Intravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.

Background: Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke.

Determinants of plasma levels of brain natriuretic peptide after acute ischemic stroke or TIA.

Plasma levels of brain natriuretic peptide (BNP) are frequently elevated after an acute stroke and have been shown to be an independent predictor of mortality. However, the relationships between stroke and BNP concentrations have not yet been systematically investigated. Plasma BNP assay and echocardiography were performed in 48 patients with ischemic stroke or TIA with a mean delay of 12.

Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study.

Background: The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. Under European Union regulations, SITS-MOST was required to assess the safety profile of alteplase in clinical practice by comparison with results in randomised controlled trials.

Methods: 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational study.

Which model of stroke unit is better for stroke patient management?

The increasing prevalence of cerebrovascular diseases has made urgent the need to develop timely and effective treatment strategies to tackle this health problem. Stroke units (SUs) appear to be the ideal setting where the management of acute stroke patients, including specific treatments as thrombolysis, may be optimized. Which model of SU gives the best results is still an unsettled issue.

The COX-2 G/C -765 polymorphism may modulate the occurrence of cerebrovascular ischemia.

In the atherosclerotic plaque, cyclooxygenase-2 (COX-2) catalyzes prostaglandin E formation, which acts as a pro-atherogenic factor. A polymorphism, G/C -765, within the COX-2 promoter region modulates gene expression and the risk of cerebrovascular disease. We have evaluated the relation between COX-2 G/C -765 genotypes and the occurrence of cerebrovascular ischemia.

Specific expression of galanin in the peri-infarct zone after permanent focal cerebral ischemia in the rat.

Galanin (Gal) is a neuropeptide with supposed neurotrophic-like action. In the present study, expression of Gal has been investigated in the core and peri-infarct zone at 1, 4, 24 and 72 h after middle cerebral artery occlusion (MCAo) in the rat. Three days after MCAo a small but consistent number of morphological intact Gal-positive neuronal cells were observed in the peri-infarct zone.

Spontaneous multiple cervical artery dissection: two case reports and a review of the literature.

Although spontaneous cervical artery dissection (CAD) is an uncommon cause of stroke in the general population, it accounts for 10-25% of cerebrovascular events in young to middle-aged patients. Two or more vessels are involved in fewer than 15% of dissections, but multiple spontaneous CADs are likely to be underestimated owing to frequent spontaneous recanalization and the possible oligo-symptomatic presentation. An extensive review of the literature shows that in the last 30 years only 28 cases of multiple CADs have been reported, and that in half of these patients symptoms were minor and transient.

Can the time window for administration of thrombolytics in stroke be increased?

Level 1 evidence now shows that thrombolysis in cases of acute ischaemic stroke is effective if administered within 3 hours of stroke onset. This benefit has been shown to be time dependent and potentially extends beyond 3 hours, with evidence that potentially viable penumbral tissue may be present in a significant proportion of cases well beyond 3-6 hours and, in isolated cases, perhaps up to 48 hours. This exposes a "stroke recovery gap", the difference observed between the clinical response to thrombolytic therapy in a given population of patients presenting with ischaemic stroke and the potential clinical recovery if all of the penumbra were salvaged under ideal circumstances.