract Source Type: research

Intravenous Recombinant Tissue Plasminogen Activator Does Not Impact Mortality in Acute Ischemic Stroke at Any Time Point up to 6 Months: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials
Conclusion Intravenous alteplase did not impact mortality in patients with acute ischemic stroke at any of the measured time points up to 6 months (i.e., there was no increase in the risk of death with alteplase). Therefore, intravenous alteplase should be given to all eligible patients with acute ischemic stroke to improve long-term neurologic outcomes. The effects of alteplase on early survival are more complex than previously understood.
Source: CNS Drugs - August 7, 2015 Category: Neurology Source Type: research

Endovascular clot retrieval for acute ischaemic stroke: the Auckland City Hospital experience.
CONCLUSIONS: Endovascular clot retrieval can be safely and effectively performed in a New Zealand setting with similar results to recent trials in anterior circulation occlusion patients. We suggest that District Health Boards develop clot retrieval services as part of regional hyperacute stroke treatment pathways. PMID: 26645756 [PubMed - in process]
Source: New Zealand Medical Journal - December 13, 2015 Category: Journals (General) Tags: N Z Med J Source Type: research

Intravenous thrombolysis is more safe and effective for posterior circulation stroke: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)
Abstract: We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) with alteplase for anterior circulation stroke (ACS) and posterior circulation stroke (PCS). From a large multicenter prospective registry—the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database—all patients who received IVT within 4.5 hours after stroke onset was reviewed. According to the clinical presentations and imaging findings, the eligible patients were divided into ACS and PCS groups. The safety and efficacy outcome measures included post-IVT symptomatic intracranial hemorrhage (sICH), paren...
Source: Medicine - June 1, 2016 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Short- and Long-Term Reduction of Door-to-Needle Time in Thrombolysis for Acute Stroke.
Conclusions: We were able to decrease our DTN time for acute stroke thrombolysis by implementing relatively simple modifications and these improvements persisted over time. PMID: 27998323 [PubMed - as supplied by publisher]
Source: The Canadian Journal of Neurological Sciences - December 20, 2016 Category: Neurology Authors: Chen BY, Moussaddy A, Keezer MR, Deschaintre Y, Poppe AY Tags: Can J Neurol Sci Source Type: research

Thrombolytic Treatment for Ischaemic Stroke: Could the Crisis of Confidence Have Been Avoided by Better Analysis of Trial Data?
AbstractIn many countries, thrombolysis with intravenous alteplase has become a central part of acute stroke care in recent years, requiring radical restructuring of services. However, a significant minority of emergency and stroke physicians have always had serious doubts about the safety and efficacy of thrombolytic treatment, and in 2015 these prompted a major review of the licensing status of alteplase by the UK regulatory authorities. Subsequent dramatic headlines and media stories have called into question the integrity of researchers and clinicians and undermined public faith in medical research. How did this situat...
Source: Drugs and Aging - January 23, 2017 Category: Geriatrics Source Type: research

Intravenous Alteplase for Acute Stroke and Pulmonary Embolism in a Patient With Recent Abdominoplasty
Conclusions: Interdisciplinary collaboration can successfully inform the decision to treat acute ischemic stroke with IV alteplase in the setting of recent major surgery.
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Endovascular thrombectomy in patients with acute ischemic stroke and atrial fibrillation. A MR CLEAN subgroup analysis.
CONCLUSIONS: This study did not show significant difference in the EVT effect between acute stroke patients with and without AF. PMID: 28649948 [PubMed - as supplied by publisher]
Source: EuroIntervention - June 28, 2017 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research

Relevance of the Updated Food and Drug Administration Alteplase Label for Acute Ischemic Stroke: The Estimated Impact and Current Guidelines.
Abstract In 2015, the Food and Drug Administration updated the contraindications for the use of alteplase in acute ischemic stroke (AIS), potentially creating a greater impact on treatment. A history of intracranial hemorrhage and recent stroke within 3 months were removed as contraindications, increasing the number of patients eligible for alteplase. The aim of this commentary is to call attention to the updates and discuss them relative to current American Heart Association/American Stroke Association guidelines. Additionally, we estimate the clinical impact of the updates by analyzing AIS admissions to a large-...
Source: The Annals of Pharmacotherapy - January 1, 2018 Category: Drugs & Pharmacology Authors: Shiue HJ, Albright KC, Sands KA Tags: Ann Pharmacother Source Type: research

Support of New Triage Protocol among Acute Stroke Care Providers
Conclusion: Among the survey responders, there is a broad acceptance of the idea of bypassing ACH and going straight to ECH when LVO is suspected; however, there is less agreement on triaging patients with non-LVO stroke.Intervent Neurol 2018;7:241 –245
Source: Interventional Neurology - March 14, 2018 Category: Neurology Source Type: research

Adrenal hormones and circulating leukocyte subtypes in stroke patients treated with reperfusion therapy.
Abstract Ischemic stroke sets in motion a dialogue between the central nervous and the immune systems that includes the sympathetic/adrenal system. We investigated the course of immune cells and adrenocortical and adrenomedullary effectors in a cohort of 51 patients with acute stroke receiving reperfusion therapy (intravenous alteplase or mechanical thrombectomy) and its correlation with stroke outcomes and infarct growth. Cortisol increased rapidly and fleetingly after stroke, but 39% of patients who had larger infarctions on admission showed a positive delta cortisol at day 1. It was associated with enhanced inf...
Source: Brain, Behavior, and Immunity - March 13, 2018 Category: Neurology Authors: Miró-Mur F, Laredo C, Renú A, Rudilosso S, Zhao Y, Amaro S, Llull L, Urra X, Planas AM, Chamorro Á Tags: Brain Behav Immun Source Type: research

Intravenous Alteplase for Mild Nondisabling Acute Ischemic Stroke
Treatment of patients with stroke has changed substantially during the past 25 years. In 1995, the NINDS rt-PA trial showed among selected patients with acute ischemic stroke who were treated with intravenous alteplase within 3 hours of known stroke onset or last known well time had reduced disability at 3 months. In 2008, the ECASS III trial demonstrated benefit of intravenous alteplase among selected patients treated up to 4.5 hours after known stroke onset or last known well time. Benefit from alteplase treatment occurred despite higher rates of symptomatic intracranial hemorrhage compared with placebo (6.4% vs 0.6% in ...
Source: JAMA - July 10, 2018 Category: General Medicine Source Type: research