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Follow-up Imaging After Thrombolysis: FIAT, A Randomized Trial
Current protocols for treatment of acute ischemic stroke with intravenous thrombolytics, such as alteplase (tPA) and tenecteplase (tNK), recommend the completion of a routine non-contrast head CT at 24 hours post treatment to evaluate for hemorrhage prior to the initiation of antiplatelet therapy for secondary stroke prevention. This guideline was instituted because it had been part of the protocol in the NINDS multicenter randomized placebo-controlled trial that showed the benefit of IV thrombolytics within 3 hours of stroke onset.
Source: Journal of Stroke and Cerebrovascular Diseases - April 15, 2023 Category: Neurology Authors: Burton Tabaac, Leah Dickstein, Kristen Gurnea, Argye E. Hillis Source Type: research

Outcomes with IV tenecteplase and IV alteplase for acute ischemic stroke with or without thrombectomy in real-world settings in the United States
Although many stroke centers in United States are using intravenous (IV) tenecteplase (TNK) for acute ischemic stroke patients, there is paucity of comparative data between IV TNK and IV alteplase from real-world settings.
Source: Journal of Stroke and Cerebrovascular Diseases - December 6, 2022 Category: Neurology Authors: Adnan I. Qureshi, William I. Baskett, Navpreet K. Bains, Brandi R. French, Farhan Siddiq, Camilo R. Gomez, Chi-Ren Shyu Source Type: research

Safety of early antiplatelet administration in patients with acute ischemic stroke treated with alteplase (SEAPT-24)
This study aimed to examine the safety of early antiplatelet therapy administration within the first 24 h after alteplase.
Source: Journal of Stroke and Cerebrovascular Diseases - November 5, 2022 Category: Neurology Authors: Drew A. Wells, Lyndsey K. Davis, Omar Saeed, G. Morgan Jones, Cheran Elangovan, Andrei V. Alexandrov, Balaji Krishnaiah, Katherine L. March Source Type: research

Histological composition of retrieved emboli in acute ischemic stroke is independent of pre-thrombectomy alteplase use
Given recent evidence suggesting the clot composition may be associated with revascularization outcomes and stroke etiology, clot composition research has been a topic of growing interest. It is currently unclear what effect, if any, pre-thrombectomy thrombolysis has on clot composition. Understanding this association is important as it is a potential confounding variable in clot composition research. We retrospectively evaluated the composition of retrieved clots from ischemic stroke patients who did and did not receive pre-treatment tPA to study the effect of tPA on clot composition.
Source: Journal of Stroke and Cerebrovascular Diseases - February 17, 2022 Category: Neurology Authors: Waleed Brinjikji, Mehdi Abbasi, Oana Madalina Mereuta, Se án Fitzgerald, Jorge Arturo Larco, Daying Dai, Ramanathan Kadirvel, Raul G. Nogueira, Peter Kvamme, Kennith F. Layton, Josser E. Delgado, Ricardo A. Hanel, Vitor M. Pereira, Mohammed A. Almekhlafi Source Type: research

Sustainability of Intravenous Alteplase Administration via Telephone-Based Consult: Data from a US Health System
Despite multiple advances in management over the last few decades, acute ischemic stroke (AIS) is still associated with high morbidity and mortality.1 Intravenous alteplase (IV tPA) was shown to be efficacious and safe for AIS about a quarter century ago2 and remains the only Food and Drug Administration-approved medication for this indication. Though ideal, stroke neurologists may not be available in-person to decide whether to administer tPA to an AIS patient.
Source: Journal of Stroke and Cerebrovascular Diseases - January 27, 2022 Category: Neurology Authors: Sarah E. Nelson, Eric Aldrich, Brenda Johnson, Susan Groman, Richard E. Thompson, Victor Urrutia 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

Caught in Action – Evolving Emergent Large Vessel Occlusion and Collateral Failure During Alteplase Infusion for Acute Ischemic Stroke
Published reports of acute deterioration during alteplase infusion for acute ischemic stroke due to development of partial to complete large vessel occlusion and collateral failure are sparce.
Source: Journal of Stroke and Cerebrovascular Diseases - October 27, 2021 Category: Neurology Authors: Peter S.W. Park, Helen M. Dewey, Philip M.C. Choi Tags: Case Report Source Type: research

Hospital Revisits for Post-Ischemic Stroke Epilepsy after Acute Stroke Interventions
Improvements in acute stroke care, namely the use of intravenous alteplase (IV-tPA) and mechanical thrombectomy (MT), have led to a considerable increase in the proportion of patients who survive a first-time ischemic stroke.1 Despite demonstrated benefits of acute stroke interventions, their impact on long term complications is not yet clear. One such complication is post-ischemic stroke epilepsy (PISE). PISE is estimated to occur in 2 –6% of stroke survivors,2–4 and is associated with poor-quality of life and high mortality in young patients.
Source: Journal of Stroke and Cerebrovascular Diseases - October 21, 2021 Category: Neurology Authors: Lindsey R. Kuohn, Alison L. Herman, Alexandria L. Soto, Stacy C. Brown, Emily J. Gilmore, Lawrence J. Hirsch, Charles C. Matouk, Kevin N. Sheth, Jennifer A. Kim Source Type: research

Familiarization with Contact Aspiration using Non-Penetrating of the Thrombus (CANP) Technique as the Initial Procedure for Acute Ischemic Stroke
Thrombectomy, along with intravenous alteplase, had been the standard medical care to achieve rapid and complete reperfusion for acute ischemic stroke.1 Many devices and techniques had been developed and devised, respectively, to achieve rapid and complete reperfusion. Thrombectomy includes stent retriever thrombectomy, with or without aspiration assistance, and contact aspiration (CA), mainly a direct aspiration first-pass technique (ADAPT). Kang et al. reported CA using a catheter with an inner diameter (I.D.) of 0.041 in.
Source: Journal of Stroke and Cerebrovascular Diseases - September 3, 2021 Category: Neurology Authors: Hiroaki Neki, Takehiro Katano, Takuma Maeda, Aoto Shibata, Hiroyuki Komine, Yuichiro Kikkawa Source Type: research

Validation of the Telestroke Mimic Score in Mayo Clinic Population
Telestroke consultations enable hospital providers to administer intravenous (IV) alteplase to patients who would otherwise not receive it due to lack of an in-hospital stroke team. However, up to 30% of acute stroke patient evaluations are deemed to be stroke mimics. Mimics present a challenge with the limitations of a virtual neurological exam. The administration of IV alteplase in these patients is not without risk. With the cost and risk associated with IV alteplase, there are both ethical and practical incentives to avoid administering alteplase to a patient manifesting a stroke-mimic.
Source: Journal of Stroke and Cerebrovascular Diseases - August 10, 2021 Category: Neurology Authors: Rachel Carlin, Nan Zhang, Bart M. Demaerschalk Source Type: research

What is the Price of the Potential for a Meaningful Recovery following Intracerebral Hemorrhage?
In this issue of the Journal of Stroke and Cerebrovascular Diseases, Vardanyan and colleagues report on the cost-utility of minimally invasive surgery (MIS) with thrombolysis for spontaneous intracerebral hemorrhage (ICH) from the perspective of the United Kingdom (UK) National Health Service (NHS)1 using data from the Minimally Invasive Surgery Plus Alteplase in Intracerebral Hemorrhage Evacuation (MISTIE III) trial2 and the UK Sentinel Stroke National Audit Programme (SSNAP).3 The economic evaluation revealed that the incremental cost-effectiveness ratio for MIS with thrombolysis fell significantly above the UK's Nationa...
Source: Journal of Stroke and Cerebrovascular Diseases - July 27, 2021 Category: Neurology Authors: Lourdes R. Carhuapoma, Avni Kapadia, Henry A. Glick, Daniel F. Hanley Source Type: research

Prognostic Significance of Stroke-Associated Infection and other Readily Available Parameters in Acute Ischemic Stroke Treated by Intravenous Thrombolysis
The impact of contracting stroke-associate infection (SAI) that requires antibiotic treatment after an acute ischemic stroke (AIS) treated with alteplase remains unclear. We studied the profiles of SAI in patients with AIS treated with alteplase toward identifying predictive factors and prognostic implications at 90 days post-stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - December 15, 2020 Category: Neurology Authors: Justyna Derbisz, Klaudia Nowak, Marcin Wnuk, Roman Pulyk, Jeremiasz Jagiella, Joanna Slowik, Tomasz Dziedzic, Agnieszka Slowik 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

Corrigendum to “Comparative Analysis of Fibrinolytic Properties of Alteplase, Tenecteplase and Urokinase in an in Vitro Clot Model of Intracerebral Haemorrhage. Journal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 9 (September), 2020: 105073”
The authors regret an error in the author list, and this should appear as above. The authors regret any inconvenience caused.
Source: Journal of Stroke and Cerebrovascular Diseases - October 27, 2020 Category: Neurology Authors: Naureen Keric, Melanie Doebel, Harald Krenzlin, Elena Kurz, Yasemin Tanyildizi, Axel Heimann, Jochem Koenig, Oliver Kempski, Florian Ringel, Julia Masomi-Bornwasser Source Type: research

M2 segment thrombectomy is not associated with increased complication risk compared to M1 segment: A meta-analysis of recent literature
Numerous trials report safety and efficacy of mechanical thrombectomy (MT) for infarcts involving the M1 segment of the middle cerebral artery (MCA; extending from the terminal bifurcation of the internal carotid artery proximally to the main bifurcation distally) in comparison to intravenous thrombolytic therapy (e.g. alteplase) therapy alone.1 –5 The Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) meta-analysis of these early studies reported a number needed to treat of 2.6 for MT to reduce the modified Rankin Scale (mRS) by 1 point.
Source: Journal of Stroke and Cerebrovascular Diseases - August 15, 2020 Category: Neurology Authors: Christopher Alexander, Andrew Caras, William Kyle Miller, Rizwan Tahir, Tarek R. Mansour, Azedine Medhkour, Horia Marin Source Type: research

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