Intravenous thrombolysis and mechanical thrombectomy in acute stroke patients on direct oral anticoagulants.

Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs).

Effect of IV Thrombolysis With Alteplase in Patients With Vessel Occlusion in the WAKE-UP Trial.

Background And Objectives: Data from randomized trials on the treatment effect of pure thrombolysis in patients with vessel occlusion are lacking. We examined data from a corresponding subsample of patients from the multicenter, randomized, placebo-controlled WAKE-UP trial to determine whether MRI-guided IV thrombolysis with alteplase in unknown-onset ischemic stroke benefits patients presenting with vessel occlusion.

Methods: Patients with an acute ischemic lesion visible on MRI diffusion-weighted imaging but no marked parenchymal hyperintensity on fluid-attenuated inversion recovery images were randomized to treatment with IV alteplase or placebo.

Stroke nurse-led intravenous thrombolytic therapy strategy for ischemic stroke based on timeline process: A quality improvement program from China.

Objective: Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes. This study investigated whether optimizing intravenous thrombolytic (IVT) therapy strategies for stroke could reduce treatment delays.

Methods: To reduce delays in IVT therapy for ischemic stroke, a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou, Zhejiang Province, from June 2021 to August 2023, which included developing a timeline process management system, forming a nurse-led stroke process management team, providing homogeneous training, standardizing the IVT therapy process for ischemic stroke, and introducing an incentive policy.

Intravenous thrombolysis in a stroke patient with a repaired aortic dissection.

Acute aortic dissection is considered a contraindication to the use of intravenous thrombolysis in patients presenting with acute ischaemic stroke, but less has been described about previously repaired dissections. We present a case of a woman in her 50s presenting with acute left hemiparesis with a known history of aortic dissection within the thrombolysis window. After multidisciplinary discussion with cardiothoracic surgery and discussion with the patient, she was treated with intravenous thrombolysis without complication.

Geographical differences in thrombolysis treatment for acute ischaemic stroke.

Background: Administering intravenous thrombolysis (IVT) as soon as possible after symptom onset impacts on the functional outcome for patients with acute ischaemic stroke. The study aimed to assess whether the distance from hospital impacts on the access to IVT for acute ischaemic stroke at the University Hospital of North Norway in Tromsø (UNN Tromsø).

Material And Method: This prospective quality study included 231 patients admitted with acute ischaemic stroke to UNN in the period 1 January 2019-31 December 2019.

The Effect of Acute Stroke Treatment on S100B, IMA, and Thiol-Disulfide Balance.

Background: A variety of processes, ranging from blood-brain barrier disruption to circulating biomarkers, contributes to reperfusion injury in acute stroke treatment.

Objective: We aimed to investigate the effects of thrombolytic therapy and endovascular thrombectomy therapy on serum S100 calcium-binding protein B, ischemia-modified albumin and thiol-disulfide balance in patients who arrived within the first 6 h of acute ischemic stroke.

Material And Methods: The study considered 66 patients with the diagnosis of acute ischemic stroke who underwent thrombolytic therapy or EVT in the first 6 h, as well as 32 healthy volunteers.

[Stroke: current state of the problem].

We review the current and emerging topics in ischemic stroke (IS) and intracerebral hemorrhage (ICH). We discuss the association of genetic predisposition and healthy lifestyle, ambient particulate air pollution, weather parameters, variations in the anatomy of cerebral blood vessels, psychological stress, depression, insonmia with the development of IS or ICH. Also, the role of oral anticoagulants (AC) as a new risk factor for ICH is presented.

Predictive factors for lack of neurological improvement in acute stroke patients without large vessel occlusion treated with low-dose thrombolysis and screened with 3T MRI.

Objective: The study evaluated the lack of neurological improvement and the factors influencing it in patients with acute ischemic stroke (AIS) without major arterial occlusion.

Patients And Methods: A cross-sectional study was conducted on patients diagnosed with acute ischemic stroke without significant occlusion of major arteries, with imaging evidence from 3-tesla magnetic resonance imaging (MRI) scans at the S.I.

Edaravone's Safety Profile in Acute Ischemic Stroke.

Background: We aimed to evaluate the safety of intravenous edaravone for the treatment of acute ischemic stroke among Filipino patients. The study, categorized as Phase IV, spans from December 2022 to November 2023. The primary objective is to document side effects and serious adverse events during the 14-day edaravone infusion period.

New Targets for Antithrombotic Medications: Seeking to Decouple Thrombosis from Hemostasis.

Arterial and venous thromboses are leading causes of morbidity and mortality worldwide. Numerous antithrombotic agents are currently available with antiplatelet, thrombolytic/fibrinolytic, and anticoagulant activity. However, all the currently available antithrombotic agents carry a risk of bleeding that often prevents their use.

Endovascular therapy for acute vertebrobasilar occlusion (VERITAS): a systematic review and individual patient data meta-analysis.

Background: Trials of endovascular therapy for basilar artery occlusion, including vertebral occlusion extending into the basilar artery, have shown inconsistent results. We aimed to pool data to estimate safety and efficacy and to explore the benefit across pre-specified subgroups through individual patient data meta-analysis.

Methods: VERITAS was a systematic review and meta-analysis that pooled patient-level data from trials that recruited patients with vertebrobasilar ischaemic stroke who were randomly assigned to treatment with either endovascular therapy or standard medical treatment alone.

Frailty reduces penumbral volumes and attenuates treatment response in hyperacute ischemic stroke.

Background: Frailty-the loss of physiological reserve to withstand a stressor event-is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke.

The role of nanomaterials in revolutionizing ischemic stroke treatment: Current trends and future prospects.

Ischemic stroke has a high disability rate, which leads to irreversible neuronal death. The efficacy of conventional stroke treatments, including thrombolytic and neuroprotective therapies, is constrained by a number of factors, including safety concerns and inefficient drug delivery. The advent of nanomaterials has created new avenues for stroke therapy, facilitating enhanced pharmacokinetic behavior of drugs, effective drug accumulation at the target site, augmented therapeutic efficacy, and concomitant reduction in side effects.

The Joint Effect of Renal Function Status and Coagulation Biomarkers on In-Hospital Outcomes in Acute Ischemic Stroke Patients With Intravenous Thrombolysis.

Objective: To demonstrate whether combining renal function status [estimating glomerular filtration rate (eGFR)] with coagulation biomarkers [fibrinogen (Fg) and d-dimer] is more beneficial in predicting in-hospital outcomes following intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients.

Methods: We studied 417 AIS patients with IVT. According to the cut-offs of coagulation biomarkers (Fg and d-dimer) and eGFR determined by receiver operating characteristic (ROC) curves, the patients were divided into four groups: LFLG (low Fg and low eGFR), LFHG (low Fg and high eGFR), HFLG (high Fg and low eGFR), and HFHG (high Fg and high eGFR); or LDLG (low d-dimer and low eGFR), LDHG (low d-dimer and high eGFR), HDLG (high d-dimer and low eGFR), and HDHG (high d-dimer and high eGFR).

[Analysis of the emergency standard ischemic stroke care system time points for in-hospital-onset ischemic stroke and community-onset stroke in general hospital].

To analyze the treatment situation at each time node in the standard in-hospital-stroke(IHS) in the general hospital compared with that in the emergency(community)-onset stroke (COS) group. A single-center retrospective case-control study was performed.The clinical cases of acute COS group and IHS group who were treated by the same stroke green channel team at Peking Union Medical College Hospital from Jan.

The stroke meta-metric, Defect-Free Care, was maintained year-over-year within the Florida stroke registry during the COVID-19 pandemic.

Background: Resource allocation for stroke care was impacted worldwide by the Coronavirus 2019 (COVID19) pandemic. Regionally, worsened stroke outcomes varied, however comparative year-over-year in-hospital performance metrics from the pandemic are unreported. Therefore, within the large Florida Stroke Registry (FSR), we assessed the pandemic's effects upon the American Heart Association (AHA) Get With The Guidelines (GWTG) ischemic stroke metrics and the meta-metric, Defect-Free Care (DFC).

Albumin-seeking near-infrared-II probe evaluating blood-brain barrier disruption in stroke.

Background: Blood-brain barrier (BBB) disruption after stroke is closely associated with brain tissue edema and neuronal injury, which requires accurate assessment. However, there is a lack of appropriate BBB imaging modality in vivo. As albumin in the blood could cross the damaged BBB into brain tissue after stroke, it serves as a biomarker for BBB disruption.