scholarly journals Hypointense Transcerebral Veins at T2∗-Weighted MRI: A Marker of Hemorrhagic Transformation Risk in Patients Treated with Intravenous Tissue Plasminogen Activator

2003 ◽  
Vol 23 (11) ◽  
pp. 1362-1370 ◽  
Author(s):  
Marc Hermier ◽  
Norbert Nighoghossian ◽  
Laurent Derex ◽  
Patrice Adeleine ◽  
Marlène Wiart ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Cerebral Blood Volume ◽  
Volume Ratio ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Cerebral Veins ◽  
Mri Findings ◽  
Intravenous Tissue Plasminogen Activator ◽  
Magnetic Resonance Imaging Mri

Prediction of hemorrhagic transformation (HT) in patients treated by intravenous recombinant tissue-type plasminogen activator (rt-PA) is a challenging issue in acute stroke management. HT may be correlated with severe hypoperfusion. Signal changes may be observed at susceptibility-weighted magnetic resonance imaging (MRI) within large perfusion defects. A signal drop within cerebral veins at T2∗-weighted gradient-echo MRI may be expected in severe ischemia, and may indicate subsequent risk of HT. The authors prospectively searched for an abnormal visibility of transcerebral veins (AVV) within the ischemic area in patients with hemispheric ischemic stroke, before they were treated with intravenous rt-PA therapy. Any correlation between AVV and baseline clinical or MRI findings, or further HT, was noted. An AVV was present in 23 of 49 patients (obvious, n = 8; moderate, n = 15), and was supported by severe hemodynamic changes at baseline MRI. The AVV was correlated with the occurrence of parenchymal hematoma type 2 at computed tomography during the first week ( r = 0.44, P = 0.002). Five of six type 2 parenchymal hematomas occurred in association with obvious AVV. At multiple regression analysis, two baseline MRI factors had an independent predictive value for HT risk during the first week: the AVV and the cerebral blood volume ratio (Nagelkerke R2 = 0.48).

scholarly journals Iron Overload Exacerbates the Risk of Hemorrhagic Transformation After tPA (Tissue-Type Plasminogen Activator) Administration in Thromboembolic Stroke Mice

Stroke ◽  
2018 ◽  
Vol 49 (9) ◽  
pp. 2163-2172 ◽  
Author(s):  
Isaac García-Yébenes ◽  
Alicia García-Culebras ◽  
Carolina Peña-Martínez ◽  
David Fernández-López ◽  
Jaime Díaz-Guzmán ◽  
...  
Keyword(s):  
Iron Overload ◽  
Plasminogen Activator ◽  
Hemorrhagic Transformation ◽  
Tissue Type ◽  
Thromboembolic Stroke ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator

Vascular

2020 ◽  
pp. 209-248
Keyword(s):  
Plasminogen Activator ◽  
Intracranial Aneurysms ◽  
Vascular Diseases ◽  
Tissue Type ◽  
Endovascular Coiling ◽  
Intravenous Tissue Plasminogen Activator ◽  
History Of ◽  
Perihematomal Edema ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

This chapter explores vascular diseases. The first set of studies discusses the natural history of unruptured intracranial aneurysms, examines the clinical outcomes of surgical and endovascular treatment, and assesses the safety and efficacy of endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms. The second set of studies compares carotid endarterectomy versus carotid angioplasty and stenting for the treatment of carotid artery stenosis, determines the efficacy of endovascular therapy after intravenous tissue plasminogen activator (tPA) versus tPA alone for the treatment of acute ischemic stroke, and tests the efficacy of endovascular thrombectomy. The third set of studies identifies risk factors for hemorrhage in patients with untreated brain arteriovenous malformation (BAVM) and looks at the management of unruptured BAVM. The fourth set of studies evaluates the effect of early neurosurgical intervention in patients with superficial lobar intracerebral hemorrhage and tests the hypothesis that minimally invasive hematoma evacuation along with the use of recombinant tissue-type plasminogen activator (rtPA) could safely reduce hematoma size and perihematomal edema. Finally, the last study describes the management of giant intracranial aneurysms.

scholarly journals Impact of metformin versus repaglinide on non-glycaemic cardiovascular risk markers related to inflammation and endothelial dysfunction in non-obese patients with type 2 diabetes

2008 ◽  
Vol 158 (5) ◽  
pp. 631-641 ◽  
Author(s):  
Søren S Lund ◽  
Lise Tarnow ◽  
Coen D A Stehouwer ◽  
Casper G Schalkwijk ◽  
Tom Teerlink ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Endothelial Dysfunction ◽  
Plasminogen Activator ◽  
Adhesion Molecule ◽  
Metabolic Regulation ◽  
Tissue Type ◽  
Intercellular Adhesion Molecule ◽  
Plasminogen Activator Inhibitor 1 ◽  
Oral Hypoglycaemic Agents

ObjectiveIn patients with type 2 diabetes mellitus (T2DM), biomarkers reflecting inflammation and endothelial dysfunction have been linked to cardiovascular disease (CVD biomarkers) and metabolic regulation. In T2DM patients, metformin and insulin secretagogues have demonstrated equal anti-hyperglycaemic potency. Here, we report the effect of metformin versus an insulin secretagogue, repaglinide, on CVD biomarkers in non-obese T2DM patients.Design and methodsSingle-centre, double-masked, double-dummy, crossover study during 2×4 months involving 96 non-obese (body mass index≤27 kg/m2) insulin-naïve T2DM patients. At enrolment, previous oral hypoglycaemic agents were stopped and the patients entered a 1-month run-in on diet-only treatment. Hereafter, patients were randomized to either 2 mg repaglinide thrice daily followed by 1 g metformin twice daily or vice versa each during 4 months with a 1-month washout between interventions.ResultsLevels of tumour necrosis factor-α, plasminogen activator inhibitor-1 antigen, tissue-type plasminogen activator antigen, von Willebrand factor, soluble intercellular adhesion molecule-1 and soluble E-selectin were significantly lower during metformin versus repaglinide treatments. In contrast, Amadori albumin and heart rate were higher during metformin versus repaglinide. Levels of interleukin-6, fibrinogen, soluble vascular cell adhesion molecule-1, asymmetric dimethylarginine and advanced glycation end products as well as glycaemic levels (previously reported) and 24-h blood pressure were similar between treatments. Adjustment for known macrovascular disease did not affect the between-treatment effects.ConclusionsIn non-obese T2DM patients, metformin was more effective in reducing selected biomarkers reflecting inflammation and endothelial dysfunction compared with repaglinide despite similar glycaemic levels between treatments.

scholarly journals Effects of 12 weeks of treatment with fermented milk on blood pressure, glucose metabolism and markers of cardiovascular risk in patients with type 2 diabetes: a randomised double-blind placebo-controlled study

2015 ◽  
Vol 172 (1) ◽  
pp. 11-20 ◽  
Author(s):  
K D Hove ◽  
C Brøns ◽  
K Færch ◽  
S S Lund ◽  
P Rossing ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Placebo Group ◽  
Cardiovascular Risk ◽  
Plasminogen Activator ◽  
Fasting Blood Glucose ◽  
Fermented Milk ◽  
Tissue Type ◽  
Controlled Study

ObjectiveStudies have indicated a blood pressure (BP)-lowering effect of milk-derived peptides in non-diabetic individuals, but the cardiometabolic effects of such peptides in patients with type 2 diabetes (T2D) are not known. We investigated the effect of milk fermented with Lactobacillus helveticus on BP, glycaemic control and cardiovascular risk factors in T2D.DesignA randomised, double-blinded, prospective, placebo-controlled study.MethodsIn one arm of a factorial study design, 41 patients with T2D were randomised to receive 300 ml milk fermented with L. helveticus (Cardi04 yogurt) (n=23) or 300 ml artificially acidified milk (placebo yogurt) (n=18) for 12 weeks. BPs were measured over 24-h, and blood samples were collected in the fasting state and during a meal test before and after the intervention.ResultsCardi04 yogurt did not reduce 24-h, daytime or nighttime systolic or diastolic BPs compared with placebo (P>0.05). Daytime and 24-h heart rate (HR) were significantly reduced in the group treated by Cardi04 yogurt compared with the placebo group (P<0.05 for both). There were no differences in HbA1c, plasma lipids, C-reactive protein, plasminogen activator inhibitor-1, tumour necrosis factor alpha, tissue-type plasminogen activator: Ag, and von Willebrand factor: Ag between the groups. The change in fasting blood glucose concentration differed significantly between the two groups with a larger increase in the placebo group (P<0.05).ConclusionsIngestion of milk fermented with L. helveticus compared with placebo for 12 weeks did not significantly reduce BP in patients with T2D. Our finding of lower HRs and fasting plasma glucose levels in T2D patients during ingestion of fermented milk needs further validation.

scholarly journals Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
James E. Siegler ◽  
Muhammad Alvi ◽  
Amelia K. Boehme ◽  
Michael J. Lyerly ◽  
Karen C. Albright ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Prediction Models ◽  
Hemorrhagic Transformation ◽  
Small Sample ◽  
Entire Cohort ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Belt ◽  
Iv Tpa

Background. Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states. Methods and Results. We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008–2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07–34.1, P=0.0422) when patients were dichotomized by score. Conclusions. In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region.

scholarly journals Intravenous Tissue Plasminogen Activator in Combination With Mechanical Thrombectomy: Clot Migration, Intracranial Bleeding, and the Impact of “Drip and Ship” on Effectiveness and Outcomes

2020 ◽  
Vol 11 ◽  
Author(s):  
Adam Chang ◽  
Elham Beheshtian ◽  
Edward J. Llinas ◽  
Oluwatoyin R. Idowu ◽  
Elisabeth B. Marsh
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Mechanical Thrombectomy ◽  
Hemorrhagic Transformation ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
The Impact ◽  
Iv Tpa

Purpose: Intravenous tissue plasminogen activator (tPA) is indicated prior to mechanical thrombectomy (MT) to treat large vessel occlusion (LVO). However, administration takes time, and rates of clot migration complicating successful retrieval and hemorrhagic transformation may be higher. Given time-to-effectiveness, the benefit of tPA may vary significantly based on whether administration occurs at a thrombectomy-capable center or transferring hospital.Methods: We prospectively evaluated 170 individuals with LVO involving the anterior circulation who underwent MT at our Comprehensive Stroke Center over a 3.5 year period. Two thirds (n = 114) of patients were admitted through our Emergency Department (ED). The other 33% were transferred from outside hospitals (OSH). Patients meeting criteria were bridged with IV tPA; the others were treated with MT alone. Clot migration, recanalization times, TICI scores, and hemorrhage rates were compared for those bridged vs. treated with MT alone, along with modified Rankin scores (mRS) at discharge and 90-day follow-up. Multivariable regression was used to determine the relationship between site of presentation and effect of tPA on outcomes.Results: Patients presenting to an OSH had longer mean discovery to puncture/recanalization times, but were actually more likely to receive IV tPA prior to MT (70 vs. 42%). The rate of clot migration was low (11%) and similar between groups, though slightly higher for those receiving IV tPA. There was no difference in symptomatic ICH rate after tPA. TICI scores were also not significantly different; however, more patients achieved TICI 2b or higher reperfusion (83 vs. 67%, p = 0.027) after tPA, and TICI 0 reperfusion was seen almost exclusively in patients who were not treated with tPA. Those bridged at an OSH required fewer passes before successful recanalization (2.4 vs. 1.6, p = 0.037). Overall, mean mRS scores on discharge and at 90 days were significantly better for those receiving IV tPA (3.9 vs. 4.6, 3.4 vs. 4.4 respectively, p ~ 0.01) and differences persisted when comparing only patients recanalized in under 6 h.Conclusion: Independent of site of presentation, IV tPA before MT appears to lead to better radiographic outcomes, without increased rates of clot migration or higher intracranial hemorrhage risk, and overall better functional outcomes.

scholarly journals Microvascular MRI and Unsupervised Clustering Yields Histology-Resembling Images in Two Rat Models of Glioma

2014 ◽  
Vol 34 (8) ◽  
pp. 1354-1362 ◽  
Author(s):  
Nicolas Coquery ◽  
Olivier Francois ◽  
Benjamin Lemasson ◽  
Clément Debacker ◽  
Régine Farion ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Volume Fraction ◽  
Region Of Interest ◽  
Tissue Type ◽  
Rat Models ◽  
Glioma C6 ◽  
Mri Features ◽  
Apparent Diffusion ◽  
Magnetic Resonance Imaging Mri

Imaging heterogeneous cancer lesions is a real challenge. For diagnosis, histology often remains the reference, but it is widely acknowledged that biopsies are not reliable. There is thus a strong interest in establishing a link between clinical in vivo imaging and the biologic properties of tissues. In this study, we propose to construct histology-resembling images based on tissue microvascularization, a magnetic resonance imaging (MRI) accessible source of contrast. To integrate the large amount of information collected with microvascular MRI, we combined a manual delineation of a spatial region of interest with an unsupervised, model-based cluster analysis (Mclust). This approach was applied to two rat models of glioma (C6 and F98). Six MRI parameters were mapped: apparent diffusion coefficient, vessel wall permeability, cerebral blood volume fraction, cerebral blood flow, tissular oxygen saturation, and cerebral metabolic rate of oxygen. Five clusters, defined by their MRI features, were found to correspond to specific histologic features, and revealed intratumoral spatial structures. These results suggest that the presence of a cluster within a tumor can be used to assess the presence of a tissue type. In addition, the cluster composition, i.e., a signature of the intratumoral structure, could be used to characterize tumor models as histology does.

Abstract TMP88: Male Gender Predicts Ultrafast Administration of Intravenous Tissue Plasminogen Activator in a Twenty-Six Hospital Network

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Archit Bhatt ◽  
Lindsay Lucas ◽  
Elizabeth Baraban
Keyword(s):  
Plasminogen Activator ◽  
Treatment Time ◽  
Tissue Type ◽  
Large Hospital ◽  
Bootstrap Analysis ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Receive Treatment ◽  
Get With The Guidelines

Background: The benefits of intravenous tissue-type plasminogen activator (IV-Alteplase) in acute ischemic stroke (AIS) are time dependent. Current guidelines recommend a 60-minute door-to-needle (DTN) time for IV-Alteplase. Moreover, for every 15-minute reduction in treatment time, clinical outcomes are improved by an estimated 4%. In this study, we identified characteristics of patients with DTN times less than 30 minutes (i.e. “ultrafast DTN”). Methods: Data obtained from the 26-hospital Providence Health and Services Get With the Guidelines stroke registry were used to identify patients with ultrafast DTN. IV-Alteplase-treated AIS patients over age 18 who were discharged from the hospital between 2009 and 2015 were included. A mixed effects logistic regression model with backwards elimination was used to identify which of the following variables were significant in predicting ultrafast DTN: year of discharge, age, gender, NIHSS score, weekend or evening admission, telestroke usage, hospital arrival time, mode of arrival (EMS vs private car), medical history of dyslipidemia, diabetes, atrial fibrillation, or hypertension, consult with a stroke neurologist, and the certification of the hospital. Parametric bootstrapped p-values, mean estimates and percentile confidence intervals were calculated. Results: We identified 2,695 AIS patients who received IV-Alteplase between 2009 and 2015. Of those, only 108 (3.9%) had ultrafast DTN times. In the final bootstrap analysis, ultrafast DTN patients were more likely to be male (adjusted odds ratio (AOR) = 2.23; p<.001), ambulance arrivals (AOR = 4.76; p<.001), weekday arrivals (AOR = 1.89; p<.001), more severe cases (AOR per NIHSS point = 1.03; p=0.04), and more recently discharged (AOR per year = 1.34; p<.001). Conclusion: In our large hospital network, we found that only a small proportion of AIS patients received ultrafast Alteplase administration, with males twice as likely as females to receive treatment in less than 30 minutes. This study highlights the necessity to further understand the role gender plays in treatment-related decisions.

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