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An Optimal Animal Model of Ischemic Stroke Established by Digital Subtraction Angiography-Guided Autologous Thrombi in Cynomolgus Monkeys
ConclusionOur study may provide an optimal non-human primate model for an in-depth study of the pathogenesis and treatment of focal cerebral ischemia.
Source: Frontiers in Neurology - April 25, 2022 Category: Neurology Source Type: research

Outcomes and risk factors of perforating and non-perforating middle cerebral artery infarctions after intravenous thrombolysis
AbstractThe clinical symptoms of perforating arteries differ, and responses to intravenous thrombolytic therapy are heterogeneous. Here, we investigated the effect of intravenous thrombolytic therapy and the related factors influencing acute perforating and non-perforating middle cerebral artery infarctions. We analyzed 320 patients with acute middle cerebral artery infarction who received alteplase thrombolysis within 4.5  h of onset at two stroke centers from January 2016 to December 2019. Outcome measures included rates of a favorable functional outcome (modified Rankin Scale scores of 0–2), distribution of modified ...
Source: Journal of Thrombosis and Thrombolysis - January 14, 2022 Category: Hematology Source Type: research

Management of Acute Ischemic Stroke-Specific Focus on Anesthetic Management for Mechanical Thrombectomy.
Abstract Acute ischemic stroke is a neurological emergency with a high likelihood of morbidity, mortality, and long-term disability. Modern stroke care involves multidisciplinary management by neurologists, radiologists, neurosurgeons, and anesthesiologists. Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3-4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16-24 hours depending on specific inclusion criteria. The anesthesia and critical care provider may b...
Source: Anesthesia and Analgesia - September 16, 2020 Category: Anesthesiology Authors: Businger J, Fort AC, Vlisides PE, Cobas M, Akca O Tags: Anesth Analg 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

Pre-hospital Triage of Acute Ischemic Stroke Patients —Importance of Considering More Than Two Transport Options
Conclusion: Pre-hospital triage algorithms for AIS patients that only take into account the nearest CSC and the nearest PSC as transport destinations may be unable to identify the optimal transport destination for a significant proportion of patients. Introduction Background International guidelines recommend early administration of intravenous thrombolysis for eligible patients with acute ischemic stroke (AIS); in addition, patients with proximal large vessel occlusion (LVO) should receive mechanical thrombectomy (MT) as quickly as possible (1). As the clinical benefit of both thrombolysis (2–4) and MT (5&#...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis
Conclusion Our data suggest that women who suffer from IS present with a poorer functional outcome than men at 3-months, regardless of other preclinical and clinical factors during the acute phase. These relationships seem to be mediated by atrial dysfunction and inflammation. The inflammatory response is slightly higher in women; however, there are no sex differences in their functional behavior. There is a probable relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, and the connection seems to be more important in cardioembolic stroke patients. In patients wi...
Source: Frontiers in Neurology - April 16, 2019 Category: Neurology Source Type: research

Intravenous Thrombolysis in Unknown-Onset Stroke Clinical Sciences
Conclusions—Our data suggest no excess risk of symptomatic intracerebral hemorrhage but increased mortality and reduced favorable outcome in patients with UKO stroke compared with patients treated within the approved time window.
Source: Stroke - February 26, 2017 Category: Neurology Authors: Laura Dorado, Niaz Ahmed, Gotz Thomalla, Manuel Lozano, Branko Maloȷcic, Mushtaq Wani, Monica Millan, Ales Tomek, Antoni Davalos Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Stroke Care: A Balanced Approach to the tPA Debate
In conclusion, alteplase is the only treatment available for acute ischemic stroke that is effective in some patients. In order to improve tPA effectiveness and minimize risks, patients with symptoms suggestive of an AIS should get rapid assessment and treatment with tPA after careful review of the contraindications. Given that smaller strokes can still be associated with considerable long term neurological morbidity, treatment should still be considered in those patients after weighing the risks and benefits and in consultation with the patient and family. Advanced age should also not be a limiting factor. Although the NI...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Burden of stroke in Italy: An economic model highlights savings arising from reduced disability following thrombolysis
ConclusionOur study reveals that performing thrombolytic therapy in eligible patients improves economic outcomes compared with patients receiving standard care. This model is useful for decision makers, both within and outside of the Italian national context, as a tool to assess the cost‐effectiveness of thrombolysis in both short‐ and long‐term period.
Source: International Journal of Stroke - April 8, 2015 Category: Neurology Authors: M. Chiumente, M. M. Gianino, D. Minniti, T. J. Mattei, B. Spass, K. M. Kamal, D. E. Zimmerman, A. Muca, E. Luda Tags: Research Source Type: research

Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial) Clinical Sciences
Conclusions— These exploratory analyses of the third International Stroke Trial (IST-3) trial support improving acute stroke patients’ access to earlier alteplase treatment, treatment of patients with poor prognosis, and further randomized controlled trials in minor stroke to replicate these findings. Clinical Trial Registration— URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25765518.
Source: Stroke - November 24, 2014 Category: Neurology Authors: Whiteley, W. N., Thompson, D., Murray, G., Cohen, G., Lindley, R. I., Wardlaw, J., Sandercock, P., on behalf of the IST-3 Collaborative Group Tags: Acute Cerebral Infarction, Thrombolysis Clinical Sciences Source Type: research

Routine serum C‐reactive protein and stroke outcome after intravenous thrombolysis
ConclusionsAccording to our findings, elevated routine serum CRP measured within 24 h after admission does not seem to independently affect the outcome in patients receiving intravenous thrombolysis for stroke. However, further studies of blood samples taken directly before the treatment are needed.
Source: Acta Neurologica Scandinavica - February 20, 2014 Category: Neurology Authors: M. Karlinski, J. Bembenek, K. Grabska, A. Kobayashi, A. Baranowska, T. Litwin, A. Czlonkowska Tags: Original Article Source Type: research

Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?
We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarc...
Source: The American Journal of Emergency Medicine - July 1, 2013 Category: Emergency Medicine Authors: Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi Tags: Correspondence Source Type: research

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