scholarly journals Intra-Arterial Tirofiban Infusion for Partial Recanalization with Stagnant Flow in Hyperacute Cerebral Ischemic Stroke

2011 ◽  
Vol 17 (4) ◽  
pp. 442-451 ◽  
Author(s):  
S.K. Baik ◽  
S.J. Oh ◽  
K-P. Park ◽  
J-H. Lee

Early reocclusion is a major concern associated with poor clinical outcomes in patients with an ischemic cerebral stroke. This occurs most frequently in patients with partial initial recanalization. This study focuses on partial recanalization with stagnant antegrade flow after intravenous (IV) tPA or spontaneously, treated with the administration of intra-arterial (IA) tirofiban. Three patients with initial M1 occlusion on diagnostic studies had an occluded segment that was recanalized with stagnant flow after IV tPA or spontaneously. In all cases, IA tirofiban was administrated. We evaluated the distal blood flow and the degree of vascular narrowing in the pre and post-procedure angiography and at follow-up in addition to the clinical status. In all patients, severe vascular narrowing with stagnation of blood flow was detected in the initial M1. After infusion of IA tirofiban, improvement of the distal blood flow was achieved rapidly within 40 minutes in all patients. The severe vascular narrowing resolved rapidly in two patients without residual stenosis. In one patient, moderate vascular narrowing was still present. The median baseline National Institutes of Health Stroke Scale (NIHSS) scores were 18 and the median post-procedural NIHSS scores were 2 at two weeks. No intracerebral hemorrhage occurred in any of the patients. Treatment with IA tirofiban was safe and effective in patients with partial initial recanalization. It can be suggested that detection of any partial recanalization is time for administration of glycoprotein IIb-IIIa receptor inhibitor in hyperacute ischemic stroke.

2013 ◽  
Vol 33 (9) ◽  
pp. 1355-1361 ◽  
Author(s):  
Claire L Gibson

Cerebral stroke continues to be a major cause of death and the leading cause of long-term disability in developed countries. Evidence reviewed here suggests that gender influences various aspects of the clinical spectrum of ischemic stroke, in terms of influencing how a patients present with ischemic stroke through to how they respond to treatment. In addition, this review focuses on discussing the various pathologic mechanisms of ischemic stroke that may differ according to gender and compares how intrinsic and hormonal mechanisms may account for such gender differences. All clinical trials to date investigating putative neuroprotective treatments for ischemic stroke have failed, and it may be that our understanding of the injury cascade initiated after ischemic injury is incomplete. Revealing aspects of the pathophysiological consequences of ischemic stroke that are gender specific may enable gender relevant and effective neuroprotective strategies to be identified. Thus, it is possible to conclude that gender does, in fact, have an important role in ischemic stroke and must be factored into experimental and clinical investigations of ischemic stroke.


2016 ◽  
Vol 3 ◽  
pp. 17-23
Author(s):  
Anzhelika Payenok ◽  
Maria Bilobryn ◽  
Iryna Mitelman

The aim of research was to reveal the dynamic changes of the level of excitatory and inhibitory neuroamino acids in patients with the primary cerebral ischemic stroke depending on postapoplectic spasticity presence at the end of the early recovery period. For this aim was studied the concentration of excitatory and inhibitory neuroamino acids in the blood plasma in first 72 hours in 97 patients with the primary ischemic cerebral stroke depending on postapoplectic spasticity on the sixth month after ischemic event. The control group included 15 patients with diagnosed chronic cerebral ischemia. In the result of research we revealed that the common sign for the two groups (with spasticity on the sixth month and without it) was the reliable rise of the level of excitatory amino acids comparing with the control. In patients without spasticity the heightened level of excitatory neurotransmitters in the most acute period of ischemic cerebral stroke was attended with the heightened level of inhibitory neuroamino acids. The distinctive feature of patients with postapoplectic spasticity was the decreased or stable level of transmitters of inhibitory action. During 6th moth after ischemic stroke was detected the rise of all studied neuroamino acids in patients with spasticity unlike to the ones without spasticity who were characterized only with the rise of taurine level and decrease of glycine and aspartate levels. So, the received results allow assume the insufficient activation of the inhibitory neuroamino acids system in the most acute period of the ischemic stroke in certain category of patients that in future are inclined to the spasticity development after stroke.


2013 ◽  
Vol 4 (2) ◽  
pp. 72-80
Author(s):  
M. G Bubnova ◽  
E. G Semenova ◽  
D. M Aronov ◽  
T. T Batysheva

Objective: to study the dose-dependent effect of rosuvastatin on blood lipids and lipoproteins (LP), endothelial functional activity, coagulation, and safety parameters in patients with hyperlipidemia (HLP) and hypertension after cerebral ischemic stroke (CIS). Subjects and method. The trial included 34 patients (mean age 59,4±7,4 years) with types IIa or IIb HLP and CIS-complicated hypertension. The patients were randomized to 2 groups: 1) rosuvastatin 10 mg and 2) rosuvastatin 20 mg. The trial lasted 12 weeks. The dose of rosuvastatin remained unchanged throughout the trial. The authors evaluated the impact of therapy on the blood concentration of lipids, LP, fibrinogen, end products of nitric oxide (NO) metabolism, and endothelin-1 (ET-1), cerebral blood flow by great cerebral artery Doppler ultrasound data, as well as the parameters reflecting the safety of the therapy. Results. After 12-week therapy with rosuvastatin 10 and 20 mg, there was a significant decrease in the level of cholesterol by 30 and 35%, low-density lipoprotein (LDL) cholesterol by 40 and 45%, and triglycerides by 18 and 26%, respectively. Increasing the dose of rosuvastatin was attended by a significant rise (by 18%) in the number of patients with target LDL cholesterol levels. Rosuvastatin therapy caused no changes in the high baseline level of fibrinogen. At the same time, at the rosuvastatin doses of 10 and 20 mg, the concentrations of end products of NO metabolism increased by 14,3 and 12,4%, respectively. The vasoprotective effect of rosuvastatin 20 mg showed itself just at therapy week 6. Significantly decreased ET-1 levels were found when rosuvastatin was given in a dose of 10 mg; this was directly related to the baseline concentration of ET-1. In the patients who had an ET-1 level of >0,51 fmol/ml, its drop was 22,5% (p


2021 ◽  
Vol 8 ◽  
Author(s):  
Amanda Moya Gómez ◽  
Lena Pérez Font ◽  
Bert Brône ◽  
Annelies Bronckaers

Cerebral stroke is a leading cause of death and adult-acquired disability worldwide. To this date, treatment options are limited; hence, the search for new therapeutic approaches continues. Electromagnetic fields (EMFs) affect a wide variety of biological processes and accumulating evidence shows their potential as a treatment for ischemic stroke. Based on their characteristics, they can be divided into stationary, pulsed, and sinusoidal EMF. The aim of this review is to provide an extensive literature overview ranging from in vitro to even clinical studies within the field of ischemic stroke of all EMF types. A thorough comparison between EMF types and their effects is provided, as well as an overview of the signal pathways activated in cell types relevant for ischemic stroke such as neurons, microglia, astrocytes, and endothelial cells. We also discuss which steps have to be taken to improve their therapeutic efficacy in the frame of the clinical translation of this promising therapy.


2020 ◽  
pp. 1-4
Author(s):  
Elisa Ciceri ◽  
Elisa Ciceri ◽  
Marco Conte ◽  
Mauro Plebani ◽  
Piergiuseppe Zampieri ◽  
...  

We report a case of a 50-year-old male presenting with right arm weakness and mixed aphasia after motorcycle accident. Basal CT/MR imaging showed absence of acute brain lesions and left internal carotid artery (ICA) wall hematoma at C1-C2 level close to a prominent styloid process. Multiphase CT angiography confirmed ICA dissection and a hypertrophic styloid process compressing the ICA at the same level; ipsilateral intracranial blood flow delay and good collateral circulation were present in the latest CTA phases [1]. Due to Patient neurological status deterioration, with progressive global aphasia and right hemiplegia onset, digital subtraction angiography (DSA) was performed urgently. DSA confirmed the CTA findings together with slowing of cerebral blood flow above the dissection; after mechanical thrombectomy by aspiration followed by balloon angioplasty, good blood flow and vessel caliber restoration were obtained. Post-procedural control and follow-up findings are described together with revision of the recent literature on the possible association between cerebral ischemic stroke and Eagle syndrome.


2019 ◽  
Vol 17 (3) ◽  
pp. 329-336
Author(s):  
Wang Jinli ◽  
Xu Fenfen ◽  
Zheng Yuan ◽  
Cheng Xu ◽  
Zhang Piaopiao ◽  
...  

Cardiovascular disease including cerebral ischemic stroke is the major complication that increases the morbidity and mortality in patients with diabetes mellitus as much as four times. It has been well established that irisin, with its ability to regulate glucose and lipid homeostasis as well as anti-inflammatory and anti-apoptotic properties, has been widely examined for its therapeutic potentials in managing metabolic disorders. However, the mechanism of irisin in the regulation of cerebral ischemic stroke remains unclear. Using PC12 cells as a model, we have shown that hypoxia/reoxygenation inhibits cell viability and increases lactic dehydrogenase. Irisin, in a dose-dependent manner, reversed these changes. The increase in inflammatory mediators (IL-1β, IL-6, and TNF-α) by hypoxia/reoxygenation was reversed by irisin. Furthermore, the cell apoptosis promoted by hypoxia/reoxygenation was also inhibited by irisin. Irisin suppressed TLR4/MyD88 signaling pathway leading to amelioration of inflammation and apoptosis in PC12 cells. Thus, inhibition of TLR4/MyD88 signaling pathway via irisin could be an important mechanism in the regulation of hypoxia/reoxygenation-induced inflammation and apoptosis in PC12 cells.


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