Mechanical Flow Restoration in Acute Ischemic Stroke: A Model System of Cerebrovascular Occlusion

2011 ◽  
Author(s):  
J. Y. Chueh ◽  
A. K. Wakhloo ◽  
M. J. Gounis
Keyword(s):  
Treatment Time ◽  
Time Window ◽  
Recombinant Tissue Plasminogen Activator ◽  
The United States ◽  
Artery Occlusion ◽  
Large Artery ◽  
Short Treatment ◽  
Flow Restoration ◽  
Cerebrovascular Occlusion ◽  
Short Treatment Time

Stroke is the leading cause of disability and the third cause of death in the United States. About 20% of acute ischemic strokes (AIS) are caused by a large artery occlusion, and restoration of blood flow in a reasonable time is the principle goal of treatment. FDA-approved recombinant tissue plasminogen activator (tPA) administration for treatment of stroke is efficacious, but it has short treatment time window and risk of symptomatic hemorrhage that result in only 3–5% patients of who receive this treatment. Alternatively, endovascular treatment using thrombectomy devices, MERCI and Penumbra systems, has been cleared by the FDA. Without adjunctive therapies, the recanalization rate and clinical outcome associated with these devices could be improved.

Abstract P164: The Impact of the Expanded EVT Window on Acute Stroke Services: A Large Northwest Telestroke Network Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Theodore Lowenkopf ◽  
Leslie Corless ◽  
Elizabeth Baraban
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Treatment Time ◽  
Time Window ◽  
Tertiary Care ◽  
The United States ◽  
Geographic Region ◽  
Anterior Circulation ◽  
Stroke Subtypes ◽  
The Impact

Background: Telestroke has led the technological revolution in providing acute medical services to rural areas in the United States since the beginning of this century. In January 2018 the American Stroke Association made a level IA recommendation to expand the treatment time window for endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from 6 to 24 hours for anterior circulation stroke based on perfusion imaging. Our study is the first to our knowledge to report the effect of the expanded time window on acute stroke consult and treatment volumes in a large rural supporting telestroke network. Methods: Stroke registry data from two tertiary care facilities from a 22 hospital telestroke network supporting a large (> 78,000 mi 2 ) primarily rural Northwest geographic region were used. Data included stroke patients arriving within 24 hours of last known well (LKW) between January 2017 and March 2019. Patients arriving January 2017 to December 2017 were grouped into the PRE-expanded time window and those arriving April 2018 to March 2019 into the POST-expanded time window. Stroke subtypes, transfers, telestroke consults (via phone or video), and EVT treatments were compared across time periods. Analyses were performed using Pearson’s chi square test, corrected for multiple comparisons. Results: A total of 1117 patients arrived with stroke symptoms within 24 hours of LKW, 567 (50.8%) in PRE and 550 (49.2%) in POST-window. The percentage of all stroke subtypes were not significantly different in the PRE and POST patient groups (p=.720). However, the percent of telestroke consults increased by 12.1% from 62.3% to 74.4% (p<.001) but the percent of video consults remained similar (25.9% vs 25.8%). The total number of transfers (142 vs 141) and percentage of transfers among AIS patients (25.0% vs 25.6%) from partner to hub did not change. The percentage of thrombectomies among transfers rose by 8.7% with the expanded time window, but was not statistically significant [p=0.118]. Conclusions: In a large Northwest telestroke rural network the expanded EVT treatment time window led to a marked increase in all telestroke consults but did not impact video consults, transfer, or percentage of patients treated.

scholarly journals Endovascular Recanalization in Early Recurrent Ischemic Stroke: A Treatment Challenge

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 49-55
Author(s):  
Huong Bich Thi Nguyen ◽  
Thang Huy Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Large Artery ◽  
Limited Information ◽  
Anterior Circulation ◽  
Endovascular Recanalization

Reperfusion therapy is the most effective treatment for acute ischemic stroke. At present, many clinical studies have shown that mechanical thrombectomy is efficient and safe for acute ischemic stroke of large artery occlusion disease in the time window of 24 h. However, there is limited information on the safety and effectiveness of this technique in cases of recurrent ischemic stroke. We report a case of early recurrent stroke of the anterior circulation after a week of the first stroke. Imaging examinations showed that there existed occlusion of corresponding vessels and obvious ischemic penumbra. Symptoms of the patient were progressive worsening and medical treatment failed; therefore, the corresponding vessel was opened. The low perfusion status in brain tissue and clinical defect symptoms of the patients have improved a lot. In conclusion, thrombectomy for early recurrent ischemic stroke may be effective. Moreover, there may be a wider reperfusion time window for ischemic stroke patients.

Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

2016 ◽  
Vol 9 (4) ◽  
pp. 352-356 ◽  
Author(s):  
Yahia Lodi ◽  
Varun Reddy ◽  
Gorge Petro ◽  
Ashok Devasenapathy ◽  
Anas Hourani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Large Artery ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Nihss Score ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Background and purposeIn recent trials, acute ischemic stroke (AIS) from large artery occlusion (LAO) was resistant to intravenous thrombolysis and adjunctive stent retriever thrombectomy (SRT) was associated with better perfusion and outcomes. Despite benefit, 39–68% of patients had poor outcomes. Thrombectomy in AIS with LAO within 3 h is performed secondary to intravenous thrombolysis, which may be associated with delay. The purpose of our study is to evaluate the safety, feasibility, recanalization rate, and outcome of primary SRT within 3 h without intravenous thrombolysis in AIS from LAO.MethodsBased on an institutionally approved protocol, stroke patients with LAO within 3 h were offered primary SRT as an alternative to intravenous recombinant tissue plasminogen activator. Consecutive patients who underwent primary SRT for LAO within 3 h from 2012 to 2014 were enrolled. Outcomes were measured using the modified Rankin Scale (mRS).Results18 patients with LAO of mean age 62.83±15.32 years and median NIH Stroke Scale (NIHSS) score 16 (10–23) chose primary SRT after giving informed consent. Near complete (TICI 2b in 1 patient) or complete (TICI 3 in 17 patients) recanalization was observed in all patients. Time to recanalization from symptom onset and groin puncture was 188.5±82.7 and 64.61±40.14 min, respectively. NIHSS scores immediately after thrombectomy, at 24 h and 30 days were 4 (0–12), 1 (0–12), and 0 (0–4), respectively. Asymptomatic perfusion-related hemorrhage developed in four patients (22%). 90-day outcomes were mRS 0 in 50%, mRS 1 in 44.4%, and mRS 2 in 5.6%.ConclusionsOur study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

High-pressure cation-exchange treatment of a ZSM-5 zeolite

2009 ◽  
Vol 24 (7) ◽  
pp. 2416-2419 ◽  
Author(s):  
Aijie Han ◽  
Yu Qiao
Keyword(s):  
Aqueous Solution ◽  
High Pressure ◽  
Cation Exchange ◽  
Treatment Time ◽  
Ambient Pressure ◽  
Short Treatment ◽  
Short Treatment Time ◽  
Exchange Technique

Under ambient pressure, an aqueous solution may not enter the nanopores of a hydrophobic ZSM-5 zeolite, which imposes difficulties to cation-exchange treatment. In the current study, a high-pressure cation-exchange technique is developed. With a relatively short treatment time, the degree of hydrophobicity is significantly increased.

Research Status of High-Intensity Pulsed Electric Field (PEF) Equipment and its Application on Food Processing

2014 ◽  
Vol 915-916 ◽  
pp. 331-335
Author(s):  
Rui Wen Yang ◽  
Jia Wang ◽  
Yan Jin ◽  
Song Yi Lin
Keyword(s):  
Electric Field ◽  
Food Processing ◽  
High Intensity ◽  
Treatment Time ◽  
Pulsed Electric Field ◽  
Short Treatment ◽  
Research Status ◽  
Chamber Pump ◽  
Cooling Coil ◽  
Short Treatment Time

Due to short treatment time, the quality change of food caused by heat can be reduced, high-intensity pulsed electric field (PEF) has been widely used, especially in food industry. PEF system consists of PEF generator, treatment chamber, pump, cooling coil, container and monitoring system. The research status of PEF generator, pulses waveforms, treatment chamber and electrodes were discussed. And the application of PEF on food processing was summarized.

scholarly journals Safety and Efficacy of Endovascular Treatment for Progressive Stroke in Patients With Acute Basilar Artery Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Yinxu Wang ◽  
Yingbing Ke ◽  
Lingling Wang ◽  
Qing Wu ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Treatment Time ◽  
Time Window ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Standard Medical Therapy ◽  
Desirable Outcome

Background and Purpose: It is unknown the benefit of endovascular therapy (EVT) for progressive stroke in patients with basilar artery occlusion (BAO). The aim of this study was to compare the efficacy and safety of EVT with standard medical therapy (SMT) in a population of BAO patients with progressive stroke.Methods: The EVT for Acute Basilar Artery Occlusion Study (BASILAR) is a national prospective registry of consecutive patients with acute BAO within 24 h of symptom onset. According to the applied therapy, all patients were divided into SMT and EVT groups. Subsequently, the EVT group was divided into early (≤6 h) and late groups (&gt;6 h) according to the time window. The efficacy outcome was favorable functional outcomes (modified Rankin Scale score ≤ 3) at 90 days. The safety outcomes included mortality within 90 days and symptomatic intracerebral hemorrhage (sICH) after EVT.Results: The EVT cohort presented more frequently with a favorable functional outcome (adjusted odds ratio, 5.49; 95% confidence interval, 2.06–14.61, p = 0.01) and with a decreased mortality (adjusted odds ratio, 0.3; 95% confidence interval, 0.17–0.54, p &lt; 0.001). What's more, EVT still safe (P = 0.584, P = 0.492, respectively) and effective (P = 0.05) in patients with progressive stroke when the treatment time window exceeds 6 h.Conclusions: EVT was more effective and safer than SMT for progressive stroke in patients with BAO. Besides, EVT remains safe and effective in patients with progressive stroke when the treatment time window exceeds 6 h. Predictors of desirable outcome in progressive stroke patients undergoing EVT included lower baseline NIHSS score, higher baseline pc-ASPECTs, successful recanalization and shorter puncture to recanalization time.

scholarly journals Synthesis of Binderless ZK-4 Zeolite Microspheres at High Temperature

Molecules ◽  
2018 ◽  
Vol 23 (10) ◽  
pp. 2647 ◽  
Author(s):  
Elyssa Fawaz ◽  
Darine Salam ◽  
Habiba Nouali ◽  
Irena Deroche ◽  
Severinne Rigolet ◽  
...  
Keyword(s):  
Treatment Time ◽  
Nitrogen Adsorption ◽  
X Ray Diffraction ◽  
Hydrothermal Conditions ◽  
Short Treatment ◽  
Synthesis Parameters ◽  
Resin Beads ◽  
Volatile Organic ◽  
Different Temperatures ◽  
Short Treatment Time

Binderless zeolite macrostructures in the form of ZK-4 microspheres were prepared using anion-exchange resin beads as shape-directing macrotemplates. The particles were synthesized under hydrothermal conditions at different temperatures and treatment times. The influence of the different synthesis parameters was investigated by X-ray diffraction, scanning electron microscopy, fluorescence X, nitrogen adsorption measurements and 29Si solid-state NMR. Fully crystalline spheres similar in size and shape to the original resin beads were obtained by a hydrothermal treatment at the highest temperatures (150–180 °C) for a short treatment time of 24 h. The synthesized microspheres showed to be promising in the molecular decontamination of volatile organic compounds (VOCs).

scholarly journals Treatment of Class I Malocclusion with a Lower Incisor Extraction: A Case Report

2018 ◽  
Vol 8 (1) ◽  
pp. 58-62
Author(s):  
Jitendra Kumar Sah ◽  
Praveen Mishra ◽  
Rabindra Man Shrestha ◽  
Alka Gupta
Keyword(s):  
Case Report ◽  
Treatment Time ◽  
Class I ◽  
Lateral Incisor ◽  
Midline Shift ◽  
Short Treatment ◽  
Lower Incisor ◽  
Facial Profile ◽  
Anterior Crowding ◽  
Short Treatment Time

A case report is presented with Class I malocclusion, moderate lower anterior crowding, maxillary dental midline shift with missing right lateral incisor. The adult orthodontic case was treated comprehensively with the extractions of lower lateral incisor, and upper and lower left first premolars as the balancing extraction. Remarkable improvements were achieved in facial profile, axial anterior inclination, esthetic smile and midline correction in short treatment time. Thus, it is concluded that lower incisor extraction in moderate lower anterior crowding and midline shift yield better and stable results with minimal intervention in select cases.

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