Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

2019 ◽  
Vol 48 (4) ◽  
pp. 679-684 ◽  
Author(s):  
Francisco Bernardo ◽  
Stefania Nannoni ◽  
Davide Strambo ◽  
Bruno Bartolini ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Artery Dissection ◽  
Intracranial Artery ◽  
Review Of Literature ◽  
Single Center ◽  
Intracranial Artery Dissection

Abstract TP219: Hyperintense Vessels on FLAIR MRI Suggest Dissection and Large-Artery Atherosclerosis but Do Not Predict Outcome in Acute Posterior Circulation Infarct

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Maki Takahashi ◽  
Takeo Sato ◽  
Takahiro Maku ◽  
Haruhiko Motegi ◽  
Hiroki Takatsu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Posterior Circulation ◽  
Unfavorable Outcome ◽  
Artery Dissection ◽  
Large Artery ◽  
Intracranial Artery ◽  
Stroke Patients ◽  
Intracranial Artery Dissection ◽  
Posterior Circulation Infarct

Background and Purpose: Hyperintense vessel sign on FLAIR (HVS) has been described in hyperacute stroke patients with arterial occlusion. It’s a surrogate marker for stroke severity in patients with acute ischemic stroke of the anterior circulation. We aimed to reveal the clinical significance of HVS in patients with acute posterior circulation infarction. Methods: This observational study is based on a single-center prospective registry study. Inclusion criteria were: symptomatic ischemic stroke patients who have lesions only in posterior circulation; and taken initial MRI within 14 days from onset.An unfavorable outcome was defined as mRS score of 2 to 6 at 3 months from the onset. First investigation is to estimate whether HVS could be related to the subtype of acute ischemic stroke (cohort A). Second, the correlation between HVS and mRS at 3 months was evaluated (cohort B). Results: From October 2012 to May 2019, consecutive 1,079 ischemic stroke subjects were screened, including 277 in cohort A (191 male, median age 64 years) and 240 in cohort B (165 male, median age 66 years, Figure A). In cohort A, HVS was independently associated with intracranial artery dissection (OR 5.228; 95% CI 2.270-12.039; p = 0.001) and large-artery atherosclerosis (OR 3.582; 95% CI 1.244-10.317; p = 0.018, Figure B). In cohort B, HVS was not a factor independently associated with unfavorable outcome (OR 2.925; 95% CI 0.881-9.714; p = 0.080). Conclusions: HVS in patients with posterior circulation infarct suggests intracranial artery dissection or large-artery atherosclerosis, but does not have impact on their clinical courses.

scholarly journals Intravenous thrombolysis in acute ischemic stroke patients with negative CT perfusion: a case series

2014 ◽  
Vol 3 (7) ◽  
pp. 204798161454321
Author(s):  
Ratnesh Mehra ◽  
Chiu Yuen To ◽  
Omar Qahwash ◽  
Boyd Richards ◽  
Richard D Fessler
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Stroke Patients ◽  
Radiographic Findings ◽  
Type Plasminogen Activator

Background Computed tomography perfusion (CTP) is a commonly used modality of neurophysiologic imaging to aid the selection of acute ischemic stroke patients for neuroendovascular intervention by identifying the presence of penumbra versus infarcted brain tissue. However many patients present with evidence of cerebral ischemia with normal CTP, and in that case, should intravenous thrombolytics be given? Purpose To demonstrate if tissue-type plasminogen activator (tPA)-eligible stroke patients without perfusion defects demonstrated on CTP would benefit from administration of intravenous thrombolytics. Material and Methods We retrospectively identified patients presenting with acute ischemic symptoms who received intravenous tPA (IV-tPA) from January to June 2012 without a perfusion defect on CTP. Clinical and radiographic findings including the NIHSS at presentation, 24 h, and at discharge, symptomatic and asymptomatic hemorrhagic transformation, and the modified Rankin score at 30 days were collected. A reduction of NIHSS of greater than 4 points or resolution of symptoms was considered significant. Results Seventeen patients were identified with a mean NIHSS of 8.2 prior to administration of intravenous thrombolytics, 3.5 after 24 h, and 2.5 at discharge. Among them, 13 patients had significant improvement of NIHSS with a mean reduction of 6.15 points at 24 h. One patient initially improved but had delayed hemorrhagic transformation and died. Two patients had improvement in NIHSS but were not significant and two patients had increased in NIHSS at 24 h, although one eventually improved at discharge. There was no asymptomatic hemorrhagic transformation. Mean mRS at 3 months is 1.76. Conclusion The failure to identify a perfusion deficit by CTP should not be used as a contraindication for intravenous thrombolytics. Criteria for administration of intravenous thrombolytics should still be based on time from symptom onset as previously published by NINDS.

scholarly journals Endovascular Thrombectomy Following Acute Ischemic Stroke: A Single-Center Case Series and Critical Review of the Literature

2013 ◽  
Vol 3 (4) ◽  
pp. 521-539 ◽  
Author(s):  
Eric Sussman ◽  
Christopher Kellner ◽  
Michael McDowell ◽  
Peter Yang ◽  
Eric Nelson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Critical Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Single Center ◽  
Endovascular Thrombectomy

Sonothrombolysis in Acute Ischemic Stroke: Current Status

2018 ◽  
Vol 1 (1) ◽  
pp. 12-18
Author(s):  
Arvind Sharma ◽  
Jose C. Navarro ◽  
Cyrus G. Escabillas ◽  
Vijay K. Sharma
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transcranial Doppler ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Current Status ◽  
Intracranial Artery ◽  
Reasonable Accuracy ◽  
Ultrasound Exposure ◽  
Intracranial Arteries

Transcranial Doppler (TCD) is an important tool in the armamentarium of stroke neurologists. This, bedsides modality, can help in establishing the presence, location, and severity of intracranial arterial occlusion in acute stroke cases. Various hemodynamic consequences of an acute arterial occlusion such as flow diversion and compensatory flow increase in other intracranial arteries can be monitored by TCD with reasonable accuracy. TCD monitoring during intravenous thrombolysis may demonstrate recanalization in real-time In addition, continuous ultrasound exposure during intravenous thrombolysis can enhance the rates of the recanalization of an acutely occluded intracranial artery. Therapeutic ultrasound or sonothrombolysis remains a widely debated application of TCD. We present the available evidence for sonothrombolysis as well as its current status in the hyperacute treatment of acute ischemic stroke.

Abstract TMP21: Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke in Patients with Thrombocytopenia

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ashkan Mowla ◽  
Haris Kamal ◽  
Navdeep Lail ◽  
Rick Magun ◽  
Sandhya Mehla ◽  
...  
Keyword(s):  
Platelet Count ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
P Value ◽  
Class Iii ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Significant Difference

Objective: To evaluate the rate of symptomatic intracranial hemorrhage (sICH) in patients who received Intravenous tPA(IVT) for acute ischemic stroke(AIS) and were later found to have platelets less than 100,000 /mm 3 . Background: With increasing use of IVT for AIS and more studies on its risk and benefits, many of the initial exclusion criteria which were part of the pivotal NINDS trial have been challenged with well-designed case series and reports. Based on the latest scientific statement from the AHA/ASA on the exclusion and inclusion criteria for IVT in AIS published in February 2016, the safety and efficacy of IVT in AIS is unknown for the patients with platelet count <100,000(Class III, Level of evidence C). The platelet threshold of 100,000 /mm 3 was derived from expert consensus in the NINDS trial and since many of the exclusion criteria have been challenged, this value also comes into question. Methods: We retrospectively reviewed the charts of all patients who received IVT for AIS from the beginning of 2006 till the end of August 2015 at our large volume comprehensive stroke center (SUNY Buffalo). Those with platelets <100,000/mm 3 were identified. Head CT done in 24 to 36 hours Post-thrombolysis was reviewed to evaluate the rate of sICH. sICH was defined as ICH with an increase in National Institute of Health Stroke Scale of at least 4 points. Results: A total of 835 patients received IV rtPA for AIS in our center during a 9·6-year period. Fifty one patients (6.1 %) were found to have sICH. A total of 5 patients (0.6 %) were identified to have platelet count <100,000 /mm 3 . One of them (20%) developed sICH post IV tPA administration .The mean platelet count of those 5 patients was 63,000 ± 19,000 /mm 3 (Range: 38,000 - 85,000 /mm 3 ) . To the best of our knowledge, only 21 thrombocytopenic patients have been reported to receive IV rtPA for AIS in the medical literature. Combining our 5 cases with 21 patients previously reported, we have 26 AIS patients who had platelet count <100,000 /mm 3 and received IV rtPA, with 2 of them developed sICH (7.7 %). Comparing the rate of sICH among this group with the patients with normal platelet count in our cohort, there was no statistically significant difference (7.7% versus 6.04%, p-value = 0.73). Conclusion: Although our extremely low number of cases precludes any solid conclusion, IV rtPA for AIS might be safe in patients with platelet count <100,000/ mm 3 and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count.

scholarly journals Intravenous thrombolysis in acute ischemic stroke of nonagenarian patients: a single center experience in Chile

2015 ◽  
Vol 357 ◽  
pp. e397 ◽  
Author(s):  
V. Montero Ruiz de Gamboa ◽  
C. Suazo Vacarezza ◽  
I. Ramírez Méndez ◽  
P. Bastías Barra ◽  
A. Hoppe Wiegering ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Single Center ◽  
Single Center Experience

Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Preexisting Intracranial Neoplasms: A Case Series

2015 ◽  
Vol 10 (3) ◽  
pp. E29-E30 ◽  
Author(s):  
Karanbir Singh ◽  
Ashkan Mowla ◽  
Sandhya Mehla ◽  
Mohammad K. Ahmed ◽  
Peyman Shirani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Intracranial Neoplasms
Sign in / Sign up

Export Citation Format

Share Document