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("Thrombolysis" OR "Thrombolytic") AND "Emergency"

Wookjin Yang, Dong Wan Kang, Hyung Seok Gook, Sueyoung Ha, Seung Hoon Lee
BACKGROUND AND PURPOSE: The recent successes of the DAWN and DEFUSE 3 trials have extended the therapeutic time window for endovascular treatment (EVT). Accordingly, an increased care burden and clinical benefit for patients with acute stroke in the emergency room are expected. It is necessary to evaluate and respond to these changes in order to provide the best care to patients. METHODS: Data of patients with acute stroke or transient ischemic attack treated at Seoul National University Hospital between October 2010 and September 2016 were reviewed...
March 11, 2019: Journal of Clinical Neurology
B Winter, M Wendt, C Waldschmidt, M Rozanski, A Kunz, F Geisler, U Grittner, S Kaczmarek, M Ebinger, H J Audebert
BACKGROUND: Time to reperfusion treatment is closely related to outcome in ischemic stroke. Prehospital stroke work-up in CT-equipped mobile stroke units is effective in reducing time to thrombolytic treatment. Current evidence predominantly comes from mobile stroke units staffed with neurologists but telemedicine-guided management may be acceptable for providing neurological expertise in ambulances. With unsatisfactory experiences in third-generation (3G)-based approaches, fourth-generation (4G) networks may provide adequate audio-visual quality but systematic comparisons of technological parameters and decision-making are lacking...
March 15, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
Ioannis Mastoris, Damianos G Kokkinidis, Iosif Bikakis, Paraschos Archontakis-Barakakis, Christos A Papanastasiou, Anil Kumar Jonnalagadda, Dimitrios Schizas, Christos Bakoyiannis, Leonidas Palaiodimos, Robert T Faillace
BACKGROUND: Oral anticoagulation therapy was the mainstay of deep vein thrombosis treatment but recently, catheter-directed thrombolysis has emerged as an alternative. OBJECTIVE: To compare the efficacy and safety of the two strategies. METHODS: Medline, Embase and Cochrane CENTRAL were reviewed. Outcomes of interest included post-thrombotic syndrome, thromboembolic events, mortality, bleeding risk and iliofemoral patency. A random effects model meta-analysis was performed...
March 14, 2019: Phlebology
Nicholas Dale, Faming Tian, Ravjit Sagoo, Norman Phillips, Chris Imray, Christine Roffe
Stroke is a leading cause of death and disability. Here, we examine whether point-of-care measurement of the purines, adenosine, inosine and hypoxanthine, which are downstream metabolites of ATP, has potential to assist the diagnosis of stroke. In a prospective observational study, patients who were suspected of having had a stroke, within 4.5 h of symptom onset and still displaying focal neurological symptoms at admission, were recruited. Clinical research staff in the Emergency Departments of two hospitals used a prototype biosensor array, SMARTCap, to measure the purines in the venous blood of stroke patients and healthy controls...
March 12, 2019: Purinergic Signalling
Victor J Del Brutto, Agnieszka Ardelt, Andrea Loggini, Zachary Bulwa, Faten El-Ammar, Raisa C Martinez, James Brorson, Fernando Goldenberg
BACKGROUND AND PURPOSE: Emergent evaluation of inpatients with suspected acute ischemic stroke faces difficulty of symptoms recognition, false alarms, and high rate of contraindications to reperfusion therapies. We aim to assess the clinical characteristics and therapeutic interventions implemented in patients evaluated though the in-hospital Stroke Alert Protocol. METHODS: We analyzed 4 years-worth of Stroke Alert cases at a university hospital. Demographics, clinical presentation, final diagnosis, and acute interventions were compared between inpatients and those presenting to the emergency department...
March 4, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Antoniu Octavian Petriş, Stavros Konstantinides, Diana Tint, Diana Cimpoeşu, Călin Pop
BACKGROUND: Acute pulmonary embolism (PE) requires rapid diagnosis and early and appropriate treatment, often under conditions of hemodynamic instability. The therapeutic strategy should optimally integrate the therapeutic arsenal in a multidisciplinary but unitary approach. AREAS OF UNCERTAINTY: The short list of the major uncertainties associated with acute PE should include limited general public awareness on venous thromboembolism, acute hemodynamic support not based on evidence from randomized clinical trials, with few updates lately, mainly linked to extracorporeal membrane oxygenation, thrombolytic therapy having firm indications only in high-risk PE, without clear strategies for particular clinical situations (ie, stroke, tumors, thrombi in transit, and cardiac arrest), using old therapeutic agents with old administration regimens, lack of evidence from large-volume trials on the optimal interventional approach, and relatively imprecise indications for surgical treatment...
March 2019: American Journal of Therapeutics
Didier Bresson, Mihaela Calcaianu, Bree Lawson, Laurent Jacquemin
Conservative management is the first-line treatment for spontaneous coronary artery dissection (SCAD) with stable haemodynamic status and thrombolysis in myocardial infarction three flow on angiography. However, in a few very specific patients, recurrent ischemia, or haemodynamic instability necessitates revascularization. Here, we describe a case of successful optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with a cutting balloon. We performed fenestration at multiple decompression sites prior to stenting in an intramural haematoma with luminal compression...
March 6, 2019: Catheterization and Cardiovascular Interventions
J Wareham, A Goswami, S Renowden, O Martinovic, D Shatti, K Phan, R Crossley, A Mortimer
AIM: To investigate factors that could impact on recanalisation and reperfusion in patients undergoing mechanical thrombectomy and to assess the technical success over time. MATERIALS AND METHODS: Two hundred consecutive patients who underwent thrombectomy for a proximal anterior circulation occlusion were dichotomised into equal groups (groups 1 and 2) based on the date that immediate access to emergency general anaesthesia (GA) commenced. RESULTS: Recanalisation success using thrombolysis in cerebral infarction (TICI) 2b/3 or TICI 2c/3 significantly improved in group 2 (67% versus 93%, p<0...
February 27, 2019: Clinical Radiology
Thomas Couri, Carla Harmath, Talia Baker, Anjana Pillai
BACKGROUND: Portal vein thrombosis (PVT) after liver transplantation (LT) is an uncommon complication with potential for significant morbidity and mortality that transplant providers should be cognizant of. Recognizing subtle changes in post-operative ultrasounds that could herald but do not definitively diagnose PVT is paramount. CASE SUMMARY: A 30-year-old female with a history of alcohol-related cirrhosis presented with painless jaundice and received a deceased donor orthotopic liver transplant...
February 27, 2019: World Journal of Hepatology
Toshiki Kuno, Takehiro Sugiyama, Shohei Imaeda, Kenji Hashimoto, Toshinobu Ryuzaki, Souichi Yokokura, Tetsuya Saito, Hiroyuki Yamazaki, Ryota Tabei, Masaki Kodaira, Yohei Numasawa
BACKGROUND: The optimal technique for percutaneous coronary intervention (PCI) of a bifurcation lesion remains uncertain. JBT/JCT techniques are now emerging for protection of the side branch (SB). We aimed to compare jailed balloon (JBT) and jailed Corsair (JCT) techniques to the conventional jailed wire technique. METHODS: We analyzed 850 consecutive patients (995 bifurcation lesions), who underwent PCI. The bifurcation lesions were classified as jailed wire (-), jailed wire (+), JBT, and JCT...
February 2, 2019: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Y P Zhao, Y Y Ji, F Y Wang, S L Wang, G K Lai, T Wang, J M Tang
Objective: To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases)...
February 24, 2019: Zhonghua Xin Xue Guan Bing za Zhi
Yen-Tung Chao, Chaur-Jong Hu, Lung Chan
RATIONALE: Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial. PATIENT CONCERNS: A 76-year-old woman with nonvalvular atrial fibrillation, who had been receiving 15 mg rivaroxaban once daily, was brought to the emergency department with right-side hemiparesis and aphasia. The onset of neurological deficits occurred 8 hours after the last dose of rivaroxaban administration...
February 2019: Medicine (Baltimore)
Syed F Zaidi, Alicia C Castonguay, Mouhammad A Jumaa, Tim W Malisch, Italo Linfante, Franklin A Marden, Michael G Abraham, Alex Bou Chebl, Roberta Novakovic, M Asif Taqi, Raul G Nogueira, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey D English, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael T Froehler, Aamir Badruddin, Thanh N Nguyen, Albert J Yoo, Hashem Shaltoni, Vallabh Janardhan, Peng R Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Rishi Gupta, Osama O Zaidat
Background and Purpose- Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry...
February 22, 2019: Stroke; a Journal of Cerebral Circulation
Felipe Teran, Anthony J Dean, Claire Centeno, Nova L Panebianco, Amy J Zeidan, Wilma Chan, Benjamin S Abella
BACKGROUND: Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the Emergency Department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We conducted a prospective observational study consisting of a convenience sample of adult patients presenting to the ED of an urban university medical center with non-traumatic OHCA...
February 16, 2019: Resuscitation
Christopher T Primiani, Angel Chinea Vicente, Michael T Brannick, Aquilla S Turk, J Mocco, Elad I Levy, Adnan H Siddiqui, Maxim Mokin
BACKGROUND: The two most common approaches to thrombectomy of emergent large vessel occlusion (direct aspiration and primary stent retriever thrombectomy) have been extensively studied; however, the detailed benefit and risk comparison is largely unknown. OBJECTIVE: To conduct a systematic review and meta-analysis to compare radiographic and clinical outcomes between the use of primary stent retrievers and direct aspiration in management of acute ischemic stroke...
February 13, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Tapan Mehta, Shailesh Male, Coridon Quinn, David F Kallmes, Adnan H Siddiqui, Aquilla Turk, Andrew Walker Grande, Ramachandra Prasad Tummala, Bharathi Dasan Jagadeesan
INTRODUCTION: Stent retriever combined with aspiration, or the 'Solumbra technique', has recently emerged as one of the popular methods of mechanical thrombectomy (MT). However, the variations in understanding and implementation of the Solumbra technique have not been reported. METHODS: An 18 part anonymous survey questionnaire was designed to extract information regarding technical variations of MT with a focus on the Solumbra technique. The survey link was posted on the Society of Neurointerventional Surgery (SNIS) website in 'SNIS connect'...
February 13, 2019: Journal of Neurointerventional Surgery
Christopher I Price, Lisa Shaw, Peter Dodd, Catherine Exley, Darren Flynn, Richard Francis, Saiful Islam, Mehdi Javanbakht, Rachel Lakey, Joanne Lally, Graham McClelland, Peter McMeekin, Helen Rodgers, Helen Snooks, Louise Sutcliffe, Pippa Tyrell, Luke Vale, Alan Watkins, Gary A Ford
BACKGROUND: Despite evidence from clinical trials that intravenous (IV) thrombolysis is a cost-effective treatment for selected acute ischaemic stroke patients, there remain large variations in the rate of IV thrombolysis delivery between stroke services. This study is evaluating whether an enhanced care pathway delivered by paramedics (the Paramedic Acute Stroke Treatment Assessment (PASTA)) could increase the number of patients who receive IV thrombolysis treatment. METHODS: Study design: Cluster randomised trial with economic analysis and parallel process evaluation...
February 12, 2019: Trials
Antonio Baule, Federico Cabigiosu, Bastianina Zanda, Alessandra Sanna, Claudia Mongili, Antonio Manca
Introduction: Dabigatran is one of the nonvitamin K antagonist oral anticoagulants. Thrombolytic treatment with intravenous recombinant tissue plasminogen activator is contraindicated in patients taking a DOAC. Idarucizumab was recently approved for dabigatran-activity reversing in severe bleeding, emergency surgery, or urgent procedures, but many attempts have been made to use idarucizumab in patients presenting with acute ischemic stroke in order to be eligible for thrombolysis. Case: Our patient was an 89-year-old woman with severe aphasia who was treated with dabigatran for nonvalvular atrial fibrillation...
November 2018: Journal of Vascular and Interventional Neurology
Slaven Pikija, Jozef Magdic, Laszlo K Sztriha, Monika Killer-Oberpfalzer, Nele Bubel, Anita Lukic, Johann Sellner
Ischemic stroke related to tandem internal carotid and middle cerebral artery (TIM) occlusion is a challenging condition where endovascular treatment (EVT) is an emerging revascularization option. The identification of factors influencing clinical outcomes can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to evaluate prognostic factors in the context of EVT for TIM occlusion. We performed a retrospective study of consecutive patients with TIM occlusion admitted within 6 h from symptom onset to two tertiary stroke centers...
February 10, 2019: Journal of Clinical Medicine
Andrea Morotti, Loris Poli, Paolo Costa
Stroke remains one of the leading determinants of death and severe disability worldwide. It is a medical emergency with a narrow window for recognition and administration of outcome-modifying treatment in the emergency department. Ischemic stroke accounts for the majority of cerebrovascular events and revascularization therapies such as intravenous thrombolysis and endovascular thrombectomy are the mainstays of treatment in carefully selected patients. Intracerebral hemorrhage is less common but remains the deadliest type of stroke...
February 2019: Seminars in Neurology
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