MR Imaging−Based Localized Intra-Arterial Thrombolysis Assisted by Mechanical Clot Disruption for Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion

During the past decade, studies on the manipulation of various inhaled inert gases during ischemia and/or reperfusion have led to the conclusion that inert gases may be promising agents for treating acute ischemic stroke and perinatal hypoxia-ischemia insults. Although there is a general consensus that among these gases xenon is a golden standard, the possible widespread clinical use of xenon experiences major obstacles, namely its availability and cost of production. Interestingly, recent findings have shown that helium, which is a cost-efficient inert gas with no anesthetic properties, can provide neuroprotection against acute ischemic stroke in vivo when administered during ischemia and early reperfusion. We have investigated whether helium provides neuroprotection in rats subjected to middle cerebral artery occlusion (MCAO) when administered after reperfusion, a condition prerequisite for the therapeutic viability and possible clinical use of helium. In this study, we show that helium at 75 vol% produces neuroprotection and improvement of neurologic outcome in rats subjected to transient MCAO by producing hypothermia on account of its high specific heat as compared with air.

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Enhanced protection by melatonin and meloxicam combination in a middle cerebral artery occlusion model of acute ischemic stroke in rat

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y02-052 ◽

2002 ◽

Vol 80 (3) ◽

pp. 210-217 ◽

Cited By ~ 23

Author(s):

Y K Gupta ◽

Geeta Chaudhary ◽

Kusum Sinha

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Motor Performance ◽

Artery Occlusion ◽

Occlusion Model ◽

Grip Test ◽

Cerebral Artery Occlusion

Mixed efficacy of neuroprotective drugs in clinical trials has led to the emergence of the approach of combination therapy in stroke. The present study was carried out to investigate the effect of the combination of melatonin (potent antioxidant) and meloxicam (preferential inhibitor of cyclooxygenase-2 enzyme) against a middle cerebral artery occlusion model of stroke in rats. Male Wistar rats in the weight range of 250300 g were used. Rats were anesthetized using chloral hydrate (400 mg/kg i.p) and subjected to 2 h of transient middle cerebral artery occlusion. Melatonin was administered at a dose of 20 mg/kg i.p. four times: at the time of middle cerebral artery occlusion, 1.5 h after middle cerebral artery occlusion, at the time of reperfusion, and 1 h after reperfusion. Meloxicam (2.5 mg/kg) was administered 4 h after middle cerebral artery occlusion. Motor performance tests (grip test, foot fault test, rotarod performance test, spontaneous locomotor activity), markers of oxidative stress, and triphenyltetrazolium chloride staining were carried out 24 h after middle cerebral artery occlusion. A vehicle-treated group was run in parallel. It was observed that melatonin treatment improved the motor performance and significantly attenuated the levels of malondialdehyde (MDA) as compared with the middle cerebral artery occluded group. Meloxicam treatment at the dose used neither showed significant improvement on the motor performance nor decreased the levels of MDA significantly as compared with the middle cerebral artery occluded group. However, when the combination of the two drugs was used, better protection was observed as was evident by the significant decrease in the percent foot fault errors, the increase in the time spent on the rotarod, and the increase in the six-point neurological score and grip test score. There was also a significant decrease in the levels of MDA in the combination group. The results of the present study demonstrate that enhanced protection is observed with the use of a combination of melatonin plus meloxicam in the middle cerebral artery occlusion model of acute ischemic stroke in rats.Key words: melatonin, antioxidant, meloxicam, focal ischemia.

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Circadian Rhythms in the Efficacy of Intravenous Alteplase in Patients With Acute Ischemic Stroke and Middle Cerebral Artery Occlusion

Chronobiology International ◽

10.3109/07420528.2012.728655 ◽

2012 ◽

Vol 29 (10) ◽

pp. 1383-1389 ◽

Cited By ~ 4

Author(s):

Dolores Vilas ◽

Meritxell Gomis ◽

Miguel Blanco ◽

Jordi Cortés ◽

Mònica Millán ◽

...

Keyword(s):

Ischemic Stroke ◽

Circadian Rhythms ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Artery Occlusion ◽

Intravenous Alteplase ◽

Cerebral Artery Occlusion

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Acute Middle Cerebral Artery Occlusion

Cerebrovascular Neurosurgery ◽

10.1093/med/9780190887728.003.0017 ◽

2019 ◽

pp. 155-164

Author(s):

Phillip A. Bonney ◽

Parampreet Singh ◽

Benjamin Yim ◽

William J. Mack

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Artery Occlusion ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Cerebral Artery Occlusion

Abstract: This chapter addresses the neurosurgical management of stroke due to acute middle cerebral artery occlusion. Large vessel occlusion is a common mechanism of acute ischemic stroke. Mechanical thrombectomy has emerged as an important procedure that drastically improves outcomes in this disease. This chapter discusses the diagnosis and treatment of acute ischemic stroke from large vessel occlusion, including the rapid radiographic evaluation with CT, CTA, MRI, and perfusion imaging. The scoring of the stroke using scales such as the ASPECTS score and their use in decision-making is reviewed. The chapter then discusses treatment with both chemical thrombolysis and mechanical thrombectomy, including the technical aspects of the procedure.

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