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Altenbernd J, Forsting M, Weber W, Fischer S. Thrombectomy of symptomatic isolated occlusions of posterior cerebral arteries in segment P1 and P2 in acute stroke treatment. Acta Radiol 2022; 63:802-809. [PMID: 33940961 DOI: 10.1177/02841851211014191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interventional stroke treatments for occlusions of the posterior circulation are established procedures. However, there are limited data on the treatment of isolated symptomatic P1 and P2 occlusions, which we have examined in this study. PURPOSE To investigate the mechanical thrombectomy of distal posterior occlusions. MATERIAL AND METHODS Retrospectively, data from patients with isolated P1 and P2 occlusions treated with MT were evaluated. Successful reperfusions have been defined as modified thrombolysis in cerebral infarct (mTICI) Grade 2b-3. A good clinical outcome was defined as a 90-day modified Rankin score 0-2. RESULTS All 79 treated patients were primarily aspirated. Stent retrievers were used secondarily in nine patients. Successful reperfusion was achieved in 95% of patients. Of the patients, 57% had a favorable clinical outcome after 90 days. CONCLUSION Mechanical thrombectomy with first line aspiration of symptomatic P1 and P2 occlusions is a safe and effective procedure.
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Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Werner Weber
- Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum, Germany
| | - Sebastian Fischer
- Department of Radiology and Neuroradiology, Knappschaftskrankenhaus Bochum, Germany
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Salt I, Aslan IK, Özgenç Biçer Çİ, Gözke E. Reversal of Oral Vitamin K Antagonists Using Prothrombin Complex Concentration Prior to IV tPA Administration. Neurol India 2022; 70:1238-1239. [PMID: 35864677 DOI: 10.4103/0028-3886.349620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Herein, we report two acute ischemic stroke cases that we used prothrombin complex to reverse the effects of warfarin in order to apply intravenous thrombolytic treatment. To the best of our knowledge, there are only limited amount of cases that prothrombin complex concentrates were applied prior to intravenous thrombolytic treatment administration. As one of the biggest acute stroke clinics in our country, we aim to open a discussion for this treatment to be fully researched and understood.
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Affiliation(s)
- Irmak Salt
- Department of Neurology, Fatih Sultan Mehmet Education and Training Hospital, University of Health Sciences Istanbul, Ataşehir, Istanbul, Turkey
| | - Işıl Kalyonu Aslan
- Department of Neurology, Fatih Sultan Mehmet Education and Training Hospital, University of Health Sciences Istanbul, Ataşehir, Istanbul, Turkey
| | - Çisil İrem Özgenç Biçer
- Department of Neurology, Fatih Sultan Mehmet Education and Training Hospital, University of Health Sciences Istanbul, Ataşehir, Istanbul, Turkey
| | - Eren Gözke
- Department of Neurology, Fatih Sultan Mehmet Education and Training Hospital, University of Health Sciences Istanbul, Ataşehir, Istanbul, Turkey
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Kim JH, Yoon W, Kim CK, Roh H, Bae HJ, Kwon TH, Suh SI, Oh K, Chong K. Efficacy and Safety of Timely Urgent Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Surgery in Patients with Acute Ischemic Stroke: A Single-Institutional Prospective Study and a Pooled Analysis. Cerebrovasc Dis 2021; 50:34-45. [PMID: 33423028 DOI: 10.1159/000512106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical outcome in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) is not satisfactory if reperfusion treatment fails or is not tried. AIMS We aimed to assess the efficacy and safety of urgent superficial temporal-to-middle cerebral artery (STA-MCA) bypass surgery in selected patients. METHODS Patients who were diagnosed with LVO-induced AIS in the anterior circulation but had a failed intra-arterial thrombectomy (IAT) or were not tried due to IAT contraindications were prospectively enrolled. Timely urgent STA-MCA bypass surgery was performed if they showed perfusion-diffusion mismatch or symptom-diffusion mismatch in the acute phase of disease. Clinical and radiological data of these patients were assessed to demonstrate the safety and efficacy of urgent bypass procedures. A pooled analysis of published data on urgent bypass surgery in acute stroke patients was conducted and analyzed. RESULTS In 18 patients who underwent timely bypass, the National Institutes of Health Stroke Scale (NIHSS) score improved from 12.11 ± 4.84 to 9.89 ± 6.52, 1 week after surgery. Three-month and long-term (9.72 ± 5.00 months) favorable outcomes (modified Rankin Scale [mRS] scores 0-2) were achieved in 50 and 75% of the patients, respectively. The pooled analysis (117 patients from 10 articles, including ours) identified favorable mRS scores in 71.79% patients at 3 months. A significant NIHSS score improvement from 11.51 ± 4.89 to 7.59 ± 5.50 was observed after surgery with significance. Major complications occurred in 3 patients (2.6%, 3/117) without mortality. CONCLUSIONS Urgent STA-MCA bypass surgery can be regarded as a safe optional treatment to prevent cerebral infarct expansion and to improve clinical and radiological outcomes in highly selected patients.
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Affiliation(s)
- Jang Hun Kim
- Trauma Center, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
| | - Wonki Yoon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea,
| | - Chi Kyung Kim
- Department of Neurology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Haewon Roh
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Bae
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Suh
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyuha Chong
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Bourcier R, Thiaudière R, Legrand L, Daumas-Duport B, Desal H, Boulouis G. Accelerated MR Evaluation of Patients with Suspected Large Arterial Vessel Occlusion: Diagnostic Performances of the FLAIR Vessel Hyperintensities. Eur Neurol 2020; 83:389-394. [PMID: 32784292 DOI: 10.1159/000509077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) document slowed vascular flow at the level and after the occlusion site patients with acute ischemic stroke (AIS). We aimed to assess the accuracy of FVH for the confirmation and location of a large vessel occlusion (LVO). METHODS Three radiologists reviewed the FLAIR sequence of the admission MRI exam of patients with suspected AIS at a single academic center. Readers were provided with the main clinical deficit with National Institute of Health Stroke Severity score and were asked to identify and locate an LVO when appropriate. Kappa coefficients were calculated for agreement along with diagnosis performances of FVH to recognize and locate an LVO with digital subtracted angiography (DSA) as gold standard. RESULTS Among 125 patients screened with MRI for a suspected AIS, 96 (81%) were diagnosed with AIS and 47 (38%) patients had an anterior LVO of whom 25 (20%) had a DSA for mechanical thrombectomy. Kappa coefficients for intra- and inter-readers were good to excellent. Overall, the sensitivity and the specificity of the FVH to predict an anterior LVO was 0.98 (95% confidence interval [CI]: 0.94-1) and 0.86 (95% CI: 0.79-0.96), respectively, while PPV and NPV were 0.87 (95% CI: 0.85-0.95) and 0.98 (0.97-1), respectively. FVH also showed good to excellent accuracy for identifying M1 and M2 versus internal carotid artery occlusion site. CONCLUSION We found that FVH demonstrated excellent diagnostic performances for the identification of LVO and its level with good to excellent reproducibility. This MRI radio marker of occlusion provides additional arguments and may speed-up the detection of potential candidates for MT.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France,
| | - Romain Thiaudière
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
| | - Benjamin Daumas-Duport
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Grégoire Boulouis
- Department of Neuroradiology, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
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Alberte-Woodward M, da Silva-França CF, Rodríguez-Gay I, Pego-Reigosa R. Safety of Intravenous Thrombolysis for Acute Stroke in Patients with an Active Malignancy: Case Series and Review of the Literature. Eur Neurol 2019; 81:163-166. [PMID: 31288236 DOI: 10.1159/000501553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence is scarce regarding the safety of alteplase for acute stroke in patients with an active malignancy. METHODS We reviewed medical records for patients with both conditions treated at our institution over a 2-year period. RESULTS Five patients were identified, of which only one developed an asymptomatic intracerebral haemorrhage, and no systemic bleedings occurred. Functional outcomes and stroke severity, as measured by National Institutes of Health Stroke Scale and modified Rankin Scale, were favourable upon discharge. CONCLUSION In the absence of active bleeding or known malignancy of the central nervous system, intravenous alteplase seems a reasonable option for patients with an active cancer and acute stroke.
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Affiliation(s)
| | | | - Isabel Rodríguez-Gay
- Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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Meyer D, Chu F, Derry K, Hailey L. Acute reversal of dabigatran with Idarucizumab for intravenous thrombolysis as acute stroke treatment. J Clin Neurosci 2019; 59:355-7. [PMID: 30309801 DOI: 10.1016/j.jocn.2018.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 11/22/2022]
Abstract
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS) is contraindicated in patient taking either Factor Xa inhibitors or direct thrombin inhibitors. Idarucizumab completely reverses the biologic effect of dabigatran within minutes. Intravenous rt-PA treatment results in a significant benefit in functional outcome when administered 3-4.5 h after stroke onset or last seen normal time. There is little reported data and no large-scale studies of the reversal of dabigatran with Idarucizumab for the purpose of treating AIS with IV rt-PA. We describe the case of a 73 year old male with AIS and active dabigatran use. Idarucizumab was administered per an approved medical center protocol and the patient was subsequently treated with IV rt-PA. The patient had a severe stroke with no other contraindications to IV rt-PA other than dabigatran use. The patient was administered Idarucizumab and IV rt-PA was given. Within 24 h of treatment, the patient had minimal stroke deficits. Imaging revealed a right middle cerebral artery patchy infarct. The patient was restarted on dabigatran therapy for his atrial fibrillation and was discharged to a skilled nursing facility for rehabilitation. The patient did not experience any symptomatic or asymptomatic intracranial hemorrhage after treatment or through day 90. Though no randomized evidence exists for the risk of IV rt-PA after dabigatran reversal with Idarucizumab, the case experiences are mounting. This case of successful stroke treatment after reversal adds to the anecdotal literature and supports the study of dabigatran reversal with Idarucizumab for thrombolysis in AIS.
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Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, Mase K. Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke. Eur Neurol 2018; 80:50-54. [PMID: 30205405 DOI: 10.1159/000492794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/07/2018] [Indexed: 11/19/2022]
Abstract
Autonomic dysfunction is one of the predictors of poor outcome in patients with acute ischemic stroke. We compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). We enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe,
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miki Kobayashi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
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Ragoschke-Schumm A, Razouk A, Lesmeister M, Helwig S, Grunwald IQ, Fassbender K. Dosage Calculation for Intravenous Thrombolysis of Ischemic Stroke: To Weigh or to Estimate. Cerebrovasc Dis Extra 2017; 7:103-110. [PMID: 28558372 PMCID: PMC5471779 DOI: 10.1159/000474955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Estimation is a widely used method of assessing the weight of patients with acute stroke. Because the dosage of tissue plasminogen activator (tPA) is weight-dependent, errors in estimation lead to incorrect dosing. METHODS We installed a ground-level scale in the computed tomography (CT) suite of our hospital and also integrated a scale into the CT table of our Mobile Stroke Unit in order to prospectively assess the differences between reported, estimated, and measured weights of acute stroke patients. An independent rater asked patients to report their weight. The patients' weights were also estimated by the treating physician and measured with a scale. Differences between reported, estimated, and measured weights were analyzed statistically. RESULTS For 100 consecutive patients, weighing was possible without treatment delays. Weights estimated by the physician diverged from measured weights by 10% or more for 27 patients and by 20% or more for 6 patients. Weights reported by the patient diverged from measured weights by 10% or more for 12 patients. Weights reported by the patients differed significantly less from measured weights (mean, 4.1 ± 3.1 kg) than did weights estimated by the physician (5.7 ± 4.4 kg; p = 0.003). CONCLUSION This first prospective study of weight assessment in acute stroke shows that the use of an easily accessible scale makes it feasible to weigh patients with acute stroke without the treatment delay associated with additional patient transfers. Physicians' estimates of patients' weights demonstrated substantial aberrations from measured weights. Avoiding these deviations would improve the accuracy of tPA dosage.
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Affiliation(s)
| | - Asem Razouk
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Stefan Helwig
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Iris Q Grunwald
- Department of Neuroscience, Faculty of Medical Science, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom.,Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Curtze S, Putaala J, Saarela M, Vikatmaa P, Kantonen I, Tatlisumak T. Carotid embolectomy and endarterectomy for symptomatic complete occlusion of the carotid artery as a rescue therapy in acute ischemic stroke. Case Rep Neurol 2011; 3:301-8. [PMID: 22220158 PMCID: PMC3250650 DOI: 10.1159/000335069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Emergency endarterectomy of an occluded internal carotid artery (ICA) has not been investigated as an option of rescue therapy for severe acute ischemic stroke in the era of intravenous (IV) thrombolysis treatment neither as a primary treatment nor after failed IV thrombolysis. Data from the pre-IV thrombolysis era are conflicting and therefore emergency endarterectomy has not been recommended. The number of patients reaching the emergency room within the IV thrombolysis time window has vastly grown due to advanced acute stroke treatment protocols. The efficacy of mechanical thrombectomy as a primary or add-on to IV thrombolysis therapy option is being actively investigated. We herein report 2 cases of acute ischemic stroke with computerized tomography (CT) angiography-documented occlusion of an ICA that were treated with emergency carotid endarterectomy and embolectomy to restore cerebral blood flow. Both cases presented with severe stroke symptoms and signs not responding to IV thrombolysis and showed severe CT-perfusion deficits mainly representing ischemic penumbra. Blood flow was surgically restored after 5 h of symptom onset. Both patients achieved a favorable outcome. We conclude that timely surgical approach of acute ICA occlusion after failed thrombolysis as a rescue therapy may be a viable option in well-selected patients.
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Affiliation(s)
- Sami Curtze
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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