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Abstract 21: Stroke Physician Report Cards Improve Physician Response Times for Thrombolytic Treatment Session Title: Concurrent Session IIC: Oral Abstracts - Stroke
Conclusion: The results show that direct, personal and comparative feedback to stroke physicians influences their page-to-response, page-to-needle times and may affect DTN times. There was a clear trend overall, and the page-to-response and page-to-needle times showed significant improvement. Though our numbers were too small to detect statistical significance for individuals, the benefit of improved treatment times is likely clinically significant.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Yanase, L., Corless, L., Stuchiner, T., Baraban, E. Tags: Session Title: Concurrent Session IIC: Oral Abstracts - Stroke Source Type: research

Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke Stroke
Conclusions Hospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care.
Source: JAHA:Journal of the American Heart Association - July 22, 2015 Category: Cardiology Authors: Lin, C. B., Cox, M., Olson, D. M., Britz, G. W., Constable, M., Fonarow, G. C., Schwamm, L., Peterson, E. D., Shah, B. R. Tags: Stroke Source Type: research

Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Original Articles
Conclusions— Presence of CKD among patients with IS treated with intravenous tissue-type plasminogen activator is associated with higher unadjusted odds of symptomatic intracranial hemorrhage or serious systemic hemorrhage, but this is explained by non-CKD related factors.
Source: Circulation: Cardiovascular Quality and Outcomes - November 18, 2014 Category: Cardiology Authors: Ovbiagele, B., Smith, E. E., Schwamm, L. H., Grau-Sepulveda, M. V., Saver, J. L., Bhatt, D. L., Hernandez, A. F., Peterson, E. D., Fonarow, G. C. Tags: Cerebrovascular disease/stroke, Risk Factors, Acute Cerebral Infarction, Thrombolysis Original Articles Source Type: research

Advances in the Stroke System of Care
Opinion statement The stroke system of care is undergoing significant evolution. There are promising data to suggest that with new technologies and approaches, primary prevention and community education will become easier and more accessible, and will allow people to have greater participation in their own healthcare. The evidence-based primary and comprehensive stroke center concepts have been translated into robust, rapidly growing certification programs. The continued dissemination of improved EMS routing protocols allows for better allocation of patients to stroke centers, even as we confront the challenge of...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2014 Category: Cardiology Source Type: research

Inflammatory Disequilibrium in Stroke.
Abstract Over the past several decades, there have been substantial advances in our knowledge of the pathophysiology of stroke. Understanding the benefits of timely reperfusion has led to the development of thrombolytic therapy as the cornerstone of current management of ischemic stroke, but there remains much to be learned about mechanisms of neuronal ischemic and reperfusion injury and associated inflammation. For ischemic stroke, novel therapeutic targets have continued to remain elusive. When considering modern molecular biological techniques, advanced translational stroke models, and clinical studies, a consi...
Source: Circulation Research - June 23, 2016 Category: Cardiology Authors: Petrovic-Djergovic D, Goonewardena SN, Pinsky DJ Tags: Circ Res Source Type: research

Use of Intravenous Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) Before Stroke.
CONCLUSIONS: -While experience of using rt-PA in ischemic stroke patients on a NOAC is limited, these preliminary observations suggest that rt-PA appears to be reasonably well tolerated without prohibitive risks for adverse events among selected NOAC treated patients. Future study should evaluate the safety and efficacy of intravenous rt-PA in ischemic stroke patients taking NOACs. PMID: 28119380 [PubMed - as supplied by publisher]
Source: Circulation - January 23, 2017 Category: Cardiology Authors: Xian Y, Federspiel JJ, Hernandez AF, Laskowitz D, Schwamm LH, Bhatt DL, Smith EE, Fonarow GC, Peterson ED Tags: Circulation Source Type: research

tPA Mobilizes Immune Cells that Exacerbate Hemorrhagic Transformation in Stroke.
Conclusions: Our findings suggest that immune invasion of the neurovascular unit represents a previously unrecognized mechanism underlying tPA-mediated brain hemorrhage, which can be overcome by precise immune modulation during thrombolytic therapy. PMID: 33070717 [PubMed - as supplied by publisher]
Source: Circulation Research - October 19, 2020 Category: Cardiology Authors: Shi K, Zou M, Jia DM, Shi S, Yang X, Liu Q, Dong J, Sheth KN, Wang X, Shi FD Tags: Circ Res Source Type: research

Treatment with TPA in the "Golden Hour" and the Shape of the 4.5 Hour Time-Benefit Curve in the National US Get With The Guidelines-Stroke Population.
CONCLUSIONS: -Thrombolysis started within the first 60 minutes after onset is associated with best outcomes for patients with acute ischemic stroke, and benefit declined more rapidly early after onset for ability to be discharged home. These findings support intensive efforts to organize stroke systems of care to improve the timeliness of thrombolytic therapy in acute ischemic stroke. PMID: 27815374 [PubMed - as supplied by publisher]
Source: Circulation - November 3, 2016 Category: Cardiology Authors: Kim JT, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC, Grau-Sepulveda MV, Hernandez AF, Peterson ED, Schwamm LH, Saver JL Tags: Circulation Source Type: research

Intravenous Recombinant Tissue Plasminogen Activator Therapy for Acute Basilar Artery Ischemic Stroke Following Transfemoral Transcatheter Aortic Valve Implantation.
Authors: Montarello NJ, Nelson AJ, Sidharta SL, Worthley SG Abstract Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing,...
Source: Journal of Heart Valve Disease - December 21, 2016 Category: Cardiology Tags: J Heart Valve Dis Source Type: research

Organizing stroke systems in the field for patients with suspected large vessel occlusion acute stroke.
Authors: Almekhlafi MA, Holodinsky JK, Hill MD, Kamal N, Goyal M Abstract INTRODUCTION: The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges....
Source: Expert Review of Cardiovascular Therapy - November 20, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke
ConclusionIn patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.
Source: European Heart Journal - June 30, 2017 Category: Cardiology Source Type: research

The impact of blood pressure variation on mortality and symptomatic intracerebral hemorrhage in acute stroke patients after thrombolysis
In conclusion, in-hospital systolic (SD, SV and CV) and diastolic (SV, SD) BPV profiles were associated with death and sICH in stroke patients after rt-PA therapy.
Source: Blood Pressure Monitoring - May 13, 2022 Category: Cardiology Tags: Clinical Methods and Pathophysiology 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

Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
CONCLUSIONS: Among older patients with stroke treated with either IVT only or IVT+EVT, shorter DTN times are associated with better long-term functional outcomes and lower mortality. These findings support further efforts to accelerate thrombolytic administration in all eligible patients, including EVT candidates.PMID:37199147 | DOI:10.1161/CIRCULATIONAHA.123.064053
Source: Circulation - May 18, 2023 Category: Cardiology Authors: Shumei Man Nicole Solomon Brian Mac Grory Brooke Alhanti Ken Uchino Jeffrey L Saver Eric E Smith Ying Xian Deepak L Bhatt Lee H Schwamm Muhammad Shazam Hussain Gregg C Fonarow Source Type: research

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