Sonothrombolysis in Acute Ischemic Stroke: Current Status

2018 ◽  
Vol 1 (1) ◽  
pp. 12-18
Author(s):  
Arvind Sharma ◽  
Jose C. Navarro ◽  
Cyrus G. Escabillas ◽  
Vijay K. Sharma
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Transcranial Doppler ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Current Status ◽  
Intracranial Artery ◽  
Reasonable Accuracy ◽  
Ultrasound Exposure ◽  
Intracranial Arteries

Transcranial Doppler (TCD) is an important tool in the armamentarium of stroke neurologists. This, bedsides modality, can help in establishing the presence, location, and severity of intracranial arterial occlusion in acute stroke cases. Various hemodynamic consequences of an acute arterial occlusion such as flow diversion and compensatory flow increase in other intracranial arteries can be monitored by TCD with reasonable accuracy. TCD monitoring during intravenous thrombolysis may demonstrate recanalization in real-time In addition, continuous ultrasound exposure during intravenous thrombolysis can enhance the rates of the recanalization of an acutely occluded intracranial artery. Therapeutic ultrasound or sonothrombolysis remains a widely debated application of TCD. We present the available evidence for sonothrombolysis as well as its current status in the hyperacute treatment of acute ischemic stroke.

scholarly journals Endovascular treatment of acute ischemic stroke: the end or just the beginning?

2014 ◽  
Vol 36 (1) ◽  
pp. E5 ◽  
Author(s):  
Maxim Mokin ◽  
Alexander A. Khalessi ◽  
J Mocco ◽  
Giuseppe Lanzino ◽  
Travis M. Dumont ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Trials ◽  
Intravenous Thrombolysis ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Medical Community ◽  
Current Status

Various endovascular intraarterial approaches are available for treating patients with acute ischemic stroke who present with severe neurological deficits. Three recent randomized trials—Interventional Management of Stroke (IMS) III, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS Expansion)—evaluated the efficacy of endovascular treatment of acute ischemic stroke and, after failing to demonstrate any significant clinical benefit of endovascular therapies, raised concerns and questions in the medical community regarding the future of endovascular treatment for acute ischemic stroke. In this paper, the authors review the evolution of endovascular treatment strategies for the treatment of acute stroke and provide their interpretation of findings and potential limitations of the three recently published randomized trials. The authors discuss the advantage of stent-retriever technology over earlier endovascular approaches and review the current status and future directions of endovascular acute stroke studies based on lessons learned from previous trials.

scholarly journals Comparison of Treatment Methods in the Management of Acute Ischemic Stroke.

2020 ◽  
Vol 7 (11) ◽  
pp. 5073-5079
Author(s):  
Ertugrul Altınbilek ◽  
Abdullah Algın ◽  
Mustafa Çalık ◽  
Ece Guven ◽  
Derya Ozturk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Mortality Rates ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Tissue Destruction ◽  
Duration Of Treatment ◽  
Nihss Score

Aim: Acute ischemic stroke is an emergency clinical condition that occurs as a result of acute intracranial arterial occlusion and neural tissue destruction. In this study, we aimed to evaluate the treatment outcomes in patients who were performed intravenous thrombolysis (IVT), mechanical thrombectomy (MT), or both. Materials and Methods: In this retrospective study, 131 patients who underwent IVT, MT or both who has the diagnosis of AIS in our hospital between June 1, 2018, and February 1, 2018, were assessed. Age, sex, concomitant chronic diseases, NIHSS score, treatment-related complications, the time between disease presentation and hospital arrival, the duration of treatment, the one-month mortality rates and modified Rankin scores (MRS) were recorded. One-month mortality, NIHSS, and MRS were compared with treatment modalities and other factors. Results: The mean age of 131 patients included in the study was 71.79±12.67. The MRS did not differ significantly in the groups with IVT, MT, and IVT+MT (p> 0.05). In the IVT and MT groups, the NIHSS score increased significantly after the treatment (p <0.05). In the MT+IVT group, the NIHSS score after treatment did not change significantly (p> 0.05). Conclusion: No significant relationship between mortality rates and MRS with treatment method was found.  Complication rates were also not different among three treatment groups.

Current Status of Intravenous Thrombolysis for Acute Ischemic Stroke in Asia

2011 ◽  
Vol 6 (6) ◽  
pp. 523-530 ◽  
Author(s):  
Vijay K. Sharma ◽  
Kay W. P. Ng ◽  
Narayanaswamy Venketasubramanian ◽  
Maher Saqqur ◽  
Hock L. Teoh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Current Status

Intra-Arterial Thrombolysis Improves the Prognosis of Acute Ischemic Stroke Patients without Large Vessel Occlusion

2018 ◽  
Vol 80 (5-6) ◽  
pp. 277-282 ◽  
Author(s):  
Shuyi Shang ◽  
Wenbo Zhao ◽  
Chuanhui Li ◽  
Kai Dong ◽  
Haiqing Song ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Large Artery ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Uk ◽  
Arterial Thrombolysis

Background and Purpose: Intravenous thrombolysis is known as the only effective reperfusion therapy for acute ischemic stroke (AIS) caused by small branches occlusion. However, it is still unclear whether intra-arterial thrombolysis (IAT) is safe and effective for patients without detectable arterial occlusion. This study evaluated the safety and efficacy of IAT in these patients. Methods: Data were collected on consecutive patients from December 2012 to February 2017 at the Xuanwu Hospital, Capital Medical University. AIS patients without large artery occlusion during digital subtraction angiography (DSA) were divided into 2 groups: (1) Intra-arterial urokinase thrombolysis group (UK group): received intra-arterial urokinase thrombolysis treatment; (2) Control group: cerebral angiography examination only. The primary outcome was 3-month favorable functional outcome (modified Rankin Scale 0–2). Results: A total of 48 patients received urokinase thrombolysis, and 34 patients underwent DSA examination only. The UK group had more frequent favorable functional outcomes (70.8 vs. 50%, p = 0.032) at 3-month follow-up and higher score of National Institutes of Health Stroke Scale improvement on the second day (p = 0.007). One patient (2%) had symptomatic intracerebral hemorrhage and 3 patients (6.3%) had asymptomatic intracerebral hemorrhage (asICH) in the UK group. One patient (3.3%) had asICH in the control group. There were no significant differences about ICH. Conclusions: AIS caused by small branches occlusion could benefit from intra-arterial urokinase thrombolysis, and the risk of intracerebral hemorrhage was not significantly higher.

Current Status of Recanalization Therapy in Acute Ischemic Stroke with Symptomatic Intracranial Arterial Occlusion in Korea

2014 ◽  
Vol 23 (5) ◽  
pp. e339-e346 ◽  
Author(s):  
Min Uk Jang ◽  
Jeong-Ho Hong ◽  
Jihoon Kang ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Occlusion ◽  
Current Status

Abstract W P8: "Double Trouble": Endovascular Treatment of Tandem Arterial Occlusions in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mikayel Grigoryan ◽  
Diogo Haussen ◽  
Andrey Lima ◽  
Jonathan Grossberg ◽  
Shannon Doppelheuer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Imaging Data ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage

Background: Tandem extracranial/intracranial arterial occlusions in acute stroke present treatment challenges both due to suboptimal response to systemic intravenous thrombolysis as well as complex endovascular approach. We report our experience in treating this cohort of acute stroke patients with the analysis of angiographic and clinical outcomes Materials and Methods: We retrospectively reviewed clinical and imaging data of all consecutive acute stroke patients with proximal intracranial arterial occlusion and additional extracranial occlusion/critical stenosis, treated with endovascular techniques between February 2011 and February 2014 at two hospitals. We analyzed patients’ demographics, clinical presentation, treatment strategies, time to recanalization, imaging and clinical outcomes. Results: A total of 66 patients were included. The mean NIHSS on presentation was 19. Extracranial carotid with concomitant intracranial anterior circulation occlusions were present in 95% of the patients (63/66), while 5% (3/66) had tandem vertebrobasilar occlusions. 41% of the patients (27/66) received intravenous rt-PA. With regards to endovascular treatment, in 70% of the cases (46/66), extracranial lesion was treated with a stent placement. Stentrievers were used in 50% (33/66) of the patients for intracranial thrombectomy. Thrombolysis in Cerebral Infarction (TICI) >= 2B reperfusion was achieved in 77% of all the patients (51/66) and in 97% (32/33) of the stentriever patients. Good clinical outcome at 90 days (mRS<=2) was seen in 42% of the patients. Symptomatic intracerebral hemorrhage (PH-2)occurred in 9% (6/66) of the patients. Conclusions: Endovascular treatment of tandem arterial occlusions in acute ischemic stroke is relatively safe, feasible, and may yield excellent angiographic and good clinical outcomes.

scholarly journals Influence of Arterial Occlusion on Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Friedrich Medlin ◽  
Michael Amiguet ◽  
Peter Vanacker ◽  
Patrik Michel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis

Abstract T P50: ASTRAL-R score Predicts absence of Recanalization after Intravenous Thrombolysis in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Peter Vanacker ◽  
Dimitris Lambrou ◽  
Mirjam Heldner ◽  
David Seiffge ◽  
Hubertus Mueller ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
External Validation ◽  
Visual Fields ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Altered Level ◽  
Derivation Cohort ◽  
Level Of Consciousness ◽  
High Prediction

Background: Intravenous thrombolysis (IVT) is the best proven recanalization treatment in acute ischemic stroke (AIS), but may be insufficient or of little value in certain patients. By predicting the probability of absence of recanalization after IVT, the decision for more aggressive revascularization treatment can be individualized with the goal to improve clinical outcome. Aim: To derive and internally validate a predictive scoring system for absence of recanalization with IVT, using readily available variables in the prehospital and emergency room phase. Methods: Data from prospective thrombolysis registries of four academic stroke centers were examined. Patients with arterial occlusion on acute imaging and repeat arterial assessment at 24hours were selected. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. The overall score was calculated as the sum of the weighted scores. In a patient with an ASTRAL-R score > 3, the likelihood of absence of recanalization was > 50%. The area under the receiver-operator curve was 0.65 in the derivation cohort. Results: In 534 thrombolyzed AIS patients, five variables were identified as independent predictors of absence of recanalization: Acute glucose >7mmol/L (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), proximal Arterial occlusion (A) and altered Level of consciousness (L). An altered level of consciousness was weighted 2 and all other variables 1 point based on β-coefficients. In a patient with an ASTRAL-R score > 3, the likelihood of absence of recanalization was >50%. The score was highly predictive (OR 0.65, 95%CI 0.55-0.76) in the derivation cohort. Conclusions: A simple 5-item ASTRAL-R score shows high prediction for absence of recanalization at 24hours in thrombolyzed AIS patients. If confirmed by external validation, planning for more aggressive revascularization strategies may facilitate through this tool.

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