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CVA Thrombolysis

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1. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA and and Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 38if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited (...) ) for people with acute stroke who meet all of the following criteria: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 17 of 38clinical deficits that suggest infarction in the territory of the middle cerebral artery, with a score above 15 on the NIHSS decreased level of consciousness, with a score of 1 or more on item 1a

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

2. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcome Full Text available with Trip Pro

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcome Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet (...) therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment

2017 EvidenceUpdates

3. Modified Thrombolysis in Cerebral Infarction 2C/Thrombolysis in Cerebral Infarction 3 Reperfusion Should Be the Aim of Mechanical Thrombectomy: Insights From the ASTER Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Full Text available with Trip Pro

Modified Thrombolysis in Cerebral Infarction 2C/Thrombolysis in Cerebral Infarction 3 Reperfusion Should Be the Aim of Mechanical Thrombectomy: Insights From the ASTER Trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Although successful reperfusion is usually defined as a modified Thrombolysis in Cerebral Infarction (mTICI) 2B or 3 at the end of the procedure, studies have shown that mTICI 2B patients had poorer functional outcomes than TICI 3 patients (...) ) prospective multicenter blinded end point trial. Reperfusion results are reported as the mTICI score, including the mTICI 2C grade. Primary outcome was the percentage of patients with favorable outcome defined as a 90-day modified Rankin Scale score of 0 to 2.Two hundred ninety patients with successful reperfusion (mTICI ≥2B), harboring ischemic stroke secondary to occlusion of the anterior circulation within 6 hours of onset of symptoms, undergoing mechanical thrombectomy by contact aspiration or stent

2018 Stroke

4. Rethinking Thrombolysis in Cerebral Infarction 2b: Which Thrombolysis in Cerebral Infarction Scales Best Define Near Complete Recanalization in the Modern Thrombectomy Era. Full Text available with Trip Pro

Rethinking Thrombolysis in Cerebral Infarction 2b: Which Thrombolysis in Cerebral Infarction Scales Best Define Near Complete Recanalization in the Modern Thrombectomy Era. Within the thrombolysis in cerebral infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. Recent studies have suggested that TICI 3 and a proposed TICI 2c should be separately reported from TICI 2b, in both the original (>66% reperfusion) and modified (>50% reperfusion (...) ) definitions, because of differences in clinical outcomes with greater reperfusion. The purpose of this study was to evaluate differences in early neurological improvement and independence at 90 days using the original TICI, modified TICI, and modified TICI with 2c scales.A retrospective review of 129 consecutive patients with middle cerebral artery, M1 segment or intracranial internal carotid artery occlusions. Patient angiograms were graded by 2 experienced readers by percentage recanalization

2017 Stroke

5. Validation of the extended thrombolysis in cerebral infarction score in a real world cohort. Full Text available with Trip Pro

Validation of the extended thrombolysis in cerebral infarction score in a real world cohort. A thrombolysis in cerebral infarction (TICI) score of 2b is defined as a good recanalization result although the reperfusion may only cover 50% of the affected territory. An additional mTICI2c category was introduced to further differentiate between mTICI scores. Despite the new mTICI2c category, mTICI2b still covers a range of 50-90% reperfusion which might be too imprecise to predict neurological (...) improvement after therapy.To compare the 7-point "expanded TICI" (eTICI) scale with the traditional mTICI in regard to predict functional independence at 90 days.Retrospective review of 225 patients with large artery occlusion. Angiograms were graded by 2 readers according the 7-point eTICI score (0% = eTICI0; reduced clot = eTICI1; 1-49% = eTICI2a, 50-66% = eTICI2b50; 67-89% = eTICI2b67, 90-99% = eTICI2c and complete reperfusion = eTICI3) and the conventional mTICI score. The ability of e- and mTICI

2019 PLoS ONE

6. Stroke and Transient Ischemic Attack ? Acute and Long-Term Management

reduces the chance of stroke. • Thrombolytic eligible patients should receive tissue plasminogen activator (tPA) as quickly as possible (within 4.5 hours of clearly defined symptom onset). • Early mobilization and appropriate positioning within 24 hours are associated with improved outcomes. • Management on a stroke rehabilitation unit improves functional outcomes. Definitions A transient ischemic attack (TIA) is a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia (...) assessment and treatment are considered critical to reducing disability and mortality related to stroke. 2 BCGuidelines.ca: Stroke and Transient Ischemic Attack – Acute and Long-Term Management (2015) Risk Factors and Primary Prevention The major treatable risk factors for cerebrovascular atherosclerotic disease are similar to those for coronary atherosclerosis. 4 Table 1. Risk factors for stroke or TIA Non-modifiable risk factors Modifiable risk factors • Age • Hypertension • Previous stroke or TIA

2015 Clinical Practice Guidelines and Protocols in British Columbia

7. [Effect of modified Buyang Huanwu Decoction on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with super early cerebral infarction]. (Abstract)

[Effect of modified Buyang Huanwu Decoction on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with super early cerebral infarction]. To study the effect of modified Buyang Huanwu Decoction on the hemorrhagic transformation after intravenous thrombolysis of recombinant tissue type plasminogen activator(rt-PA) in patients with super early(onset time<4. 5 h) cerebral infarction. From March 2016 to July 2018,at the brain disease zone of the First Affiliated Hospital (...) of Henan University of Traditional Chinese Medicine,212 cases of super early cerebral infarction were selected and divided into two group according to the randomized complete blocks designs: control group(106 cases) and traditional Chinese medicine group(106 cases). The control group was treated with rt-PA intravenous thrombolysis,while the traditional Chinese medicine group was treated with modified Buyang Huanwu Decoction in addition to the therapy of the control group. Both groups were treated

2019 Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica Controlled trial quality: uncertain

8. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

, will experience a transient ischemic attack (TIA). 2 Although a TIA leaves no immediate impairment, affected individuals have a Abstract—The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors (...) of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines. (Stroke. 2014;45:2160-2236.) Key Words: AHA Scientific Statements ? atrial fibrillation ? carotid stenosis ? hypertension ? ischemia ? ischemic attack, transient ? prevention ? stroke Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association The American Academy

2014 Congress of Neurological Surgeons

9. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Full Text available with Trip Pro

cholesterol; LMWH, low-molecular-weight heparin; LV, left ventricular; LVAD, left ventricular assist device; MI, myocardial infarction; PFO, patent foramen ovale; SAMMPRIS, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis; STEMI, ST-elevation myocardial infarction; TIA, transient ischemic attack; UFH, unfractionated heparin; and VKA, vitamin K antagonist. * Includes recommendations for which the class was changed from one whole number to another (...) on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease Originally published 1 May 2014 Stroke. 2014;45:2160–2236 You are viewing the most recent version of this article. Previous versions: Abstract The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage

2014 American Heart Association

10. Early Detection of Cerebral Infarction With Middle Cerebral Artery Occlusion With Functional Near-Infrared Spectroscopy: A Pilot Study Full Text available with Trip Pro

to patients with stroke to evaluate the usefulness of NIRSIT as an fNIRS device for the early detection of stroke. Methods: We performed a prospective pilot study in an emergency department (ED). Adult patients who had suspected symptoms and signs of stroke within 12 h of the first abnormal time and who underwent intravenous thrombolysis (IVT) or intra-arterial thrombectomy with acute middle cerebral artery (MCA) or internal carotid artery (ICA) infarction were enrolled. NIRSIT was applied to the patients (...) Early Detection of Cerebral Infarction With Middle Cerebral Artery Occlusion With Functional Near-Infrared Spectroscopy: A Pilot Study Background: NIRSIT, a functional near-infrared spectroscopy (fNIRS) device with 204 channels, can measure oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in non-pulsatile blood flow non-invasively using the absorption difference between HbO2 and HbR at a wavelength of 700-1,000 nm and can display the perfusion status in real time. Objective: We applied NIRSIT

2018 Frontiers in neurology

11. Clinical treatment efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis for acute moderate/severe cerebral infarction. (Abstract)

Clinical treatment efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis for acute moderate/severe cerebral infarction. This study aims to compare clinical efficiency of mechanical thrombectomy combined with rhPro-UK thrombolysis on moderate or severe acute brain infarction.A total of 90 acute cerebral infarction patients due to artery stenosis or blockade from May 2016 to May 2017 were recruited and randomly assigned into thrombolysis group (N = 30), mechanical thrombectomy (...) (N = 30), and combined treatment group (N = 30). Clinical information was collected. Thrombolysis group received rhPro-UK, mechanical thrombectomy group received Solitaire scaffold, and combined group received rhPro-UK after Solitaire scaffold. Barthel scale and NIHSS scale were used to evaluate the quality of life and mental deficit of patients. Modified thrombolysis in cerebral infarction (mTICI) was compared among three groups, along with the observation of hemorrhage, neurological recovery

2018 European review for medical and pharmacological sciences Controlled trial quality: uncertain

12. The clinical study on the treatment for acute cerebral infarction by intra-arterial thrombolysis combined with mild hypothermia. (Abstract)

The clinical study on the treatment for acute cerebral infarction by intra-arterial thrombolysis combined with mild hypothermia. This study was purposed to evaluate the clinical efficacy of the treatment for acute cerebral infarction by intra-arterial thrombolysis combined with mild hypothermia.Thirty patients, diagnosed with acute anterior circulation cerebral infarction and admitted to the Hospital between January 2013 and September 2015, were randomly divided into the control group (...) and the mild hypothermia group, each group comprising 15 cases. The treatment of intra-arterial thrombolysis combined with mild hypothermia was administered to the mild hypothermia group, while only the treatment of intra-arterial thrombolysis was performed on the control group. The National Institutes of Health Stroke Scale (NIHSS) score, Modified RANKIN Scale (MRS) score, cerebral hemorrhage transformation, pulmonary infection, and the incidence of gastrointestinal bleeding of the two groups were

2018 European review for medical and pharmacological sciences Controlled trial quality: uncertain

13. Telestroke for Comprehensive Transient Ischemic Attack Care in Acute Stroke Ready Hospitals

Telemedicine Secondary stroke prevention Additional relevant MeSH terms: Layout table for MeSH terms Ischemia Stroke Ischemic Attack, Transient Pathologic Processes Cerebrovascular Disorders Brain Diseases Central Nervous System Diseases Nervous System Diseases Vascular Diseases Cardiovascular Diseases Brain Ischemia (...) studies before adding more. Telestroke for Comprehensive Transient Ischemic Attack Care in Acute Stroke Ready Hospitals (TELECAST-TIA) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03724110 Recruitment Status : Recruiting

2018 Clinical Trials

14. Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke. Full Text available with Trip Pro

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke. The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evaluate performance for patients with TIA or minor stroke, and most include only a limited subset of guideline-recommended processes.To assess the quality of guideline-recommended (...) TIA and minor stroke care across the Veterans Health Administration (VHA) system nationwide.This cohort study included 8201 patients with TIA or minor stroke cared for in any VHA emergency department (ED) or inpatient setting during federal fiscal year 2014 (October 1, 2013, through September 31, 2014). Patients with length of stay longer than 6 days, ventilator use, feeding tube use, coma, intensive care unit stay, inpatient rehabilitation stay before discharge, or receipt of thrombolysis were

2018 JAMA neurology

15. The positive predictive value of an ambulance prealert for stroke and transient ischaemic attack. (Abstract)

The positive predictive value of an ambulance prealert for stroke and transient ischaemic attack. Therapeutic options for ischaemic stroke, such as thrombolysis or thrombectomy, are time sensitive. Multiple innovations have been established to reduce the symptom-to-needle time. One such innovation is the prealerting of emergency department (ED) or stroke unit staff by prehospital personnel of suspected stroke patients. The diagnosis of stroke can sometimes be difficult, with stroke mimics being (...) a recognized issue. The prealert mobilizes ED, stroke and imaging personnel, which, for a true-positive, improves door-to-needle times. However, there are a proportion of false-positive prealerts (nonstrokes) that have a significant resource activation implication. The aim of this study was to evaluate the positive predictive value of a prealert for stroke and transient ischaemic attack (TIA).Ambulance service prealert forms for stroke and TIA collated by the ED were compared with the Scottish Stroke Audit

2017 European Journal of Emergency Medicine

16. Efficacy of Minimally Invasive Intervention in Patients With Acute Cerebral Infarction. (Abstract)

Efficacy of Minimally Invasive Intervention in Patients With Acute Cerebral Infarction. Our aim was to explore the efficacy of minimally invasive intervention in patients with acute cerebral infarction (ACI). Seventy patients with ACI were randomized into either an experimental group or a control group. In addition to the regular treatment, patients in the control group also received intravenous thrombolysis with urokinase, while patients in the other group underwent percutaneous transluminal (...) cerebral angioplasty and stenting. Metrics included recanalization rate, serum cytokines, fibrinolytic markers, and 36-Item Short Form Health Survey score and were compared between the 2 groups. After treatment, patients in the experimental group had better recanalization rate, higher SF-36 score and greater levels of vascular endothelial growth factors, neurotrophic factors, and nerve growth factors than those in the control group. Moreover, the values of fibrinolytic markers changed significantly

2019 Journal of cardiovascular pharmacology Controlled trial quality: uncertain

17. Determinants of Adherence to Post-stroke/Transient Ischemic Attack Secondary Prevention Treatment: Cohort Study in the Rhône

, 2017 Last Update Posted: May 15, 2017 Last Verified: May 2017 Individual Participant Data (IPD) Sharing Statement: Plan to Share IPD: No Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Additional relevant MeSH terms: Layout table for MeSH terms Stroke Ischemia Ischemic Attack, Transient Cerebrovascular Disorders Brain Diseases Central Nervous System Diseases Nervous System Diseases Vascular Diseases Cardiovascular (...) attack (TIA), in patients included in the STROKE 69 cohort. Condition or disease Intervention/treatment Stroke Transient Ischemic Attack Other: Patients with stroke or transient ischemic attack Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 750 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Determinants of Adherence to Post-stroke/Transient Ischemic Attack Secondary Prevention Treatment: Cohort Study

2017 Clinical Trials

18. Which Factors Influence the Duration and the Success of Mechanical Thrombectomy During the Acute Phase of Cerebral Infarction?

. Condition or disease Intervention/treatment Acute Stroke Drug: Actilyse Procedure: Mechanical thrombectomy Detailed Description: Mechanical thrombectomy (MT), associated with standard IV thrombolysis (IVT) treatment, is effective during the acute phase of cerebral infarction with proximal occlusion of the anterior circulation in reducing disability at three months. MT-only treatment has only been assessed retrospectively in subgroups of controlled studies, with a significant difference in favour (...) : Plan to Share IPD: No Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Keywords provided by Centre Hospitalier Universitaire de Besancon: stroke thrombectomy procedure time revascularisation thrombolytic therapy Additional relevant MeSH terms: Layout table for MeSH terms Infarction Stroke Cerebral Infarction Ischemia Pathologic Processes Necrosis Cerebrovascular Disorders Brain Diseases Central Nervous System

2018 Clinical Trials

19. Simultaneous acute cardio-cerebral infarction: is there a consensus for management? Full Text available with Trip Pro

Simultaneous acute cardio-cerebral infarction: is there a consensus for management? Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory (...) the optimal management of this rare co-occurrence. This review paper examines the existing literature on the management of simultaneous acute cardio-cerebral infarction (CCI) and highlights the existing challenge to management.

2018 Annals of Translational Medicine

20. Cerebral infarction as initial presentation in stress cardiomyopathy: Case report and literature review. Full Text available with Trip Pro

cardiomyopathy to increase recognition of the disease.A 28-year-old man was admitted to our hospital for sudden-onset weakness of the right limbs and unconsciousness for 1 day. Ten days prior, he began consuming copious amounts of alcohol (500 mL/day) secondary to reactive depression.Imaging revealed a left internal carotid artery occlusion as assessed by carotid artery ultrasonography. Brain magnetic resonance imaging/magnetic resonance angiography showed new large left cerebral infarction complicated (...) by a reperfusion injury. Moreover, cardiac ultrasonography showed decreased motion of the left ventricular apex, a 3.7 cm mural thrombus in the ventricular apex. The results of coronary and renal artery angiography did not reveal any significant epicardial coronary disease with thrombolysis in the myocardial infarction grade 3 in any of the coronary arteries.The patient was administered antiplatelet, anticoagulation, antihypertension, antibiotic, and neurotrophic therapies.The symptoms of cerebral infarction

2018 Medicine

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