Thrombolysis in Real Time: Demonstration of Revascularization with Intravenous Thrombolysis Therapy in the CT Scanner

2016 ◽  
Vol 27 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Jessica Tan ◽  
Aimee Aysenne ◽  
Vineeta Singh
Keyword(s):  
Real Time ◽  
Intravenous Thrombolysis ◽  
Ct Scanner ◽  
Thrombolysis Therapy

Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy

2021 ◽  
pp. 1-8
Author(s):  
Hongmin Li ◽  
Suliman Khan ◽  
Rabeea Siddique ◽  
Qian Bai ◽  
Yang Liu ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Thrombolysis Therapy

Abstract 104: Golden Hour-Thrombolysis by Starting Treatment Before Hospital Arrival the Pre-Hospital Acute Neurological Treatment and Optimization of Medical Care in Stroke Study (PHANTOM-S)

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Martin Ebinger ◽  
Matthias Wendt ◽  
Michal Rozanski ◽  
Benjamin Winter ◽  
Carolin Waldschmidt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Time ◽  
Point Of Care ◽  
Intravenous Thrombolysis ◽  
Conventional Care ◽  
Ct Scanner ◽  
Term Outcome ◽  
Golden Hour ◽  
Stroke Study ◽  
A Prospective Study

Objective: The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if onset-to-treatment time (OTT) is < 60 minutes, the so called Golden-Hour. Starting thrombolysis in a specialized ambulance with a CT-scanner plus point-of-care laboratory reduced time from emergency call to treatment in the prospective controlled PHANTOM-S study. We evaluated the rate and effectiveness of Golden-Hour thrombolysis. Methods: The stroke emergency mobile (STEMO) is staffed with a neurologist trained in emergency medicine, a paramedic and a technician. The effects of the STEMO implementation were evaluated in a prospective study comparing weeks with and without STEMO-availability. STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (in operation or maintenance), patients received conventional care. OTT-intervals were dichotomized in either ≤60 (Golden-Hour) or > 60 minutes as well as categorized in 10-minute intervals from 0 to 270 minutes for graphical description. Results: Overall, thrombolysis rates in ischemic stroke were 33% (200/614) when STEMO was deployed and 22% (330/1497) in conventional care (p<0.001). The proportion of Golden-Hour treatments (from all thrombolysis) was 6-fold higher after STEMO deployment (31.0%; n= 62 versus 4.9%; n=16; p<0.01). Compared to patients with longer OTT patients with Golden-Hour thrombolysis had no higher risks for 7- or 90-day mortality (adjusted ORs: 0.38, 95%-CI: 0.09-1.70 and 0.69, 95%-CI: 0.32-1.53) but were more likely to be discharged at home (adjusted OR: 1.93 95%CI: 1.09-3.41; p=0.024). Conclusion: STEMO increased the percentage of patients treated within the Golden-Hour. This entailed no risk to patients’ safety and was associated with better short-term outcome.

Early Carotid Artery Endarterectomy after Intravenous Thrombolysis Therapy

2013 ◽  
Vol 8 (6) ◽  
pp. E28-E28 ◽  
Author(s):  
Bruno Barroso ◽  
Brice Laurens ◽  
Stéphanie Demasles ◽  
Mohamed Faik ◽  
Gael Ledoyer
Keyword(s):  
Carotid Artery ◽  
Intravenous Thrombolysis ◽  
Carotid Artery Endarterectomy ◽  
Thrombolysis Therapy

Abstract W MP100: Applying Real-Time Location Systems to Acute Stroke Workflow: A Novel Quality Improvement Tool

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Adam Prater ◽  
Meredith Bowen ◽  
Emily Pavich ◽  
Thomas Loehfelm ◽  
Aaron M Anderson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Real Time ◽  
Human Observer ◽  
Ct Scanner ◽  
Urban Hospital ◽  
Ir Detectors ◽  
Arrival Times ◽  
Patient Arrival ◽  
Location Systems

Background: Real-Time Location Systems (RTLS) utilize tracking tags and detectors to locate objects or people. This technology has been implemented in healthcare, chiefly to track hospital assets, and a few healthcare systems have applied this technology to track patients in the emergency department. This pilot study tested the feasibility of RTLS to monitor the acute stroke workflow in a large, urban hospital. Methods: An asset tracking RTLS was installed in a large, urban hospital. A series of 21 acute stroke patients were tracked throughout the workflow process by a human observer and via RTLS asset tag attached to the patient’s hospital equipment. A Wi-Fi detector documented initial patient arrival times in the ER Hallway, radiofrequency/infrared (RFID/IR) detectors documented ER CT scanner and ER patient room times. Patient Arrival and departure times in the emergency room (ER) and radiology CT scanner were measured. Time differences between human observer and RTLS were calculated. Results: A total of 21 patients were tracked with RTLS. The mean time difference, interquartile range and standard deviation in minutes are as follows: initial arrival (mean 106, IQR 112, SD 197); CT arrival ( mean 1, IQR 1, SD 0.86); CT departure (mean 2, IQR 2, SD 1.13); patient return to ED (mean 1, IQR 1, SD 0.94). Discussion: Our data demonstrate that RTLS can provide accurate, real-time patient location information, and has the potential to provide data for quality improvement. Combination RFID/IR detectors provided accurate time information while the Wi-Fi detector, proved unreliable for initial arrival times. Our preliminary data supports the development of an unique RTLS system specifically designed to allow for complete visualization of the stroke workflow from patient arrival to treatment along with a dashboard user interface to facilitate treatment team coordination.

Intracerebellar Hemorrhage in a Premature Newborn: Diagnosis by Real-Time Ultrasound and Correlation with Autopsy Findings

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
James S. Nelson ◽  
William H. McAlister ◽  
Joseph J. Volpe
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Premature Infant ◽  
Brain Imaging ◽  
Real Time ◽  
Critically Ill ◽  
Ultrasound Scan ◽  
Ultrasound Scanning ◽  
Ct Scanner

The identification of intracerebellar hemorrhage in a living premature infant by real-time ultrasound scan and confirmation of the findings at autopsy are described. This represents the first demonstration of the value of this noninvasive, convenient, and safe means of brain imaging in diagnosis of this lesion. Previous studies have described the role of the computed tomography (CT) scan in identification of intracerebellar hemorrhage in the newborn. Because infants with intracerebellar hemorrhage are usually critically ill, a means of identification of the lesion that could be utilized at the bedside rather than an approach that requires transport to a CT scanner is needed. This study indicates that portable real-time ultrasound scanning can satisfy that need.

scholarly journals Sex Differences in Long-Term Survival after a First Stroke with Intravenous Thrombolysis: Ebrictus Study

2015 ◽  
Vol 5 (3) ◽  
pp. 95-102 ◽  
Author(s):  
José Luis Clua-Espuny ◽  
Rosa Ripolles-Vicente ◽  
Teresa Forcadell-Arenas ◽  
Vicente Francisco Gil-Guillen ◽  
Maria Lluïsa Queralt-Tomas ◽  
...  
Keyword(s):  
Therapy Group ◽  
Intravenous Thrombolysis ◽  
Term Survival ◽  
Death Rates ◽  
Barthel Score ◽  
The Relationship ◽  
Cardiovascular Secondary Prevention ◽  
Stroke Death ◽  
Thrombolysis Therapy

Background: A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences. We sought to examine the relationship between sex and outcome after thrombolysis. Methods: This was a prospective cohort study including 1,272 incident ischemic strokes (597 in women) from April 1, 2006 to December 31, 2014. Statistical approaches were used for analyzing survival outcomes and their relationship with thrombolysis therapy. Results: The death rates were lower (p = 0.003) in the thrombolysis therapy group with an incidence ratio of 0.57 (95% CI 0.39-0.83). 113 (8.8%) patients (53 women) received thrombolysis. They were significantly younger (69.2 ± 12.7 vs. 73.9 ± 12.5 years; p < 0.001), had higher NIHSS score (12.7 ± 6.3 vs. 7.3 ± 7.0; p < 0.001), spent more days in hospital (10.4 ± 8.3 vs. 8.3 ± 7.9; p < 0.001), and had a higher average Barthel score at discharge (85.5 ± 24.4 vs. 79.2 ± 28.6; p = 0.023). The male/female incidence ratio showed a significant decrease (p = 0.01) in the incidence of mortality in women and a better Barthel score. The thrombolysis improved the survival in the overall group with thrombolysis versus without thrombolysis (p = 0.028), in women versus in men with thrombolysis (p = 0.023), and in women with thrombolysis versus in those without thrombolysis (p < 0.001) but not in men with thrombolysis versus in those without thrombolysis (p = 0.743). The protective factors as regards mortality were thrombolysis therapy (95% CI 0.37-0.80; p = 0.002), Barthel score ≥60 (95% CI 0.81-0.94; p = 0.002), and cardiovascular secondary prevention 1 year after stroke (0.13, 95% CI 0.06-0.28). Conclusions: The stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting. The overall benefit on survival of the patients treated with thrombolysis might be explained by the beneficial effect of the thrombolysis on the women.

Prehospital idarucizumab prior to intravenous thrombolysis in a mobile stroke unit

2018 ◽  
Vol 14 (3) ◽  
pp. 265-269 ◽  
Author(s):  
Henry Zhao ◽  
Skye Coote ◽  
Lauren Pesavento ◽  
Brett Jones ◽  
Edrich Rodrigues ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
Inpatient Rehabilitation ◽  
Reperfusion Therapy ◽  
Ct Scanner ◽  
Vessel Occlusion ◽  
Prehospital Treatment ◽  
Mobile Stroke Unit ◽  
Stroke Team

Background Administration of intravenous idarucizumab to reverse dabigatran anticoagulation prior to thrombolysis for patients with acute ischemic stroke has been previously described, but not in the prehospital setting. The speed and predictability of idarucizumab reversal is well suited to prehospital treatment in a mobile stroke unit and allows patients with recent dabigatran intake to access reperfusion therapy. Aims To describe feasibility of prehospital idarucizumab administration prior to thrombolysis on the Melbourne mobile stroke unit. Methods The Melbourne mobile stroke unit is a specialized stroke ambulance servicing central metropolitan Melbourne, Australia and provides prehospital assessment, scanning and treatment with an integrated CT scanner and multidisciplinary stroke team. All cases were identified through the mobile stroke unit treatment registry since launch in November 2017. Results Of a total of n = 20 thrombolysis cases in the first 4 months of operation, three patients (15%) received intravenous idarucizumab 5 g for dabigatran reversal prior to thrombolysis. Mean time between idarucizumab administration and thrombolysis was approximately 10 minutes. Two of the three patients were shown to have large vessel occlusion on CTA in the mobile stroke unit and proceeded to endovascular thrombectomy. At 24 hours, only one patient had a small amount of asymptomatic petechial hemorrhage on follow-up imaging. All patients demonstrated substantial neurological recovery and were discharged to inpatient rehabilitation. Conclusions Rapid treatment with prehospital administration of idarucizumab prior to thrombolysis using a mobile stroke unit is feasible and facilitates hyperacute treatment.

Development and evaluation of a real-time three-dimensional CT (4D-CT) scanner

2002 ◽  
Author(s):  
Yasuo Saito ◽  
Hiroshi Aradate ◽  
Hiroaki Miyazaki ◽  
Yoji Kudo ◽  
Kazuhiko Tsujita ◽  
...  
Keyword(s):  
Real Time ◽  
Three Dimensional ◽  
Ct Scanner ◽  
4D Ct
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