scholarly journals Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

2019 ◽  
Vol 9 (2) ◽  
pp. e01189
Author(s):  
Qiang Huang ◽  
Hai-qing Song ◽  
Qing-feng Ma ◽  
Xiao-wei Song ◽  
Jian Wu
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Time Delays ◽  
Intravenous Thrombolysis ◽  
Posterior Circulation ◽  
Therapeutic Outcomes

Endovascular Stroke Therapy

2017 ◽  
Vol 43 (08) ◽  
pp. 893-901
Author(s):  
Scott Caganap ◽  
Wade Smith
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Delays ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Multiple Time ◽  
Stroke Therapy ◽  
Angiography Suite ◽  
Ideal System ◽  
Endovascular Stroke Therapy

AbstractAcute ischemic stroke therapy has rapidly evolved over the past two decades. Recently, a paradigm shift has occurred in the treatment of acute ischemic stroke due to large vessel occlusion with the publication of several randomized trials proving that mechanical thrombectomy with stent retriever devices improves clinical outcome in comparison to intravenous thrombolysis. Furthermore, pooled data from the clinical trials suggest that mechanical thrombectomy can improve outcome in a broad range of patients, and that the sooner the intervention can be performed, the greater the benefit. Delays in endovascular stroke therapy can occur during multiple time points during a patient's encounter, and these time delays are associated with worse outcomes. This association emphasizes the importance of enhancing speed-of-care processes in patients undergoing endovascular reperfusion. Efforts to reduce time delays in endovascular stroke treatment can be achieved by reflecting on the health care initiatives that took place for the treatment of acute myocardial infarction almost 20 years ago. The ideal system of care to reduce delays in endovascular stroke therapy will likely include rapid transport of all eligible patients directly to the angiography suite to bypass the inefficiencies of workflow during the early inhospital setting. These strategies will undoubtedly take time to implement, as they require further research, infrastructure funding, and policy changes at local, regional, and national levels.

Effect of Cardioembolic Etiology on Intravenous Thrombolysis Efficacy for Acute Ischemic Stroke

2016 ◽  
Vol 13 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Sabrina Anticoli ◽  
Maria Cristina Bravi ◽  
Giovanni Perillo ◽  
Antonio Siniscalchi ◽  
Claudio Pozzessere ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis

Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

2020 ◽  
Vol 17 ◽  
Author(s):  
Jie Chen ◽  
Fu-Liang Zhang ◽  
Shan Lv ◽  
Hang Jin ◽  
Yun Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Leukocyte Count ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Independence ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

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