Thrombolytic Treatment of Acute Cerebral Infarction

CNS Spectrums ◽  
2005 ◽  
Vol 10 (7) ◽  
pp. 539-549 ◽  
Author(s):  
Kathleen M. Burger ◽  
Deborah R. Horowitz
Keyword(s):  
Case Reports ◽  
Optimal Management ◽  
Thrombolytic Treatment ◽  
Acute Stroke Patient ◽  
Acute Therapy ◽  
Common Cause ◽  
Intravenous Tissue Plasminogen Activator ◽  
The World ◽  
Tissue Plasminogen ◽  
Improved Outcome

AbstractStroke is a common cause of death and disability throughout the world. Acute neurologic deficits due to ischemic injury deserve rapid recognition and diagnosis in order to provide effective therapy. Intravenous tissue plasminogen activator (t-PA) provided to carefully selected patients that can be treated within 3 hours of stroke onset results in improved outcome in these patients. Intra-arterial administration of t-PA within a 6-hour window is performed at several academic centers in patients with middle cerebral and other intracranial artery occlusions based on results of one randomized clinical trial and numerous case reports. Although acute therapy of ischemic stroke has received much attention since the approval of intravenous t-PA, only a small percentage of individuals suffering a stroke actually receive t-PA. This article will review the optimal management of the acute stroke patient and discuss thrombolytic clinical trials that have been completed as well as those that are in progress.

scholarly journals Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Cynthia Mardinger ◽  
Paul J. E. Boiteau ◽  
John B. Kortbeek
Keyword(s):  
Standard Dose ◽  
Case Reports ◽  
Cruciate Ligament ◽  
Physically Active ◽  
Future Studies ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Lateral Meniscectomy ◽  
Anterior Cruciate ◽  
In Transit

Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered.

Republished: Basilar artery occlusion in a child treated successfully with mechanical thrombectomy using ADAPT

2016 ◽  
Vol 9 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Jonathan Lena ◽  
Ramin Eskandari ◽  
Libby Infinger ◽  
Kyle M Fargen ◽  
Alejandro Spiotta ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Pediatric Population ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
First Case ◽  
Intravenous Tissue Plasminogen Activator ◽  
First Pass ◽  
Tissue Plasminogen ◽  
Arterial Thrombolysis

Acute ischemic stroke (AIS) in the pediatric population is rare. Furthermore, it is common for physicians to take significantly longer diagnosing a posterior circulation stroke in a child than in an adult. There are increasing case reports in the literature of treating AIS in children with intravenous tissue plasminogen activator, intra-arterial thrombolysis, and/or mechanical thrombectomy. We present the first case of pediatric AIS treated using a direct aspiration first pass technique (ADAPT) as a means of mechanical thrombectomy.

Histórias escritas com sangue: Uma análise de processos judiciários de assassinatos de mulheres em Goiânia (1970-1984)

2020 ◽  
Author(s):  
Neide Célia Ferreira Barros
Keyword(s):  
Power Relations ◽  
Case Reports ◽  
Border Region ◽  
Life And Death ◽  
Country Life ◽  
The World ◽  
Gender Power

This book analyzes the criminal processes of homicides or attempted homicides of women in Goiânia during the period of 1970-1984. We observed the gender power relations in the capital of Goiás, a border region, a mixture of country life elements and discourses of modernity. Hence, through case reports of women who suffered attacks on their lives in a period of intense changes, such as the organization of feminist groups in Brazil and the world, political and economic repercussions of the construction of Brasília in Goiás and mass immigration to Goiânia, we have pursued to understand what it meant socially to "be a man" and "to be a woman" in this capital and what consequences were brought into their bodies, concerning life and death, protection and punishment.

scholarly journals GRP per capita and hospital characteristics associated with intravenous tissue plasminogen activator adherence rate: evidence from the Chinese Stroke Center Alliance

2021 ◽  
pp. svn-2020-000633
Author(s):  
Suxi Zheng ◽  
Tian Jie Lyu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Xin Yang ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
Emergency Services ◽  
Influential Factors ◽  
Adherence Rate ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Per Capita ◽  
Stroke Center

BackgroundTimely delivery of intravenous tissue plasminogen activator (IV-rt PA) is pivotal to eligible patients who had a stroke while achieving higher rates of IV-rt PA has been problematic. This paper focuses on investigating influential factors associated with the administration of IV-rt PA, primarily per capita gross regional product (GRP) and healthcare system factors.MethodsThe study included 980 hospitals in the Chinese Stroke Center Alliance where 158 003 patients who had an acute ischaemic stroke received IV-rt PA between August 2015 and August 2019. The adherence rate to IV-rt PA within 4.5 hours time window in each hospital was the primary outcome. Influential factors were grouped into two categories: macroeconomic status and hospital characteristics. The outcome was analysed using multivariable linear regression.ResultsGRP per capita (β=2.37, p<0.001), hospital stroke centre certification (β=3.77, p<0.001), number of neurologists (β=0.12, p<0.001), existence of emergency services for neurological treatment (β=7.43, p=0.014), presence of emergency department (β=10.03, p=0.019) and cooperating with emergency centre (β=4.65, p=0.029) were significantly positively associated with the adherence rate to IV-rt PA.ConclusionsHigher GRP per capita, affluent neurological personnel, well-equipped emergency services for neurological treatment and routine cooperation with the emergency centre were important for enhancing the adherence rate to IV-rt PA among patients who had an acute ischaemic stroke in China.

scholarly journals Comparison of outcome of patients with acute minor ischaemic stroke treated with intravenous t-PA, DAPT or aspirin

2020 ◽  
pp. svn-2019-000319
Author(s):  
Peng Wang ◽  
Mengyuan Zhou ◽  
Yuesong Pan ◽  
Xia Meng ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
National Institutes Of Health ◽  
Minor Stroke ◽  
Post Hoc Analysis ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Ischemic Attack ◽  
Post Hoc

BackgroundWhether to treat minor stroke with intravenous tissue plasminogen activator (t-PA) treatment or antiplatelet therapy is a dilemma. Our study aimed to explore whether intravenous t-PA treatment, dual antiplatelet therapy (DAPT) and aspirin have different efficacies on outcomes in patients with minor stroke.MethodsA post hoc analysis of patients with acute minor stroke treated with intravenous t-PA within 4.5 hours from a nationwide multicentric electronic medical record and patients with acute minor stroke treated with DAPT and aspirin from the Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack Database. Minor stroke was defined by a score of 0–3 on the National Institutes of Health Stroke Scale at randomisation. Favourable functional outcome (defined as modified Rankin Scale (mRS) score of 0–1 or 0–2 at 3 months).ResultsCompared with those treated with intravenous t-PA, no significant association with 3-month favourable functional outcome (defined as mRS score of 0–1) was found neither in patients treated with aspirin (87.8% vs 89.4%; OR, 0.83; 95% CI, 0.46 to 1.50; p=0.53) nor those treated with DAPT (87.4% vs 89.4%; OR, 0.84; 95% CI, 0.46 to 1.52; p=0.56). Similar results were observed for the favourable functional outcome defined as mRS score of 0–2 at 3 months.ConclusionsIn our study, no significant advantage of intravenous t-PA over DAPT or aspirin was found. Due to insufficient sample size, our study is probably unable to draw such a conclusion that that intravenous t-PA was superior or non-superior to DAPT.

scholarly journals Treating ischaemic stroke with intravenous tPA beyond 4.5 hours under the guidance of a MRI DWI/T2WI mismatch was safe and effective

2019 ◽  
Vol 4 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Qing-ke Bai ◽  
Zhen-guo Zhao ◽  
Lian-jun Lu ◽  
Jian Shen ◽  
Jian-ying Zhang ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Contrast Material ◽  
Final Analysis ◽  
National Institutes Of Health ◽  
Haemorrhagic Transformation ◽  
Intravenous Tissue Plasminogen Activator ◽  
Hyperintense Signal ◽  
Rapid Sequence ◽  
Tissue Plasminogen ◽  
Sequence Study

PurposeClinical trials have provided evidence that treating patients with acute ischaemic stroke (AIS) beyond 4.5 hours was feasible. Among them using MRI diffusion-weighted imaging/fluid attenuation inversion response (DWI/FLAIR) mismatch to guide intravenous tissue plasminogen activator (tPA) was successful. Our study explored the outcome and safety of using DWI/T2-weighted imaging (T2WI) mismatch to guide intravenous tPA therapy for patients with AIS between 4.5 hours and 12 hours of onset.MethodThis was a retrospective study. Records of 1462 AIS patients with the time of onset of <12 hours were reviewed. Those had MRI rapid sequence study and had hyperintense signal on DWI but normal T2WI and received intravenous tPA up to 12 hours of onset were included in the analysis. Their demographics, risk factors, post-tPA complications, National Institutes of Health Stroke Scale (NIHSS) scores and outcome were recorded and analyse. χ2 was used to compare the intergroup variables. SAS was used to perform statistical calculation. A p<0.05 was considered statistically significant.ResultsOf 1462 identified, 601 (41%) patients were entered into the final analysis. Among them, 327 (54%) had intravenous tPA within 4.5 hours of onset and 274 (46%) were treated between 4.5–12 hours. After intravenous tPA, 426 cases (71%) had >4 pints of improvement on NIHSS score within 24 hours. Postintravenous tPA, 32 (5.32%) cases had haemorrhagic transformation. 26 (4.33%) were asymptomatic ICH and 4 (0.67%) died. At 90 days, 523 (87%) achieved a modified Rankin scale of 0–2.ConclusionUsing MRI DWI/T2WI mismatch to identify patients with AIS for intravenous tPA between 4.5 hours and 12 hours was safe and effective. The outcome was similar to those used DWI/PWI or DWI/FLAIR mismatch as the screening tool. However, obtaining DWI/T2WI was faster and avoided the need of contrast material.

Aortic Transgraft Hemorrhage after Intravenous Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

2014 ◽  
Vol 23 (8) ◽  
pp. 2145-2150 ◽  
Author(s):  
Tomohiro Kawano ◽  
Katsufumi Kajimoto ◽  
Masahiro Higashi ◽  
Kenji Minatoya ◽  
Kazunori Toyoda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen
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