Republished: Revisiting the therapeutic time window dogma: successful thrombectomy 6 days after stroke onset

2018 ◽  
Vol 11 (10) ◽  
pp. e8-e8 ◽  
Author(s):  
Pedro Aguilar-Salinas ◽  
Roberta Santos ◽  
Manuel F Granja ◽  
Sabih Effendi ◽  
Eric Sauvageau ◽  
...  
Keyword(s):  
American Heart Association ◽  
American Heart ◽  
Time Window ◽  
Arterial Occlusion ◽  
Heart Association ◽  
Stroke Onset ◽  
Current Guideline ◽  
The Usa ◽  
Therapeutic Time Window

Stroke is the leading cause of serious long-term disability in the USA. Recent clinical trials, DAWN and DEFUSE 3, have expanded the endovascular therapeutic time window which has been adopted by the American Heart Association stroke guideline. However, there continues to be a dilemma as to what is the best approach for patients who present beyond the time window set by these trials and the current guideline. The interval from arterial occlusion to completion of brain tissue infarction varies from patient to patient and depends on the actual time and also a physiological clock or a tissue time window. Offering endovascular treatment based solely on a rigid time criterion excludes patients who may have a clinical benefit because of potentially salvageable tissue. We present a case of a patient who underwent successful stroke thrombectomy 6 days after stroke onset.

scholarly journals Does Reversible AF Exist? Or is AF Just AF?

2018 ◽  
Vol 13 (SP1) ◽  
Author(s):  
Michael Quon ◽  
Louise Pilote
Keyword(s):  
Atrial Fibrillation ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Heart Rhythm ◽  
Management Approaches ◽  
Term Management ◽  
Af Recurrence

Self-limited or transient atrial fibrillation (AF) occurring during an acute reversible, precipitant has been referred to as secondary AF, temporary cause of AF (TCAF), and AF occurring transiently during stress (McIntyre et al).  Alternatively, it has been classified as either ‘reversible’ versus ‘provoked’ AF, varying in terms of underlying cardiac substrate and risk for AF recurrence.  Given it was described in prior American Heart Association / American College of Cardiology / Heart Rhythm Society guidelines, we continue using the defining term ‘secondary AF’.   In this article, we review prior studies and provide an overview of long-term management approaches to secondary AF.  We will use the term ‘primary AF’ to describe established AF, without an associated secondary cause.  

Intravenous Thrombolysis in Acute Ischemic Stroke

2018 ◽  
pp. 128-152
Author(s):  
Waldo R. Guerrero ◽  
Edgar A. Samaniego ◽  
Santiago Ortega
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
American Heart Association ◽  
American Heart ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Heart Association ◽  
Standard Of Care

The only proven therapy for patients with acute ischemic stroke is early recanalization. The use of intravenous thrombolytic alteplase is the standard of care for patients presenting with ischemic stroke within the first 4.5 hours from symptom onset. This chapter reviews the indications and contraindications to alteplase including the 2015 American Heart Association guidelines and their relevance to clinical practice. Furthermore, emerging research and ongoing trials on expanding the time window for intravenous thrombolysis are discussed.

scholarly journals A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: the MEtabolic Syndrome REduction in NAvarra (RESMENA) project

2013 ◽  
Vol 111 (4) ◽  
pp. 643-652 ◽  
Author(s):  
Rocio de la Iglesia ◽  
Patricia Lopez-Legarrea ◽  
Itziar Abete ◽  
Isabel Bondia-Pons ◽  
Santiago Navas-Carretero ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Body Weight ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Control Group ◽  
The Metabolic Syndrome ◽  
Long Term Treatment ◽  
Dietary Strategy

The long-term effects of dietary strategies designed to combat the metabolic syndrome (MetS) remain unknown. The present study evaluated the effectiveness of a new dietary strategy based on macronutrient distribution, antioxidant capacity and meal frequency (MEtabolic Syndrome REduction in NAvarra (RESMENA) diet) for the treatment of the MetS when compared with the American Heart Association guidelines, used as Control. Subjects with the MetS (fifty-two men and forty-one women, age 49 (se1) years, BMI 36·11 (se0·5) kg/m2) were randomly assigned to one of two dietary groups. After a 2-month nutritional-learning intervention period, during which a nutritional assessment was made for the participants every 15 d, a 4-month self-control period began. No significant differences were found between the groups concerning anthropometry, but only the RESMENA group exhibited a significant decrease in body weight ( − 1·7 %;P= 0·018), BMI ( − 1·7 %;P= 0·019), waist circumference ( − 1·8 %;P= 0·021), waist:hip ratio ( − 1·4 %;P= 0·035) and android fat mass ( − 6·9 %;P= 0·008). The RESMENA group exhibited a significant decrease in alanine aminotransferase and aspartate aminotransferase (AST) concentrations ( − 26·8 %;P= 0·008 and − 14·0 %;P= 0·018, respectively), while the Control group exhibited a significant increase in glucose (7·9 %;P= 0·011), AST (11·3 %;P= 0·045) and uric acid (9·0 %;P< 0·001) concentrations. LDL-cholesterol (LDL-C) concentrations were increased (Control group: 34·4 %;P< 0·001 and RESMENA group: 33·8 %;P< 0·001), but interestingly so were the LDL-C:apoB ratio (Control group: 28·7 %;P< 0·001, RESMENA group: 17·1 %;P= 0·009) and HDL-cholesterol concentrations (Control group: 21·1 %;P< 0·001, RESMENA group: 8·7;P= 0·001). Fibre was the dietary component that most contributed to the improvement of anthropometry, while body-weight loss explained changes in some biochemical markers. In conclusion, the RESMENA diet is a good long-term dietary treatment for the MetS.

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