Incidence of Cardioembolic Stroke Including Paradoxical Brain Embolism in Patients with Acute Ischemic Stroke before and after the Great East Japan Earthquake

2014 ◽  
Vol 37 (6) ◽  
pp. 431-437 ◽  
Author(s):  
Ryo Itabashi ◽  
Eisuke Furui ◽  
Shoichiro Sato ◽  
Yukako Yazawa ◽  
Kenta Kawata ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Great East Japan Earthquake ◽  
Cardioembolic Stroke ◽  
Before And After

scholarly journals Treatment with Delipid Extracorporeal Lipoprotein Filter from Plasma after Intravenous Thrombolysis for Acute Ischemic Stroke: A Single-Center Experience

2020 ◽  
Vol 10 (3) ◽  
pp. 148-158
Author(s):  
Yu Cui ◽  
Zhong-He Zhou ◽  
Xiao-Wen Hou ◽  
Hui-Sheng Chen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Intravenous Thrombolysis ◽  
Single Center Experience ◽  
Before And After ◽  
Prospective Trials ◽  
Symptomatic Intracranial Hemorrhage ◽  
Rate Of Improvement

<b><i>Introduction:</i></b> The delipid extracorporeal lipoprotein filter from plasma (DELP) has been approved for the treatment of acute ischemic stroke (AIS) by the China Food and Drug Administration, but its effectiveness and mechanism are not yet fully determined. The purpose of this study was to evaluate the effect of DELP treatment on AIS patients after intravenous thrombolysis. <b><i>Methods:</i></b> A retrospective study was performed on AIS patients with no improvement within 24 h after intravenous thrombolysis who were subsequently treated with or without DELP. Primary outcome was the proportion with a modified Rankin scale (mRS) of 0–1 at 90 days. Secondary outcomes were changes in National Institute of Health Stroke Scale (NIHSS) score from 24 h to 14 days after thrombolysis, and the rate of improvement in stroke-associated pneumonia (SAP). The main safety outcomes were the rates of symptomatic intracranial hemorrhage and mortality. To investigate its mechanisms, serum biomarkers were measured before and after DELP. <b><i>Results:</i></b> A total of 252 patients were recruited, 63 in the DELP group and 189 matched patients in the NO DELP group. Compared with the NO DELP group, the DELP group showed an increase in the proportion of mRS 0–1 at 90 days (<i>p</i> = 0.042). More decrease in NIHSS from 24 h to 14 days (<i>p</i> = 0.024), a higher rate of improvement in SAP (<i>p</i> = 0.022), and lower mortality (<i>p</i> = 0.040) were shown in DELP group. Furthermore, DELP decreased levels of interleukin (IL)-1β, E-selectin, malondialdehyde, matrix metalloprotein 9, total cholesterol, low-density lipoprotein, and fibrinogen, and increased superoxide dismutase (<i>p</i>&#x3c; 0.05). <b><i>Conclusions:</i></b> DELP following intravenous thrombolysis should be safe, and is associated with neurological function improvement, possibly through multiple neuroprotective mechanisms. Prospective trials are needed.

Cardioembolic stroke on unaffected side during thrombolysis for acute ischemic stroke

2010 ◽  
Vol 58 (1) ◽  
pp. 112 ◽  
Author(s):  
Arun Garg ◽  
Amitabh Yaduvanshi ◽  
KapilDev Mohindra
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cardioembolic Stroke ◽  
Unaffected Side

Abstract WP57: Utility of Flat Panel CT Perfusion for Physiologic Assessment of Acute Ischemic Stroke in the Angiography Suite

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert W Ryan ◽  
Paula Eboli ◽  
Michael J Alexander ◽  
Shlee S Song ◽  
Marcel M Maya ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Defect ◽  
Ct Perfusion ◽  
Endovascular Intervention ◽  
Flat Panel ◽  
Post Intervention ◽  
Angiography Suite ◽  
Before And After

Introduction The decision to perform endovascular intervention in patients with acute ischemic stroke (AIS) may be guided by physiologic imaging such as CT perfusion (CTP) demonstrating a salvageable penumbra, but such studies can delay transfer to the angiography suite. Flat Panel Detector CT (FPD-CT) allows pre, intra and post-procedural physiologic assessment using rotational images acquired on the angiography table; however these measurements have not been correlated with conventional perfusion techniques. We began a prospective, observational comparison of standard, multi-slice CTP with FPD-CT perfusion for AIS interventions, and report our initial results. Methods Patients with AIS that are candidates for endovascular intervention and have standard CTP images available were enrolled in the study after obtaining informed consent and following the IRB approved protocol. FPD-CTP images were obtained with aortic contrast injection and commercially available workstation image assessment (Siemens, Erlangen, Germany) before and after intervention, and compared with standard CT perfusion and follow up images. Results A total of 3 cases have been enrolled. All demonstrated anatomic correlations between perfusion defects in the standard CTP and the FPD-CTP. Case example: A 58 year old man developed left sided hemiplegia and standard CTP demonstrated a right MCA defect with a small core infarction (Fig 1 A). Pre-intervention FPD-CTP showed the same defect pattern (Fig 1 B), and successful mechanical thrombectomy was performed (Fig 1 C,D). Post-intervention FPD-CT showed reversal of perfusion defect outside the core infarct (Fig 1 E). The patient had good clinical recovery and only small infarct on follow up CT (Fig 1 F). Conclusions Early experience with FPD-CTP imaging shows correlation with standard CTP images and reversal of perfusion defect following successful recanalization, suggesting it may be a valuable aid for decision making in AIS intervention.

‘Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment

2015 ◽  
Vol 40 (5-6) ◽  
pp. 251-257 ◽  
Author(s):  
Andreas Ragoschke-Schumm ◽  
Umut Yilmaz ◽  
Panagiotis Kostopoulos ◽  
Martin Lesmeister ◽  
Matthias Manitz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Time ◽  
Diagnosis And Treatment ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Single Location ◽  
Before And After ◽  
Therapeutic Procedures ◽  
Therapeutic Measures

Background: For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment (‘time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment. Methods: Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site (‘stroke room'). Result: After implementation of the intervention, the median intervals between admission and first angiography series were significantly shorter for 174 intervention patients (102 min, interquartile range (IQR) 85-120 min) than for 81 control patients (117 min, IQR 89-150 min; p < 0.05), as were the intervals between admission and clot removal or end of angiography (152 min, IQR 123-185 min vs. 190 min, IQR 163-227 min; p < 0.001). However, no significant differences in clinical outcome were observed. Conclusion: This study shows for the, to our knowledge, first time that for patients with acute ischemic stroke, stroke diagnosis and treatment at a single location (‘stroke room') saves crucial time until IAT.

scholarly journals Comparison of plasma levels of soluble fibrin monomer complex in patients with acute ischemic stroke before and after commencement of antithrombotic treatment

Nosotchu ◽  
2016 ◽  
Vol 38 (6) ◽  
pp. 387-392
Author(s):  
Seira Maeda ◽  
Masahiro Yasaka ◽  
Yuichiro Tsurusaki ◽  
Yohei Mima ◽  
Koichiro Maeda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasma Levels ◽  
Antithrombotic Treatment ◽  
Soluble Fibrin ◽  
Fibrin Monomer ◽  
Before And After

Abstract 161: Lean Process Improvements Reduce Door to CT and Door to Needle Times for Acute Ischemic Stroke Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cory McCann ◽  
Aleks Tkach ◽  
Adam de Havenon ◽  
Joel Loosli ◽  
Jamie Troyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Improve Patient Safety ◽  
Post Intervention ◽  
Process Improvements ◽  
Slowing Down ◽  
Before And After ◽  
Ct Brain ◽  
Student’S T ◽  
First Time

Background: In late 2015, we assembled a multi-disciplinary team to analyze current emergency department (ED) processes and identify improvement opportunities in the current “brain attack” (BA) protocol. Using lean process engineering tools, including time study analysis, gemba walks, and cause and effect diagrams, we mapped our baseline state and identified delaying activities that did not add value to the BA process. We defined a new BA process (see Figure 1) to eliminate waste and improve team communication, including 3 Time Outs to ensure that increased speed didn’t decrease safety. Methods: To determine the effect of our intervention, we retrospectively reviewed patients who were admitted to our ED as a BA for evaluation of possible acute ischemic stroke and had a CT brain after ED arrival between April 2015 and August 2016. ED arrival was defined as the time that patients physically arrived at the ED and “time to CT” was the time from ED arrival to the first time stamp of the CT brain. The time from ED arrival to tPA bolus was also measured for "door to needle" time. The time to CT and door to needle times were compared between BA patients before and after lean process improvements using Student’s T-test. Results: Our cohort included 239 patients who presented to the ED as a BA. We included 116 BA patients from before the intervention and 123 from afterwards. The mean±SD time to CT prior to the intervention was 19.0±13.9 minutes. After our lean process improvements the time to CT was 14.2±15.6 minutes. The delta of 4.8 minutes resulted in a significant reduction in time to CT, p = 0.012. There were 14 patients who received tPA prior to the intervention and 9 afterwards, for a total of 23 door to needle times (10% of cohort). Door to needle time was significantly shortened post-intervention (46±13 minutes versus 32±12 minutes, p=0.013). Conclusions: Lean process improvement methodology significantly reduces door to CT and door to needle times, supporting current AHA Target: Stroke goals and allowing faster treatment of patients with acute ischemic stroke. Incorporating time-outs into standardized processes that aim to deliver care more quickly may improve patient safety without substantially slowing down DTN times. Further investigation is required to determine whether the new process improved safety and clinical outcomes.

Abstract 159: Current Treatment with Clotting Factors Does not Improve Outcome from Intracranial Hemorrhage After Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yazan J Alderazi ◽  
Niravkumar V Barot ◽  
Vivek Misra ◽  
James C Grotta ◽  
Sean I Savitz
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Conservative Management ◽  
Small Sample ◽  
Stroke Severity ◽  
Clotting Factors ◽  
Prognostic Variables ◽  
Before And After ◽  
Iv Tpa

Objective & Background: Significant intracranial hemorrhage (sigICH), defined as either symptomatic intracerebral hemorrhage SICH or parenchymal hematoma type 2 (PH2), is a concerning complication of thrombolysis for acute ischemic stroke (AIS). While clotting factors have been incorporated into clinical protocols, the effectiveness of such treatment for sigICH has not been evaluated. We investigated the effects of clotting factors, fresh frozen plasma FFP and cryoprecipitate, in patients with sigICH post thrombolysis. Methods: We retrospectively evaluated all patients with sigICH after TPA for AIS in the prospective University of Texas at Houston Stroke registry; January 2007 - July 2011. We included all patients who received TPA for AIS and subsequently developed sigICH. Patients either received clotting factors (FFP or cryoprecipitate) or conservative management. The primary outcome measure was modified Rankin scale at discharge. The other outcome was death. We collected data on confounding variables: Stroke risk factors, infarct prognostic variables and intracerebral hematoma prognostic variables. Statistical analysis was by Fisher-exact, Chi-square and Mann-Whitney-U tests. Results: Out of 921 patients receiving TPA, sigICH occurred in 50. We excluded 3 because of enrollment in clinical trials. Out of 47 patients, 37 received IV TPA alone and 10 received IV TPA with subsequent intra-arterial therapy. Clotting factors were given in 22/47 (46.8%) patients; 18 received FFP & 9 received cryoprecipitate. The rest received no specific therapies for hemorrhage. There was no difference in stroke severity between groups before and after TPA. The incidence of hydrocephalus was higher in patients receiving clotting factors. There were no differences in outcomes at discharge in either group; the majority of patients in both groups had poor outcomes (mRS was >3). Mortality was high and not different between the two groups. Fibrinogen levels before and after clotting factors did not significantly differ from the patients who received only conservative management. Table 1. Conclusions: We found that clinical outcome of sigICH post TPA is poor. Furthermore, our data suggest that clotting factors do not improve the poor outcome associated with sigICH after t-PA. Our study is limited by small sample size, and the higher incidence of hydrocephalus in those receiving clotting factors may have influenced the outcomes. Nevertheless, our data suggest that new therapies are urgently needed for t-PA associated intracranial hemorrhage.

Abstract WP268: Von Willebrand Factor Expression in Various Subtypes of Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Oana M Mereuta ◽  
Sean Fitzgerald ◽  
Mehdi Abbasi ◽  
Daying Dai ◽  
Ramanathan Kadirvel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Von Willebrand Factor ◽  
Cryptogenic Stroke ◽  
Cardioembolic Stroke ◽  
Unknown Etiology ◽  
Learning Software ◽  
Von Willebrand ◽  
The Relationship ◽  
Willebrand Factor

Introduction: Von Willebrand factor (VWF) is a key component of acute ischemic stroke (AIS) thrombi. The aim of our prospective study was to investigate the immunohistochemical expression of VWF in clots and to evaluate whether VWF is associated with certain subtypes of AIS. Methods: VWF immunostaining was performed on 79 thrombi collected as part of the multi-center Stroke Thromboembolism Registry of Imaging and Pathology (STRIP) registry. The cases were classified according to TOAST criteria. The VWF expression was quantified using Orbit Image Analysis (www.Orbit.bio) machine learning software. IBM SPSS statistics 25 was used to assess the relationship between the VWF levels and different etiology subtypes. Results: A cardioembolic stroke was defined in 39 cases (49.4%) whereas an atherosclerotic origin was identified in 13 patients (16.5%). Other causes accounted for 12 cases (15.1%). Unknown etiology was reported in 15 cases (19%). The mean VWF content in the clots was 12.8%. According to the Mann-Whitney U-test, the level of VWF was significantly higher in the cases with unknown etiology compared to cardioembolic origin (p=0.044). We found also that patients with unknown etiology of stroke had higher VWF expression as compared to the other two subtypes, although this difference was not statistically significant. Conclusions: Among the patients with ischemic stroke included in this study, the VWF expression was significantly increased in those with unknown etiology compared to the group with cardioembolic stroke. Our finding provides new insights into clot composition in cryptogenic stroke and may influence the treatment and secondary prevention in these cases.

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