Idarucizumab for Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Stroke: A Case Report

2020 ◽  
Vol 58 (3) ◽  
pp. e113-e116
Author(s):  
Yu-Ting Lin ◽  
Yen-Jun Lai ◽  
Tzu-Hsien Lai
Keyword(s):  
Case Report ◽  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Endovascular Thrombectomy

scholarly journals Successful Intravenous Thrombolysis in Ischemic Stroke Caused by Tuberculous Meningitis: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Xinke Peng ◽  
Xiaomei Wu ◽  
Lingling Lv ◽  
Qile Xiao ◽  
Yajing Zhan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Cerebral Infarction ◽  
Acute Stroke ◽  
Tuberculous Meningitis ◽  
Acute Treatment ◽  
Clinical Manifestations ◽  
Intravenous Thrombolysis ◽  
Treatment Method ◽  
Common Complication

Tuberculous meningitis (TBM) has a variety of clinical manifestations and complications, and ischemic stroke is a common complication of TBM. However, there is no established prevention or treatment for stroke associated with TBM, and the safety and efficiency of thrombolysis in acute stroke caused by TBM remain unknown. Herein, we present a case of successful intravenous thrombolysis in ischemic stroke caused by TBM. A 50-year-old male patient with cerebral infarction had substantially improved neurological function after intravenous thrombolysis, and he was subsequently found to have TBM. Our findings suggest that intravenous thrombolysis might be an effective acute treatment method for infectious stroke.

Acute Stroke

2019 ◽  
Vol 39 (01) ◽  
pp. 061-072 ◽  
Author(s):  
Loris Poli ◽  
Paolo Costa ◽  
Andrea Morotti
Keyword(s):  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Blood Pressure Reduction ◽  
Intravenous Thrombolysis ◽  
Medical Emergency ◽  
Endovascular Thrombectomy ◽  
Stroke Units ◽  
Cerebrovascular Events ◽  
Acute Intracerebral Hemorrhage ◽  
Improved Outcome

AbstractStroke 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. Blood pressure reduction and hemostatic treatment in case of coagulopathy are the cornerstones of acute intracerebral hemorrhage treatment. Admission to dedicated stroke units is associated with improved outcome in patients suffering from acute stroke.

scholarly journals Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023265 ◽  
Author(s):  
Jan F Scheitz ◽  
Henrik Gensicke ◽  
Sanne M Zinkstok ◽  
Sami Curtze ◽  
Marcel Arnold ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Research Collaboration ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Laboratory Findings ◽  
Endovascular Thrombectomy ◽  
Multicentre Research

PurposeThe ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration aims to address clinically relevant questions about safety and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy. The findings can provide observational information on treatment of patients derived from everyday clinical practice.ParticipantsTRISP is an open, investigator-driven collaborative research initiative of European stroke centres with expertise in treatment with revascularisation therapies and maintenance of hospital-based registries. All participating centres made a commitment to prospectively collect data on consecutive patients with stroke treated with IVT using standardised definitions of variables and outcomes, to assure accuracy and completeness of the data and to adapt their local databases to answer novel research questions.Findings to dateCurrently, TRISP comprises 18 centres and registers >10 000 IVT-treated patients. Prior TRISP projects provided evidence on the safety and functional outcome in relevant subgroups of patients who were excluded, under-represented or not specifically addressed in randomised controlled trials (ie, pre-existing disability, cervical artery dissections, stroke mimics, prior statin use), demonstrated deficits in organisation of acute stroke care (ie, IVT during non-working hours, effects of onset-to-door time on onset-to-needle time), evaluated the association between laboratory findings on outcome after IVT and served to develop risk estimation tools for prediction of haemorrhagic complications and functional outcome after IVT.Future plansFurther TRISP projects to increase knowledge of the effect and safety of revascularisation therapies in acute stroke are ongoing. TRISP welcomes participation and project proposals of further centres fulfilling the outlined requirements. In the future, TRISP will be extended to include patients undergoing endovascular thrombectomy.

scholarly journals Physicians are not well informed about the new guidelines for the treatment of acute stroke

2017 ◽  
Vol 75 (10) ◽  
pp. 718-721
Author(s):  
Luana Antunes Maranha Gatto ◽  
Gelson Luis Koppe ◽  
Zeferino Demartini Junior ◽  
Viviane de Hiroki Flumignan Zétola
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Phase ◽  
Gold Standard ◽  
Standard Treatment ◽  
Intravenous Thrombolysis ◽  
Online Questionnaire ◽  
Endovascular Thrombectomy ◽  
New Guidelines ◽  
Acute Event

ABSTRACT Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. Objective: To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. Methods: An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. Results: 456 physicians from different specialties answered the questions. Most of them did not know that mechanical endovascular thrombectomy is often considered as the gold standard treatment in cases of ischemic stroke in the acute phase; and 85% of them did not realize that thrombectomy together with intravenous thrombolysis was possible. The maximum time to act in an acute event also presented many divergences, even with regard to the infusion of rtPA. The lack of structure, medication and absence of a neurologist were considered the main barriers to treatment. Conclusion: Physicians are not well informed about the new guidelines for the treatment of acute stroke. Most physicians incorrectly answered most of the questions on the questionnaire.

scholarly journals Maximising access to thrombectomy services for stroke in England: A modelling study

2018 ◽  
Vol 4 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Michael Allen ◽  
Kerry Pearn ◽  
Martin James ◽  
Gary A Ford ◽  
Phil White ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Acute Care ◽  
Intravenous Thrombolysis ◽  
Average Delay ◽  
Endovascular Thrombectomy ◽  
Stroke Units ◽  
Average Improvement ◽  
Small Delay ◽  
Acute Stroke Unit ◽  
Stroke Centre

Purpose Both intravenous thrombolysis (IVT) and intra-arterial endovascular thrombectomy (ET) improve the outcome of patients with acute ischaemic stroke, with endovascular thrombectomy being an option for those patients with large vessel occlusions. We sought to understand how organisation of services affects time to treatment for both intravenous thrombolysis and endovascular thrombectomy. Method A multi-objective optimisation approach was used to explore the relationship between the number of intravenous thrombolysis and endovascular thrombectomy centres and times to treatment. The analysis is based on 238,887 emergency stroke admissions in England over 3 years (2013–2015). Results Providing hyper-acute care only in comprehensive stroke centres (CSC, providing both intravenous thrombolysis and endovascular thrombectomy, and performing >150 endovascular thrombectomy per year, maximum 40 centres) in England would lead to 15% of patients being more than 45 min away from care, and would create centres with up to 4300 stroke admissions/year. Mixing hyper-acute stroke units (providing intravenous thrombolysis only) with comprehensive stroke centres speeds time to intravenous thrombolysis and mitigates admission numbers to comprehensive stroke centres, but at the expense of increasing time to endovascular thrombectomy. With 24 comprehensive stroke centres and all remaining current acute stroke units as hyper-acute stroke units, redirecting patients directly to attend a comprehensive stroke centre by accepting a small delay (15-min maximum) in intravenous thrombolysis reduces time to endovascular thrombectomy: 25% of all patients would be redirected from hyper-acute stroke units to a comprehensive stroke centre, with an average delay in intravenous thrombolysis of 8 min, and an average improvement in time to endovascular thrombectomy of 80 min. The balance of comprehensive stroke centre:hyper-acute stroke unit admissions would change from 24:76 to 49:51. Conclusion Planning of hyper-acute stroke services is best achieved when considering all forms of acute care and ambulance protocol together. Times to treatment need to be considered alongside manageable and sustainable admission numbers.

scholarly journals Pathway Design for Acute Stroke Care in the Era of Endovascular Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3452-3460 ◽  
Author(s):  
Willemijn J. Maas ◽  
Maarten M.H. Lahr ◽  
Erik Buskens ◽  
Durk-Jouke van der Zee ◽  
Maarten Uyttenboogaart ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Organizational Models ◽  
Acute Stroke Care ◽  
Endovascular Thrombectomy ◽  
Regular Treatment ◽  
Model Based ◽  
Comprehensive Stroke Center

The efficacy of intravenous thrombolysis and endovascular thrombectomy (EVT) for acute ischemic stroke is highly time dependent. Optimal organization of acute stroke care is therefore important to reduce treatment delays but has become more complex after the introduction of EVT as regular treatment for large vessel occlusions. There is no singular optimal organizational model that can be generalized to different geographic regions worldwide. Current dominant organizational models for EVT include the drip-and-ship- and mothership model. Guidelines recommend routing of suspected patients with stroke to the nearest intravenous thrombolysis capable facility; however, the choice of routing to a certain model should depend on regional stroke service organization and individual patient characteristics. In general, design approaches for organizing stroke care are required, in which 2 key strategies could be considered. The first entails the identification of interventions within existing organizational models for optimizing timely delivery of intravenous thrombolysis and/or EVT. This includes adaptive patient routing toward a comprehensive stroke center, which focuses particularly on prehospital triage tools; bringing intravenous thrombolysis or EVT to the location of the patient; and expediting services and processes along the stroke pathway. The second strategy is to develop analytical or simulation model-based approaches enabling the design and evaluation of organizational models before their implementation. Organizational models for acute stroke care need to take regional and patient characteristics into account and can most efficiently be assessed and optimized through the application of model-based approaches.

scholarly journals Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

2021 ◽  
pp. 1-7
Author(s):  
Gabriel Velilla-Alonso ◽  
Andrés García-Pastor ◽  
Ángela Rodríguez-López ◽  
Ana Gómez-Roldós ◽  
Antonio Sánchez-Soblechero ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Stroke ◽  
Time Course ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Group Data ◽  
Radiological Data ◽  
History Of ◽  
Prehospital Delays

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the CO­VID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

scholarly journals In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

2020 ◽  
Author(s):  
Juha-Pekka Pienimäki ◽  
Jyrki Ollikainen ◽  
Niko Sillanpää ◽  
Sara Protto
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Clinical Laboratory ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ordinal Logistic Regression Analysis ◽  
Stroke Center

Abstract Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

scholarly journals Repeated intravenous thrombolysis in early recurrent stroke secondary to carotid web: Case report

2021 ◽  
Vol 16 (4) ◽  
pp. 843-846
Author(s):  
Siham Bouchal ◽  
Youssef Alaoui Lamrani ◽  
Naima Chtaou ◽  
Mustafa Maaroufi ◽  
Faouzi Belahsen
Keyword(s):  
Case Report ◽  
Recurrent Stroke ◽  
Intravenous Thrombolysis
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