Abstract TP345: Early Mobilization Following Recombinant Tissue Plasminogen Activator Administration and/or Mechanical Thrombectomy Reduces Length of Stay

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Kevin O'Connor ◽  
Allison Frazure ◽  
Margie Campbell ◽  
Megan Polly ◽  
Katie Reckner ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Mechanical Thrombectomy ◽  
Early Mobilization ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen

scholarly journals Dural sinus mechanical thrombectomy and continuous local rt-PA infusion in a child with refractory intracranial hypertension and progressive visual loss: A case report

2020 ◽  
Vol 11 ◽  
pp. 253
Author(s):  
Martino Cellerini ◽  
Rosa Francavilla ◽  
Caterina Testoni ◽  
Monica Maffei ◽  
Mino Zucchelli ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Visual Loss ◽  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Therapeutic Option ◽  
Recombinant Tissue Plasminogen Activator ◽  
Dural Sinus ◽  
Tissue Plasminogen

Background: Children with intracranial hypertension are at risk for visual loss and their visual function must be closely monitored. Surgery with the insertion of a ventriculoperitoneal shunt is imperative when vision is threatened. Case Description: Herein, we report a case of a 5-year-old boy whose refractory intracranial hypertension and severe, progressive visual loss (secondary to a chronic, otogenic, right sigmoid sinus thrombosis, and a contralateral sinus tight stenosis) were resolved by a combination of continuous (6 h), locoregional, infusion of recombinant tissue plasminogen activator (rt-PA), and mechanical thrombectomy. Conclusion: The association of in loco and continuous infusion of recombinant tissue plasminogen activator (rt- PA) with mechanical thrombectomy resulted in effective in partially reopening the occluded sinus and facilitating a good clinical recovery. This combined endovascular approach may represent an alternative, less invasive, therapeutic option to surgery in children with intracranial hypertension caused by chronic cerebral venous sinus thrombosis.

Safety and Outcome of Intravenous Recombinant Tissue Plasminogen Activator (rt-PA) in the Nursing Home Residents Following an Acute Ischemic Stroke

2021 ◽  
pp. 251660852110162
Author(s):  
Elanagan Nagarajan ◽  
Lakshmi P. Digala ◽  
Anudeep Yelam ◽  
Pradeep C. Bollu ◽  
Premkumar C. Nattanmai
Keyword(s):  
Ischemic Stroke ◽  
Nursing Home ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Mechanical Thrombectomy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Care Hospital ◽  
Tissue Plasminogen

Background and Purpose: Intravenous recombinant tissue plasminogen activator (IV rt-PA) is an effective treatment of acute ischemic stroke. The safety and efficacy of IV rt-PA were extensively studied in adults, including both octogenarians and nonagenarians.This study provides safety outcome of exclusive nursing home (NH) residents (dependent on activities of daily living [ADLs]) , who received IV rt-PA. Not much literature or studies are available exclusively on the NH residents. Aim: To assess the safety and outcome of IV rt-PA in patients from NHs who were admitted to our university-based tertiary care hospital, using data from a prospective stroke registry. Methods: Our study is a retrospective review of patients living in nursing facilities, admitted to our neuroscience intensive care unit after receiving IV rt-PA, from January 2010 to June 2018. We reviewed the clinical symptoms, comorbid conditions, medications, diagnostic evaluation, complications, and functional outcomes. The functional outcome was assessed based on the modified Rankin Scale (mRS) at the time of discharge, and 1- and 3-month follow-up. Results: Twenty-eight NH residents (20 [71.4%] were female with a mean age of 80.96 +/− 12.43 years) were identified who had received IV rt-PA for symptoms of acute ischemic stroke. The median mRS on admission was 3, and all of them were dependent on ADL. Twenty-seven (96.5%) patients were treated within the window (≤3 h) for IV rt-PA. There were no IV rt-PA-related violations from both our hospital and outside hospital treatment protocols. The initial computed tomographic (CT) scan of 8 (28.5%) patients revealed evidence of infarction. CT angiogram of head and neck revealed an acute intracranial blood vessel occlusion in 13 (46.4%) patients, and asymptomatic stenosis of intracranial and extracranial blood vessels in 4 (14.2%) patients. Mechanical thrombectomy was attempted in 6 (21.4%) patients and among them, the procedure was unsuccessful in 2 (7.1%) patients due to severe stenosis. One (1/21; 16.6%) patient received an intra-arterial rt-PA, and 5 (5/6;83.3%) patients developed symptomatic intracranial hemorrhage within 24 h following the procedure. Families of 9/28 (32.1%) patients decided to withdraw care. The median mRS on 30 and 90 days follow-up was 4 (interquartile range: 3-6). Conclusion: In this population, mechanical thrombectomy has a high risk for hemorrhagic conversion. IV rt-PA treatment in the NH residents may not improve the outcome of ischemic stroke.

Computed Tomography Angiography in Acute Stroke Patients Receiving Recombinant Tissue Plasminogen Activator: Outcome and Safety Evaluations in an Asian Population

2020 ◽  
Vol 49 (1) ◽  
pp. 62-69
Author(s):  
Chuan-Min Lin ◽  
Hsiu-Chuan Wu ◽  
Yi-Ming Wu ◽  
Chi-Hung Liu ◽  
Kuo-Hsuan Chang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Computed Tomography Angiography ◽  
Mechanical Thrombectomy ◽  
Medical Center ◽  
Asian Population ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Tissue Plasminogen

Introduction: The multiphase computed tomography angiography (mCTA) is superior to the noncontrast computed tomography (NCCT) in selecting patients that would benefit from mechanical thrombectomy following an acute ischemic stroke (AIS). It remains unclear whether the longer examination time of mCTA worsens outcomes of intravenous recombinant tissue plasminogen activator (IV r-tPA) or increases the risk of hemorrhagic transformation (HT) compared to NCCT in Asian stroke patients. Methods: Between January 2011 and December 2017, 199 AIS patients receiving IV r-tPA with initial National Institute of Health Stroke Scale (NIHSS) scores between 6 and 25 were enrolled in a single medical center. Onset-to-needle time (ONT), door-to-needle time (DNT), and creatinine levels before and after thrombolysis were recorded. We evaluated NIHSS scores 2, 24 h after treatment, and at discharge, the modified Rankin Scale (mRS) at discharge, and mortality rate. The presence of HT was reviewed within 7 days after thrombolysis. Results: DNT, perithrombolysis creatinine levels, NIHSS, and mRS scores at the emergency room were similar between the NCCT and mCTA groups. ONT was shorter in the mCTA group. AIS patients got more significant neurologic improvement (NIHSS decrease ≥4) after thrombolysis and physically independent (mRS ≤2) at discharge in the mCTA group. Mortality rates, symptomatic, and total HT rates were similar between the NCCT and mCTA groups. Conclusion: Comparing to NCCT, mCTA-based IV r-tPA would not delay DNT nor worsen the outcome. Furthermore, mCTA provides more information for early identification of candidates for mechanical thrombectomy in Asian AIS patients.

scholarly journals Is early mobilization associated with functional improvement in acute middle cerebral artery ischemic stroke treated with recombinant tissue plasminogen activator? A proof of concept and retrospective single-center study

2021 ◽  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Artery ◽  
Early Mobilization ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Improvement ◽  
Tissue Plasminogen ◽  
Stroke Center

Background: The benefit of commencing early mobilization for patients after ischemic stroke (IS) is well established. However, the timing and benefits of early mobilization in recombinant tissue plasminogen activator (rtPA)-treated patients remain mostly undefined. Methods: In this retrospective observational cohort study, we analyzed rtPA-treated patients after a first-episode middle cerebral artery (MCA)-IS, that were admitted in a Stroke Center, using electronic medical records during the period of January 1, 2015 through December 31, 2017. These patients who received a standard early rehabilitation during the stay in the Stroke Center served as the control group. We examined the association between early mobilization via early rehabilitation within 24-72 hours and activities of daily living and postural control improvements, as indicated by the Barthel Index (BI) effectiveness and the Postural Assessment Scale for Stroke (PASS) effectiveness, respectively. Results: Total 60 patients with a first MCA-IS treated after rtPA were analyzed. Multiple linear regression analysis indicated that BI and PASS effectiveness were positively correlated with not only age and the stroke severity at 24 hours after rtPA treatment but commencing early mobilization within 24-72 hours after stroke in patients with a first MCA-IS treated after rtPA. Conclusions: This study concludes that early mobilization may be associated with an acceleration of functional improvement in patients with a first MCA-IS treated with rtPA within four weeks after the onset.

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