[PDF] Safety And Efficacy Of Reperfusion Therapies For Acute Ischemic Stroke Patients With Active Malignancy U2013 A Single Center Experience eBook

Author : Marina Diomedi
Publisher :
Page : pages
File Size : 32,42 MB
Release : 2017
Category :
ISBN :

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Background and Purpose: Epidemiological correlations between active malignancy (AM) and acute ischemic stroke are well established. However, the effect of reperfusion strategies, particularly mechanical thrombectomy (MT), has been barely investigated in patients with acute ischemic stroke and AM. We aim to evaluate safety and efficacy of reperfusion strategies in such patients.Materials and Methods: we performed a case-control analysis comparing patients with AM and acute ischemic stroke (AM group) to a group of cancer-free patients with acute ischemic stroke (control group). All enrolled patients underwent reperfusion therapies (i.e. intravenous thrombolysis, mechanical thrombectomy, intravenous thrombolysis plus mechanical thrombectomy). Main outcomes were 3-month functional independence, successful reperfusion, 3-month mortality, symptomatic intracranial hemorrhage.Results: 24 patients with AM and acute ischemic stroke (mean age: 69u00b110.1) were individually matched to 24 control patients (mean age: 70.7u00b19.3). In both groups 50% were treated with mechanical thrombectomy, 46% with intravenous thrombolysis and 4% with intravenous thrombolysis plus mechanical thrombectomy. No difference were found in successful reperfusion, 3-month functional independence, symptomatic intracranial hemorrhage and mortality. However an overall mortality of 33% in the AM group was reported.Conclusions: Reperfusion strategies for acute ischemic stroke patients with AM seem to be safe and effective. However an individualized approach to understand cancer stage and life-expectation is warranted.

Author : R. Gilberto González
Publisher : Springer Science & Business Media
Page : 299 pages
File Size : 24,73 MB
Release : 2010-10-05
Category : Medical
ISBN : 3642127517

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This updated second edition of Acute Ischemic Stroke: Imaging and Intervention provides a comprehensive account of the state of the art in the diagnosis and treatment of acute ischemic stroke. The basic format of the first edition has been retained, with sections on fundamentals such as pathophysiology and causes, imaging techniques and interventions. However, each chapter has been revised to reflect the important recent progress in advanced neuroimaging and the use of interventional tools. In addition, a new chapter is included on the classification instruments for ischemic stroke and their use in predicting outcomes and therapeutic triage. All of the authors are internationally recognized experts and members of the interdisciplinary stroke team at the Massachusetts General Hospital and Harvard Medical School. The text is supported by numerous informative illustrations, and ease of reference is ensured through the inclusion of suitable tables. This book will serve as a unique source of up-to-date information for neurologists, emergency physicians, radiologists and other health care providers who care for the patient with acute ischemic stroke.

Author : Rosa Fortunata Musolino
Publisher :
Page : pages
File Size : 48,26 MB
Release : 2017
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ISBN :

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The global population aging will accelerate in the coming decade. 30% of stroke patients are older than 80. Findings regarding i.v. rt-PA and mechanical thrombectomy in aged patients lead to uncertainty. This observational study aims to evaluate the safety and effectiveness of reperfusion therapies in over 90-year-old patients with acute ischemic stroke. We retrospectively evaluated ischemic stroke patients, consecutively admitted to our stroke center, aged over 90 and divided into two groups: treated (Tp) and not treated (NTp). Primary end-points were variation of NIHSS from admission to discharge, hemorrhagic transformation, and 3-month mRS. Secondary end-points were the length of hospitalization and in-hospital mortality. Over 72 patients included, 21 were treated with rt-PA, 5 with mechanical thrombectomy, and 3 with bridging therapy. We found no differences in cardiovascular risk factors between the two groups. We found clinical improvement in both groups, with the Tp group showing a significant more improvement compared to the NTp group (Figure 1: u0394NIHSS 5,76 DS 5,35 vs 2,8 DS 4,91; p

Author : A. Geibel
Publisher : Springer Science & Business Media
Page : 202 pages
File Size : 10,57 MB
Release : 2012-12-06
Category : Medical
ISBN : 3642511902

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The value of echocardiography in the diagnostic work-up of patients with suspected acute pulmonary embolism.- New developments in the thrombolytic therapy of venous thrombosis.- Mechanism of blood coagulation. Newer aspects of anticoagulant and antithrombotic therapy.MR-angiography in the diagnosis of pulmonary embolism.Scintigraphy-ventilation/perfusion scanning and imaging of the embolus.- Clinical course and prognosis of acute pulmonary embolism.- The molecular mechanisms of inherited thombophilia.

Author : Michel T. Torbey
Publisher : Cambridge University Press
Page : 395 pages
File Size : 33,91 MB
Release : 2013-07-18
Category : Medical
ISBN : 1107634725

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An essential companion for busy professionals seeking to navigate stroke-related clinical situations successfully and make quick informed treatment decisions.

Author : Giuseppe D’Aliberti
Publisher : Springer
Page : 103 pages
File Size : 13,72 MB
Release : 2016-11-22
Category : Medical
ISBN : 3319317059

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This book provides detailed practical guidance on the management of acute ischemic stroke in the clinical settings encountered in daily practice. Real-life cases are used to depict a wide range of clinical scenarios and to highlight significant aspects of management of ischemic stroke. In addition, diagnostic and therapeutic protocols are presented and helpful decision-making algorithms are provided that are specific to the different professionals involved in delivery of acute stroke care and to differing types of hospital facility. The coverage is completed by the inclusion of up-to-date scientific background information relevant to diagnosis and therapy. Throughout, the approach adopted is both practical and multidisciplinary. The book will be of value for all practitioners involved in the provision of acute stroke care, and also for medical students.

Author : Milou0161 Aju010deviu0107
Publisher :
Page : pages
File Size : 36,25 MB
Release : 2017
Category :
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Background and Aims:Efficacy and safety of reperfusion treatment in acute ischemic stroke was widely studied in known onset stroke patients, while the data on real world experience with rt-PA in Wake-up stroke (WUS) patients is limited. Even though WUS is observed in up to 25% of ischemic stroke patients, in clinical practice WUS patients are generally not treated with reperfusion therapy. The aim of this study was to investigate the efficacy and safety of thrombolysis in patients with WUS.Methods:We retrospectively analyzed the clinical and imaging data of WUS patients admitted to our Stroke Unit between March 2014 and March 2017. We evaluated the outcome of rt-PA treated and non-treated WUS patients in terms of NIHSS and mRS at discharge, sICH as well as mortality.Results:We studied 114 WUS patients (60 treated with rt-PA; 54 non-treated). Age, NIHSS, mRS, ASPECT at admission and time from last seen to admission were not significantly different between treated and non-treated patients. In the treated group NIHSS at discharge was significantly lower (median 1; range 0-21) compared to the non-treated (median 4; range 0-20). The number of patients with mRS 0-2 was significantly higher in the treated group compared to the non-treated (57% vs. 37%), while mortality and sICH did not differ.Conclusions:The main finding of this study is that WUS may benefit from rt-PA showing improvement in clinical outcome in terms of NIHSS and mRS at discharge, without additional risks.

Author : Thomas Meinel
Publisher :
Page : pages
File Size : 39,47 MB
Release : 2017
Category :
ISBN :

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Background In acute ischemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data points to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. Aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR) and (2) to assess the safety and technical efficacy of MT according to strata of TTR. MethodsUsing the retrospective multicenter BEYOND-SWIFT registry data (NCT03496064), we compared safety and efficacy of MT in 1461 patients between TTR strata of 0-180 minutes (n=192), 180-360 minutes (n=876) and >360 minutes (n=393). Clinical effect of TTR was evaluated using multivariable logistic regression analyses adjusting for prespecified confounders (adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was good functional outcome (modified Rankin Scale: mRS 0-2) at day 90.ResultsEvery hour delay in TTR was a significant factor related to mRS 0-2 (aOR 0.933, 95%-CI 0.887 u2013 0.981) with an estimated 1.5% decreased probability of good functional outcome per hour delay of reperfusion, mRS 0-1 (aOR 0.929, 95%-CI 0.877 u2013 0.985) and mRS 0-3 (aOR 0.955, 95%-CI 0.911 u2013 1.000). Patients with late TTR had lower rates of successful and excellent reperfusion, higher complication rate and number of passes. ConclusionsTime to reperfusion is an independent factor related to long-term functional outcome. With increasing TTR, interventional procedures become technically less effective. Efforts should be made to shorten TTR through optimized prehospital and in-hospital pathways.

Author : Catarina Perry Cu00e2mara
Publisher :
Page : pages
File Size : 45,48 MB
Release : 2017
Category :
ISBN :

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Background and Aims:Current guidelines for treatment of acute ischemic stroke recommend mechanical thrombectomy (MT) in selected patients with large vessel occlusion. Atherosclerotic occlusions of the middle cerebral artery (MCA) frequently reocclude after thrombectomy, and require additional angioplasty and stenting. However, the safety and efficacy of acute intracranial stenting is not yet proved. We aimed to describe our experience with acute MCA stenting as rescue therapy in hyperacute ischemic stroke.Methods:We retrospectively selected, from our prospective registry, acute stroke patients with MCA occlusion, who underwent MT and intracranial stenting as rescue therapy. The degree of recanalization, clinical variables and outcome at 3 months were described, as well as safety parameters [procedure complications and symptomatic intracranial hemorrhage (sICH)].Results:In our center, 820 patients underwent MT from January 2016 to December 2018. Recurrent re-occlusion after thrombectomy of an MCA occlusion occurred in 6 patients, requiring intracranial stenting. A loading dose of aspirin and a glycoprotein IIb/IIIa receptor inhibitor were acutely administered. Mean age was 66u00b115.2, mean NIHSS was 11u00b18.8, and median ASPECTS was 8.5. All patients had successful recanalization [thrombolysis in cerebral infarction (TICI) score 2b/3]. There were no procedural complications, but one patient had late stent occlusion and sICH. Three-month follow-up was available in 5 patients with no mortality, two patients with mRS=3, but only one had mRS