Symptomatic intracerebral hemorrhage (sich) after
|
|
- Christina McBride
- 5 years ago
- Views:
Transcription
1 Reduced Pretreatment Ipsilateral Middle Cerebral Artery Cerebral Blood Flow Is Predictive of Symptomatic Hemorrhage Post Intra-Arterial Thrombolysis in Patients With Middle Cerebral Artery Occlusion Rishi Gupta, MD; Howard Yonas, MD; James Gebel, MD; Steven Goldstein, MD ; Michael Horowitz, MD; Stephen Z. Grahovac, MD; Lawrence R. Wechsler, MD; Maxim D. Hammer, MD; Ken Uchino, MD; Tudor G. Jovin, MD Background and Purpose Intracerebral hemorrhage (ICH) can be a devastating complication associated with thrombolytic therapy for acute ischemic stroke. We hypothesized that patients with lower prethrombolysis cerebral blood flow (CBF) were at a higher risk of symptomatic ICH (sich). Methods Twenty-three patients who underwent quantitative CBF assessment with Xenon CT studies for acute stroke before intra-arterial (IA) thrombolysis for a middle cerebral artery (MCA) or internal carotid artery terminus occlusion within 6 hours of symptom onset were studied. Univariate and multivariate analysis were carried out to determine predictors of sich post-ia thrombolysis. Receiver operating characteristic curves were generated to determine the association between mean ipsilateral CBF and the occurrence of sich. Results The mean age of our cohort was years and a mean National Institutes of Health Stroke Scale (NIHSS) score of In univariate analysis, patients with higher percent of core infarct, hyperglycemia, and reduced mean ipsilateral CBF were at risk of sich. In multivariate analysis only mean ipsilateral CBF was associated with higher rates of sich (odds ratio 1.58; 95% CI, 1.01 to 2.51; P 0.04). The area under the receiver operating characteristic curve was 0.87 (95% CI, 0.76 to 0.97; P 0.005). Conclusions Patients with lower pre-ia thrombolysis mean ipsilateral MCA CBF are at significantly higher risk for sich in the setting of a MCA or carotid terminus occlusion. The threshold identified in this study may be useful for selection of patients with acute MCA occlusions for acute stroke thrombolysis. (Stroke. 2006;37: ) Key Words: acute stroke intracranial hemorrhage thrombolysis Symptomatic intracerebral hemorrhage (sich) after thrombolytic therapy for acute ischemic stroke is associated with a high morbidity and mortality. 1 Thrombolysis-related ICH has been classified into 2 types 2 : hemorrhagic infarct (HI), usually without clinical consequence, and parenchymal hemorrhage (PH), which commonly causes clinical deterioration. The latter has been further subclassified into PH1 representing blood clots in 30% of the infarcted area with slight space-occupying effect and PH2 representing blood clots in 30% of the infarcted area with substantial space-occupying effect. 3 Other studies have noted that the extent of hypoattenuation on initial head CT 4,5 and the use of tissue plasminogen activator (t-pa) 5,6,7 are associated with a higher risk of developing PH-type sich. Additionally, it has been observed that patients with lower regional cerebral blood flow (CBF) on single-photon emission CT in the hemisphere ipsilateral to an occluded cerebral artery is at a higher likelihood of undergoing hemorrhagic changes post intra-arterial (IA) thrombolysis. 8 The objective of this study was to quantify the relationship between different CBF thresholds in the ipsilateral middle cerebral artery (MCA) and the development of sich. Additionally, we sought to determine the relationship between core infarct, penumbra and sich. Patients and Methods This study was conducted with institutional Institutional Review Board approval. Received March 28, 2006; final revision received June 14, 2006; accepted July 4, From the Department of Neurology (R.G., J.G., L.R.W., M.D.H., K.U., T.G.J.), Stroke Institute, University of Pittsburgh Medical Center, Pa; the Department of Neurology (R.G.), Section of Stroke and Neurocritical Care, Michigan State University, East Lansing, Mich; the Department of Neurosurgery (H.Y.), University of New Mexico, Albuquerque; the Department of Neurosurgery (M.H., T.G.J.), University of Pittsburgh Medical Center, Pa; and the Department of Radiology (M.H., S.Z.G.), University of Pittsburgh Medical Center, Pa. Deceased. Correspondence and reprint requests to Tudor G. Jovin, MD, Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, 200 Lothrop St, Suite C-400, Stroke Institute, Pittsburgh, PA jovintg@upmc.edu 2006 American Heart Association, Inc. Stroke is available at DOI: /01.STR b4 2526
2 Gupta et al Reduced CBF Is Associated With ICH Post-Thrombolysis 2527 Patients Twenty-three acute ischemic stroke patients who underwent a Xenon CBF CT (Xe-CT-CBF) study were included in the study according to the following inclusion criteria: CBF study within 6 hours of symptom onset, patient taken to angiography for administration of IA or a combination of IV/IA thrombolytics, presence of an MCA or carotid terminus occlusion demonstrated by catheter angiography, and a Xe- CT-CBF study free of significant movement artifact allowing reliable interpretation of the quantitative CBF data. The patients included in our study were selected from a prospective registry of 378 consecutive individuals admitted to the University of Pittsburgh Stroke Service between January 1997 and April 2001 who underwent a Xe-CT-CBF study during that admission. Of these 378 patients, 160 patients were studied within 6 hours of symptom onset, and of these, 50 patients had MCA or carotid terminus occlusions. Fourteen of these 50 patients were excluded because of excessive motion artifact, and 10 additional patients were not treated with any thrombolytic agents because of an exclusion criterion, and 3 patients were treated with IV t-pa alone and not taken for catheter angiography. Thus, a total of 23 patients were analyzed as part of this study. The IA therapy protocol was to infuse t-pa or urokinase within the thrombus without aggressive mechanical manipulation. A maximum dose of 22 mg of t-pa (Genentech, Inc) was administered in the thrombus over 2 hours unless recanalization occurred before maximal dose administration. IA urokinase was administered in similar fashion: increments of U every 15 minutes for a maximal dose of 2 million units over 2 hours. The end point of IA therapy was vessel recanalization or 2 hours whichever came first as was the protocol at the time of this study period. These patients were treated in the 3- to 6-hour time window. Patients who presented 3 hours and met inclusion criteria were treated with IV t-pa. Patients who received combined IV/IA therapy (n 12) were treated with a full dose of 0.9 mg/kg IV t-pa if symptom onset was under 3 hours and then the patient was taken to Xenon CT and angiography if persistent MCA or internal carotid artery terminus occlusion was suspected at the discretion of the treating stroke neurologist. Xe-CT-CBF studies were ordered by the treating stroke neurologist according to the established prospective protocol during the study period. It is thus unlikely that a significant number of patients were missed attributable to ordering patterns of the treating neurologist. Admission head CTs were reviewed for the presence of hypodensity using a previously published scale (ASPECTS). 9 The score was dichotomized to 7 or 7 because this has been previously shown to have good inter-rater reliability. Data were obtained from a clinical database that included clinical, laboratory and demographic data as well as follow-up CT data at 24 hours post-treatment. Digitally subtracted angiograms were reviewed by 1 of the authors (S.Z.G.) to determine the location of the clot (ie, carotid terminus or M1 MCA). The final run after administration of IA therapy was also reviewed by the same author to determine whether recanalization had occurred. Follow-up imaging studies at 24 hours were assessed for the presence of hemorrhage using the ECASS-2 classification. 3 All patients screened had a documented time of symptom onset as well as a documented time at which the CBF study was performed, enabling accurate determination between symptom onset and the CBF study. The admission blood glucose level of each patient was recorded and included as part of the analysis. Systolic blood pressures were averaged over the first 48 hours of admission for all patients. Patients with a decline of their National Institutes of Health Stroke Scale (NIHSS) score by 4 points and evidence of PH1- or PH2-type hemorrhage were considered to have a symptomatic ICH. 10 Xe-CBF-CT Data Analysis The stable Xe-CT-CBF technique has been previously published. 11,12 Xenon data analysis, calculation of ipsilateral MCA CBF, percent core, penumbra, noncore/nonpenumbra (NC/NP) and the validation of this method has also been previously published using region of interest (ROI). 13 The same approach was used for tabulating percent core (ROIs 8 ml/100 g per minute), penumbra (ROIs 8 to 20 ml/100 g per minute), NC/NP (ROIs 20 ml/100 g per minute) and mean hemispheric CBF s in this study. Statistical Analyses Statistical analyses were performed using SPSS Correlations were performed using Spearman correlation coefficients for mean ipsilateral CBF and ipsilateral percent core, penumbra, and NC/NP. Baseline clinical and Xenon CT values were compared using a Fisher exact test for categorical variables and a Student t test for continuous variables with regards to predictors of sich. A binary logistic regression model was constructed to determine independent predictors of developing sich with variables found to have a P value 0.10 in the univariate analysis. A receiver operating characteristic (ROC) curve was constructed for the mean ipsilateral CBF values with respect to the risk of subsequent sich. The values for the area under the curve are reported. Results There were 23 total patients studied with a mean age of years and a mean NIHSS of Eleven patients received IA and 12 patients received combined IV/IA thrombolytic therapy. There were 5 patients (22%) who developed sich in this cohort. All of these patients showed evidence of clinical decline in the first 24 hours post-thrombolysis and 4 of the hemorrhages were classified as PH2 and 1 as PH1. One patient was found to have clinical deterioration attributable to a large infarct with mass effect and petechial blood within the infarct. This patient was not considered in the sich group because the deterioration was felt to be secondary to the edema from the infarct. The median time from onset of symptoms to the CBF study was 210 minutes (range 120 to 360 minutes). The Table summarizes the univariate analysis comparing patients with and without sich. Of note, patients with sich were more likely to have a reduced ipsilateral mean MCA CBF, a higher percent of core, and presence of hyperglycemia. Additionally, patients with an ipsilateral MCA CBF of 13 ml/100 g per minute who recanalized had a significantly higher risk of developing sich in univariate analysis. A multivariate binary logistic regression model was constructed with these variables and the only variable found to be independently predictive of sich was mean ipsilateral MCA CBF (odds ratio [OR] 1.58; 95% CI, 1.01 to 2.51; P 0.04). There was a highly significant correlation between ipsilateral MCA CBF and percent core (Spearman 0.916; P ), and thus these variables were tested separately in multivariate modeling. When ipsilateral MCA CBF was removed from the multivariate model the percent ipsilateral core was found to be independently predictive of sich (OR 1.03; 95% CI, to 1.10; P 0.05). The area under the curve for the ROC curve for comparing mean ipsilateral MCA CBF and sich was 0.87 (95% CI, 0.76 to 0.97; P 0.005). We identified the mean ipsilateral MCA CBF of 13 ml/100 g per minute as most strongly predictive of developing sich (OR 5.0; 95% CI, 2.2 to 10.5; P 0.008) based on the ROC curve. The Figure outlines the distribution of CBF values and percent core values for each individual patient.
3 2528 Stroke October 2006 Univariate Analysis Comparing Clinical and Xenon-CT Values Between Patients Developing sich and Those Without sich Variable sich, n 5 No sich, n 18 P Value Age, mean SD, years NIHSS, mean SD Systolic blood pressure, mean SD, mm Hg Percent core, mean SD, % Percent penumbra, mean SD, % Percent NC/NP, mean SD, % Ipsilateral MCA CBF, mean SD, ml/100 g per min Contralateral MCA CBF, mean SD, ml/100 g per min Ratio of ipsilateral MCA CBF/contralateral MCA CBF Time to Xenon CT, mean SD, min Expiratory PCO 2, mean SD, mm Hg Lesion at carotid terminus 3(60) 9(50) 0.64 Glucose, mg/dl Hyperdense MCA sign, n (%) 2 (40) 2 (11) 0.19 ASPECTS 7 4 (80) 8 (44) 0.19 Combined IV/IA therapy, n (%) 3 (60) 9 (50) 0.64 Recanalization, n (%) 4 (80) 9 (50) 0.25 Recanalization ipsilateral MCA CBF 13 ml/100 g per min, n (%) 4 (80) 1 (6) Discussion The main finding of this study is that patients with lower mean ipsilateral CBF values and higher volume of infarcted tissue in the presence of an MCA occlusion are at the highest risk of developing sich. The second finding is that there may be a threshold for mean ipsilateral CBF for which patients are at higher risk and revascularization therapies may be too high risk. Our data suggests that this threshold is 13 ml/100 g per minute for mean ipsilateral MCA CBF. In these patients, the risk of sich after recanalization may be too high and other therapeutic approaches may be appropriate. The risk of developing hemorrhagic transformation after thrombolysis has been linked to MRI variables such as lower apparent diffusion coefficient values. 14,15 Other clinical parameters such as the severity of the NIHSS, older age 5 and presence of hyperglycemia 16 have been associated with a significantly higher risk of developing sich. In our univariate analysis, we found that patients who developed sich tended to have higher admission blood glucose levels as has been A scatterplot of all patients studied with respect to each individual patient s percent of core infarct (x axis) and mean ipsilateral MCA CBF (y axis). ( ) Designates patients who developed symptomatic ICH. ( ) Designates patients without symptomatic ICH.
4 Gupta et al Reduced CBF Is Associated With ICH Post-Thrombolysis 2529 observed in other studies. 16,17 This association was not significant in multivariate modeling likely attributable to the small sample size in our cohort. Unfortunately, many of these studies did not stratify the hemorrhages into PH- and HI-type bleeds and some patients may have deteriorated from cerebral edema and not the bleed itself. HI and PH are 2 distinct types of hemorrhages noted post-thrombolysis with likely different mechanisms. HI has not been shown to impact clinical outcome 18 and is associated with larger territories of infarcted tissue. 7 In contrast, PH is associated with a poor outcome after thrombolysis and is linked to the use of thrombolytics 5,6,7 and extent of infarct. 4,5 In our cohort the 5 patients who experienced sich all had PH-type bleeds. The development of PH-type bleeds may result from a combination of the size of the infarct and the presence of thrombolytic agents. 19 Patients with PH bleeds in the setting of t-pa administration have been found to have an increase in fibrinogen degradation products. 20 In our cohort, all patients received thrombolytic agents. Thus, we are unable to assess the isolated effect of a reduced mean ipsilateral CBF and the risk of developing sich after reperfusion therapy with other methods. Other authors have observed that delayed recanalization of an occluded MCA leads to an increased risk of PH-type bleeds post-thrombolysis. 21 This is likely attributable to reperfusion into large territories of infarcted tissue. We found that patients who were recanalized with a mean ipsilateral MCA CBF 13 ml/100 g per minute were more likely to develop sich in the univariate analysis. These patients had larger infarcts at the time of recanalization and thus likely developed reperfusion sich in the setting of IA thrombolysis. Ueda et al noted that patients who develop ICH post-thrombolysis were noted to have a reduced pretreatment CBF via semiquantitative methods. 8 This study did not separate patients into HI- and PH-type bleeds and symptomatic versus asymptomatic hemorrhage. Nonetheless, the authors found that patients who developed bleeds were more likely to have a lower baseline CBF using single-photon emission CT. Our study suggests that pretreatment CBF 13 ml/100 g per minute at the time of delivery of thrombolytics may be linked to the development of sich. A quantitative approach may be more practical in the design of future studies examining which patients are most likely to benefit from thrombolytic therapy in acute ischemic stroke. The number of patients developing sich in our cohort is higher than that reported in the literature. This is likely because at the time of this protocol patients were selected for IA thrombolysis based on rigid time criterion (ie, under 6 hours from symptom onset). There were patients in this cohort with larger areas of hypodensity on head CT as evidenced by a low ASPECTS score before IA thrombolysis. Such patients are currently treated with endovascular mechanical maneuvers such as angioplasty or a clot-retrieving device at our institution. Additionally, although not statistically significant in this cohort, there were just over 50% of patient who received full-dose IV t-pa followed by IA thrombolysis. Higher doses of thrombolytics may lead to higher rates of sich. Lastly, the higher percentage of sich may be a result of a small sample size. There are limitations of this study including the retrospective nature and the small number of patients studied. Although the number of patients is small, we were able to identify significant predictors for patients developing sich post-ia thrombolysis that would require further validation. Another limitation of this study is that a selection bias may be present for patients unable to tolerate Xenon CT. Increasing the number of patients will aid in more precisely identifying the CBF threshold associated with a higher risk of sich. In conclusion, we have found that patients with a lower mean ipsilateral CBF and a high percent of core infarct are at a significantly higher risk of sich after IA thrombolysis for MCA occlusion. The threshold of 13 ml/100 g per minute identified in this study may be useful for selection of patients with acute MCA occlusions for acute stroke thrombolysis. Disclosures H.Y. is a consultant for Diversified Diagnostics. The other authors report no conflicts of interest. References 1. The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. Intracerebral hemorrhage after intravenous t-pa for ischemic stroke. Stroke. 1997;28: Pessin M, del Zoppo GJ, Estol C. Thrombolytic agents in the treatment of stroke. Clin Neuropharmacol. 1990;13: Hacke W, Kaste M, Fieschi C, Von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P; for the Second European-Australasian Acute Stroke Study Investigators. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet. 1998;352: Dzialowski I, Hill MD, Coutts SB, Demchuk AM, Kent DM, Wunderlich O, von Kummer R. Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke. 2006;37: Larrue V, von Kummer R, Müller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator. A secondary analysis of the European-Australian Acute Stroke Study (ECASS II). Stroke. 2001;32: The ATLANTIS, ECASS, and NINDS rt-pa Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS and NINDS rt-pa stroke trials. Lancet. 2004;363: Larrue V, Von Kummer R, Del Zoppo G, Bluhmki E. Hemorrhagic transformation in acute ischemic stroke. Potential contributing factors in the European Cooperative Acute Stroke Study. Stroke. 1997;28: Ueda T, Hatakeyama T, Kumon Y, Sakaki S, Uraoka T. Evaluation of risk of hemorrhagic transformation in local intra-arterial thrombolysis in acute ischemic stroke by SPECT. Stroke. 1994;25: Barber PA, Demchuk AM, Zhang J, Buchan AM; for the ASPECTS Study Group. Validity and reliability of a quantitated computer tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet. 2000;355: Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark W, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study: a randomized controlled trial. JAMA. 1999;282: Yonas H, Pindzola RP, Johnson DW. Xenon/computed tomography cerebral blood flow and its use in clinical management. Neurosurg Clin NAm. 1996;7: Gur D, Yonas H, Good WF. Local cerebral blood flow by xenonenhanced CT: current status, potential improvements, and future directions. Cerebrovasc Brain Metab Rev. 1989;1: Jovin TG, Yonas H, Gebel JM, Kanal E, Chang YF, Grahovac SZ, Goldstein S, Wechsler LR. The cortical ischemic core and not the con-
5 2530 Stroke October 2006 sistently present penumbra is a determinant of clinical outcome in acute middle cerebral artery occlusion. Stroke. 2003;34: Tong DC, Adami A, Moseley ME, Marks MP. Prediction of hemorrhagic transformation following stroke. Arch Neurol. 2001;58: Derex L, Hermier M, Adeleine P, Pialat JB, Wiart M, Berthezene Y, Philippeau F, Honnorat J, Froment JC, Trouillas P, Nighoghossian N. Clinical and imaging predictors of intracerebral hemorrhage in stroke patients treated with intravenous tissue plasminogen activator. J Neurol Neurosurg Psychiatry. 2005;76: Kase CS, Furlan AJ, Wechsler LR, Higashida RT, Rowley HA, Hart RG, Molinari GF, Frederick LS, Roberts HC, Gebel JM, Sila CA, Schulz GA, Roberts RS, Gent M; PROACT II investigators. Cerebral hemorrhage after intra-arterial thrombolysis for acute ischemic stroke: the PROACT II trial. Neurology. 2001;57: Leigh R, Zaidat OO, Suri MF, Lynch G, Sundararajan S, Sunshine JL, Tarr R, Selman W, Landis DM, Suarez JI. Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. Stroke. 2004;35: Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L. Hemorrhagic transformation within 36 hours of a cerebral infarct. Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort. Stroke. 1999;30: Trouillas P, von Kummer R. Classification and pathogenesis of cerebral hemorrhages after thrombolysis in ischemic stroke. Stroke. 2006;37: Trouillas P, Derex L, Phillippeau F, Nighoghossian N, Honnorat J, Hanss M, French P, Adeleine P, Dechavanne M. Early fibrinogen degradation coagulopathy is predictive of parenchymal hematoma in cerebral rt-pa thrombolysis: a study of 157 cases. Stroke. 2004;35: Molina CA, Alvarez-Sabin J, Montaner J, Albilleira S, AZroenillas JF, Cocojuela P, Romero F, Codina A. Thombolysis-related hemorrhagic infarction: A marker or reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke. 2002;33:
Noncontrast computed tomography (CT) reliably distinguishes
Extent of Early Ischemic Changes on Computed Tomography (CT) Before Thrombolysis Prognostic Value of the Alberta Stroke Program Early CT Score in ECASS II Imanuel Dzialowski, MD; Michael D. Hill, MD, MSc,
More informationACUTE STROKE IMAGING
ACUTE STROKE IMAGING Mahesh V. Jayaraman M.D. Director, Inter ventional Neuroradiology Associate Professor Depar tments of Diagnostic Imaging and Neurosurger y Alper t Medical School at Brown University
More informationInterrater Reliability and Sensitivity of CT Interpretation by Physicians Involved in Acute Stroke Care
Detection of Early CT Signs of >1/3 Middle Cerebral Artery Infarctions Interrater Reliability and Sensitivity of CT Interpretation by Physicians Involved in Acute Stroke Care Mary A. Kalafut, MD; David
More informationACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS. Justin Nolte, MD Assistant Profession Marshall University School of Medicine
ACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS Justin Nolte, MD Assistant Profession Marshall University School of Medicine History of Presenting Illness 64 yo wf with PMHx of COPD, HTN, HLP who was in
More informationIntra-arterial thrombolysis (IAT) has the potential to rescue
Published September 3, 2008 as 10.3174/ajnr.A1276 ORIGINAL RESEARCH G.A. Christoforidis C. Karakasis Y. Mohammad L.P. Caragine M. Yang A.P. Slivka Predictors of Hemorrhage Following Intra-Arterial Thrombolysis
More informationEFFECT OF OLDER AGE ON THE RISK OF HEMORRHAGIC COMPLICATIONS AFTER INTRAVENOUS AND/OR INTRA-ARTERIAL THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE
EFFECT OF OLDER AGE ON THE RISK OF HEMORRHAGIC COMPLICATIONS AFTER INTRAVENOUS AND/OR INTRA-ARTERIAL THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE By SVETLANA PUNDIK, M.D. Submitted in partial fulfillment of
More informationAcute Stroke Treatment: Current Trends 2010
Acute Stroke Treatment: Current Trends 2010 Helmi L. Lutsep, MD Oregon Stroke Center Oregon Health & Science University Overview Ischemic Stroke Neuroprotectant trials to watch for IV tpa longer treatment
More informationStroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University
More informationBY MARILYN M. RYMER, MD
Lytics, Devices, and Advanced Imaging The evolving art and science of acute stroke intervention. BY MARILYN M. RYMER, MD In 1996, when the US Food and Drug Administration (FDA) approved the use of intravenous
More informationCerebral hemorrhage is the most feared complication of
Classification and Pathogenesis of Cerebral Hemorrhages After Thrombolysis in Ischemic Stroke Paul Trouillas, MD; Rüdiger von Kummer, MD Background and Purpose Brain hemorrhage after ischemic stroke is
More informationDownloaded from by on January 15, 2019
Alberta Stroke Program Early Computed Tomography Score to Select Patients for Endovascular Treatment Interventional Management of Stroke (IMS)-III Trial Michael D. Hill, MD, FRCPC; Andrew M. Demchuk, MD,
More informationAn intravenous thrombolysis using recombinant tissue
ORIGINAL RESEARCH I. Ikushima H. Ohta T. Hirai K. Yokogami D. Miyahara N. Maeda Y. Yamashita Balloon Catheter Disruption of Middle Cerebral Artery Thrombus in Conjunction with Thrombolysis for the Treatment
More informationCerebrovascular Disease lll. Acute Ischemic Stroke. Use of Intravenous Alteplace in Acute Ischemic Stroke Louis R Caplan MD
Cerebrovascular Disease lll. Acute Ischemic Stroke Use of Intravenous Alteplace in Acute Ischemic Stroke Louis R Caplan MD Thrombolysis was abandoned as a stroke treatment in the 1960s due to an unacceptable
More informationSafety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic stroke
Original Article Medical Journal of the Islamic Republic of Iran, Vol. 27, No. 3, Aug 2013, pp. 113-118 Safety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic
More informationI schaemic stroke is currently the third leading cause
1426 PAPER The probability of middle cerebral artery MRA flow signal abnormality with quantified CT ischaemic change: targets for future therapeutic studies P A Barber, A M Demchuk, M D Hill, J H Warwick
More informationAnalysis of DWI ASPECTS and Recanalization Outcomes of Patients with Acute-phase Cerebral Infarction
J Med Dent Sci 2012; 59: 57-63 Original Article Analysis of DWI ASPECTS and Recanalization Outcomes of Patients with Acute-phase Cerebral Infarction Keigo Shigeta 1,2), Kikuo Ohno 1), Yoshio Takasato 2),
More informationThrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome
AJNR Am J Neuroradiol 26:880 884, April 2005 Thrombolytic Therapy of Acute Ischemic Stroke: Correlation of Angiographic Recanalization with Clinical Outcome Osama O. Zaidat, Jose I. Suarez, Jeffrey L.
More informationMohamed Al-Khaled, MD,* Christine Matthis, MD, and J urgen Eggers, MD*
Predictors of In-hospital Mortality and the Risk of Symptomatic Intracerebral Hemorrhage after Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Mohamed Al-Khaled,
More informationOne of the most important issues a clinician must consider
Defining Clinically Relevant Cerebral Hemorrhage After Thrombolytic Therapy for Stroke Analysis of the National Institute of Neurological Disorders and Stroke Tissue-Type Plasminogen Activator Trials Neal
More informationIntravenous (IV) recombinant tissue plasminogen activator
Combined Intravenous and Intra-Arterial Recanalization for Acute Ischemic Stroke: The Interventional Management of Stroke Study The IMS Study Investigators Background and Purpose To investigate the feasibility
More informationAn Updated Systematic Review of rt-pa in Acute Ischaemic Stroke
Wardlaw An Updated Systematic Review of rt-pa in Acute Ischaemic Stroke Joanna M Wardlaw COMPETING INTERESTS The author is on the Steering Committees of the Third International Stroke Trial (IST3) and
More informationCT-Based Assessment of Acute Stroke. CT, CT Angiography, and Xenon-Enhanced CT Cerebral Blood Flow
CT-Based Assessment of Acute Stroke CT, CT Angiography, and Xenon-Enhanced CT Cerebral Blood Flow Megan M. Kilpatrick, BS; Howard Yonas, MD; Steven Goldstein, MD; Amin B. Kassam, MD; James M. Gebel, Jr,
More informationEndovascular stroke treatments are being increasingly used
Published March 18, 2010 as 10.3174/ajnr.A2050 ORIGINAL RESEARCH A.C. Flint S.P. Cullen B.S. Faigeles V.A. Rao Predicting Long-Term Outcome after Endovascular Stroke Treatment: The Totaled Health Risks
More informationEndovascular Treatment for Acute Ischemic Stroke
ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1
More informationAlthough intravenous (IV) thrombolysis has gained wide
Intravenous Versus Combined (Intravenous and Intra-Arterial) Thrombolysis in Acute Ischemic Stroke A Transcranial Color-Coded Duplex Sonography Guided ilot Study Lucka Sekoranja, MD; Jaouad Loulidi, MD;
More informationDisclosures. Anesthesia for Endovascular Treatment of Acute Ischemic Stroke. Acute Ischemic Stroke. Acute Stroke = Medical Emergency!
Disclosures Anesthesia for Endovascular Treatment of Acute Ischemic Stroke I have nothing to disclose. Chanhung Lee MD, PhD Associate Professor Anesthesia and perioperative Care Acute Ischemic Stroke 780,000
More informationJudicious use of thrombolytic agents has greatly improved the
Predictors of Clinical Improvement, Angiographic Recanalization, and Intracranial Hemorrhage After Intra-Arterial Thrombolysis for Acute Ischemic Stroke J.I. Suarez, MD; J.L. Sunshine, MD; R. Tarr, MD;
More informationThrombolytic Therapy in Clinical Practice The Norwegian Experience
Thrombolytic Therapy in Clinical Practice The Norwegian Experience Thomassen Lars Thomassen, Ulrike Waje-Andreassen, Halvor Næss ABSTRACT Background: Awaiting the European approval of thrombolysis, we
More informationSpontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke
Original Contribution Spontaneous Recanalization after Complete Occlusion of the Common Carotid Artery with Subsequent Embolic Ischemic Stroke Abstract Introduction: Acute carotid artery occlusion carries
More informationSince the National Institute of Neurologic Disorders and
ORIGINAL RESEARCH R.M. Sugg E.A. Noser H.M. Shaltoni N.R. Gonzales M.S. Campbell R. Weir E.D. Cacayorin J.C. Grotta Intra-Arterial Reteplase Compared to Urokinase for Thrombolytic Recanalization in Acute
More informationComparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
More informationEarly computed tomographic (CT) ischemic change in the
Hyperdense Sylvian Fissure MCA Dot Sign A CT Marker of Acute Ischemia Philip A. Barber, MRCP(UK); Andrew M. Demchuk, FRCPC; Mark E. Hudon, FRCPC; J.H. Warwick Pexman, FRCPC; Michael D. Hill, FRCPC; Alastair
More informationMechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
More information7 TI - Epidemiology of intracerebral hemorrhage.
1 TI - Multiple postoperative intracerebral haematomas remote from the site of craniotomy. AU - Rapana A, et al. SO - Br J Neurosurg. 1998 Aug;1():-8. Review. IDS - PMID: 1000 UI: 991958 TI - Cerebral
More informationPARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET
PARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET Hye Seon Jeong, *Jei Kim Department of Neurology and
More informationAcute Stroke Care: the Nuts and Bolts of it. ECASS I and II ATLANTIS. Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center
Acute Stroke Care: the Nuts and Bolts of it Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center ECASS I and II tpa for patients presenting
More informationThe principal goal in treating acute ischemic stroke is rapid
ORIGINAL RESEARCH S. Sugiura K. Iwaisako S. Toyota H. Takimoto Simultaneous Treatment with Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Acute Ischemic Stroke Within
More informationEffect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke
Effect of Collateral Blood Flow on Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke Michael P. Marks, MD; Maarten G. Lansberg, MD; Michael Mlynash, MD; Jean-Marc Olivot, MD; Matus Straka,
More informationComparative Analysis of Endovascular Stroke Therapy Using Urokinase, Penumbra System and Retrievable (Solitare) Stent
www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2015.57.5.342 J Korean Neurosurg Soc 57 (5) : 342-349, 2015 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright 2015 The Korean Neurosurgical Society Clinical
More informationNeurological Deterioration in Acute Ischemic Stroke
Neurological Deterioration in Acute Ischemic Stroke Potential Predictors and Associated Factors in the European Cooperative Acute Stroke Study (ECASS) I A. Dávalos, MD; D. Toni, MD; F. Iweins, MSc; E.
More informationIntravenous tpa has been a mainstay of acute stroke
J Neurosurg 115:359 363, 2011 Aggressive intervention to treat a young woman with intracranial hemorrhage following unsuccessful intravenous thrombolysis for left middle cerebral artery occlusion Case
More informationPrediction of Hemorrhage in Acute Ischemic Stroke Using Permeability MR Imaging
AJNR Am J Neuroradiol 26:2213 2217, October 2005 Technical Note Prediction of Hemorrhage in Acute Ischemic Stroke Using Permeability MR Imaging Andrea Kassner, Timothy Roberts, Keri Taylor, Frank Silver,
More informationEpidemiology. Epidemiology 6/1/2015. Cerebral Ischemia
Presenter Disclosure Information Paul Nyquist MD/MPH FCCM FAHA Updates on the Acute Care of Ischemic Stroke and Intracranial Hemorrhage Updates on the Acute Care of Ischemic Stroke Paul Nyquist MD/MPH,
More informationManaging the Measures: A Serious Look at Key Abstraction Concepts for the Comprehensive Stroke (CSTK) Measure Set Session 2
Managing the Measures: A Serious Look at Key Abstraction Concepts for the Comprehensive Stroke (CSTK) Measure Set Session 2 January 28, 2015 1 to 3 PM Central Time Continuing Education Credit This course
More informationIMAGING IN ACUTE ISCHEMIC STROKE
IMAGING IN ACUTE ISCHEMIC STROKE Timo Krings MD, PhD, FRCP (C) Professor of Radiology & Surgery Braley Chair of Neuroradiology, Chief and Program Director of Diagnostic and Interventional Neuroradiology;
More informationDirect Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Trunk Occlusion. An Alternative Option to Intra-arterial Thrombolysis
Direct Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Trunk Occlusion An Alternative Option to Intra-arterial Thrombolysis Shinichi Nakano, MD; Tsutomu Iseda, MD; Takumi Yoneyama,
More informationCurrent treatment options for acute ischemic stroke include
ORIGINAL RESEARCH M.-N. Psychogios A. Kreusch K. Wasser A. Mohr K. Gröschel M. Knauth Recanalization of Large Intracranial Vessels Using the Penumbra System: A Single-Center Experience BACKGROUND AND PURPOSE:
More informationImaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital
Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital Disclosures Penumbra, Inc. research grant (significant) for
More informationEFFICACY AND SAFETY OF INTRA-ARTERIAL THROMBOLYTIC
Open Access Research Journal Medical and Health Science Journal, MHSJ www.pradec.eu ISSN: 1804-1884 (Print) 1805-5014 (Online) Volume 10, 2012, pp. 2-9 EFFICACY AND SAFETY OF INTRA-ARTERIAL THROMBOLYTIC
More informationENDOVASCULAR THERAPIES FOR ACUTE STROKE
ENDOVASCULAR THERAPIES FOR ACUTE STROKE Cerebral Arteriogram Cerebral Anatomy Cerebral Anatomy Brain Imaging Acute Ischemic Stroke (AIS) Therapy Main goal is to restore blood flow and improve perfusion
More informationArticle ID: WMC ISSN
Article ID: WMC004795 ISSN 2046-1690 Correlation of Alberta Stroke Program Early Computed Tomography Score on CT and Volume on Diffusion Weighted MRI with National Institutes of Health Stroke Scale Peer
More informationBlood Pressure Variability and Hemorrhagic Transformation after Intravenous Thrombolysis in Acute Ischemic Stroke
www.jneurology.com Neuromedicine www.jneurology.com Research Article Open Access Blood Pressure Variability and Hemorrhagic Transformation after Intravenous Thrombolysis in Acute Ischemic Stroke Hanna
More information11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment
More informationACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke
ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center
More informationBridging therapy (the combination of intravenous [IV] and
Bridging Therapy in Acute Ischemic Stroke A Systematic Review and Meta-Analysis Mikael Mazighi, MD, PhD; Elena Meseguer, MD; Julien Labreuche, BS; Pierre Amarenco, MD Background and Purpose Pending the
More informationHypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy
AJNR Am J Neuroradiol 26:1798 1803, August 2005 Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy Lee H. Schwamm,
More informationIodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis
Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis Niall J.J. MacDougall, MRCP; Ferghal McVerry, MRCP; Sally Baird; Tracey Baird, MRCP; Evelyn Teasdale, FRCR; Keith W. Muir,
More informationFigures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials
Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials Figure 1: Lay Press Judgment May Belie a Deeper Examination of the Data. Truman ultimately defeated Dewey for the Presidency Subject
More informationIntracranial Hemorrhage after Endovascular Revascularization for Acute Ischemic Stroke
Journal of Neuroendovascular Therapy 2017; 11: 391 397 Online May 23, 2017 DOI: 10.5797/jnet.oa.2016-0089 Intracranial Hemorrhage after Endovascular Revascularization for Acute Ischemic Stroke Koichi Arimura,
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationThe cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage
ORIGINAL ARTICLE The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage J.-M. Kim a, K.-Y. Park a, W. J. Lee b, J. S. Byun b, J.
More informationHow to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval
How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval Peter Howard MD FRCPC Disclosures No conflicts to disclose How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular
More informationWithout reperfusion therapy, almost 80% of patients with
ORIGINAL RESEARCH V. Puetz P.N. Sylaja M.D. Hill S.B. Coutts I. Dzialowski U. Becker G. Gahn R. von Kummer A.M. Demchuk CT Angiography Source Images Predict Final Infarct Extent in Patients with Basilar
More informationORIGINAL RESEARCH. Ischemic stroke
Ischemic stroke For numbered affiliations see end of article. Correspondence to Dr R Gupta, Emory University School of Medicine, 49 Jesse Hill Dr SE, Room 393, Atlanta, GA 30303, USA; rishi.gupta@emory.edu
More informationBroadening the Stroke Window in Light of the DAWN Trial
Broadening the Stroke Window in Light of the DAWN Trial South Jersey Neurovascular and Stroke Symposium April 26, 2018 Rohan Chitale, MD Assistant Professor of Neurological Surgery Vanderbilt University
More informationSignificant Relationships
Opening Large Vessels During Acute Ischemic Stroke Significant Relationships Wade S Smith, MD, PhD Director UCSF Neurovascular Service Professor of Neurology Daryl R Gress Endowed Chair of Neurocritical
More informationHistorical. Medical Policy
Medical Policy Subject: Mechanical Embolectomy for Treatment of Acute Stroke Policy #: SURG.00098 Current Effective Date: 01/01/2016 Status: Revised Last Review Date: 08/06/2015 Description/Scope This
More informationIMAGING IN ACUTE ISCHEMIC STROKE
IMAGING IN ACUTE ISCHEMIC STROKE Timo Krings MD, PhD, FRCP (C) Professor of Radiology & Surgery Braley Chair of Neuroradiology, Chief and Program Director of Diagnostic and Interventional Neuroradiology;
More informationThrombus hounsfield unit on CT predicts vascular recanalization in stroke patients
Thrombus hounsfield unit on CT predicts vascular recanalization in stroke patients Poster No.: C-2616 Congress: ECR 2010 Type: Scientific Exhibit Topic: Neuro Authors: H. F.Termes, J. Puig, J. Daunis-i-Estadella,
More informationEndovascular Treatment of Tandem Internal Carotid and Middle Cerebral Artery Occlusions
Endovascular Treatment of Tandem Internal Carotid and Middle Cerebral Artery Occlusions Haitham Dababneh, MD *1, Asif Bashir, MD *1, Mohammed Hussain, MD *1, Waldo R Guerrero, MD 2, Walter Morgan, MD 3,
More informationReview Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials Steven Warach
Review Use of diffusion and perfusion magnetic resonance imaging as a tool in acute stroke clinical trials Steven Warach Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological
More informationThrombolysis in acute stroke
152 Thrombolysis in acute stroke Cerebrovascular disease has a major impact on people s physical, social and mental well-being, and is a major financial burden on the NHS. In recent times, the management
More informationEndovascular Treatment for Acute Ischemic Stroke: Considerations from Recent Randomized Trials
Published online: March 13, 2015 1664 9737/15/0034 0115$39.50/0 Review Endovascular Treatment for Acute Ischemic Stroke: Considerations from Recent Randomized Trials Manabu Shirakawa a Shinichi Yoshimura
More informationIntravenous thrombolysis (IVT) using recombinant tissue
Intra-Arterial Thrombolysis in 100 Patients With Acute Stroke Due to Middle Cerebral Artery Occlusion Marcel Arnold, MD; Gerhard Schroth, MD; Krassen Nedeltchev, MD; Thomas Loher, MD; Luca Remonda, MD;
More informationBackground. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association
for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association An Scientific Statement from the Stroke Council, American Heart Association and American Stroke Association
More informationDoor to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD. Virginia Mason Medical Center March 16, 2018
Door to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD Virginia Mason Medical Center March 16, 2018 2016 Virginia Mason Medical Center No disclosure 2016 Virginia Mason Medical Center
More informationDrano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients
Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School
More informationThe approval of intravenous thrombolysis with tissue
Two Tales: Hemorrhagic Transformation but Not Parenchymal Hemorrhage After Thrombolysis Is Related to Severity and Duration of Ischemia MRI Study of Acute Stroke Patients Treated With Intravenous Tissue
More informationThe Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients
The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients Yu Mi Jang, MD Deok Hee Lee, MD Ho Sung Kim, MD Chang Woo Ryu,
More informationBest medical therapy (includes iv t-pa in eligible patients)
UDATE ON REVASCAT: (Randomized Trial Of Revascularization With Solitaire FR Device Versus Best Medical Therapy In The Treatment Of Acute Stroke Due To Anterior Circulation Large Vessel Occlusion Presenting
More informationMechanical thrombectomy beyond the 6 hours. Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital
Mechanical thrombectomy beyond the 6 hours Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital Disclosures None Worldwide statistics 1 IN 6 people will have a stroke at some
More informationStroke is the fourth leading cause of death in the United
Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous Intra-Arterial Thrombolysis Michael T. Mullen,
More informationSubtherapeutic Warfarin Is Not Associated With Increased Hemorrhage Rates in Ischemic Strokes Treated With Tissue Plasminogen Activator
Subtherapeutic Warfarin Is Not Associated With Increased Hemorrhage Rates in Ischemic Strokes Treated With Tissue Plasminogen Activator Mervyn D.I. Vergouwen, MD, PhD; Leanne K. Casaubon, MD, MSc; Richard
More informationNew therapies directed at acute middle cerebral artery
Regional Angiographic Grading System for Collateral Flow Correlation With Cerebral Infarction in Patients With Middle Cerebral Artery Occlusion Jane J. Kim, MD; Nancy J. Fischbein, MD; Ying Lu, PhD; Daniel
More informationMedico-Legal Aspects of Using Tissue Plasminogen Activator in Acute Ischemic Stroke
Current Treatment Options in Cardiovascular Medicine (2011) 13:233 239 DOI 10.1007/s11936-011-0122-0 Cerebrovascular Disease and Stroke Medico-Legal Aspects of Using Tissue Plasminogen Activator in Acute
More informationPractical Considerations in the Early Treatment of Acute Stroke
Practical Considerations in the Early Treatment of Acute Stroke Matthew E. Fink, MD Neurologist-in-Chief Weill Cornell Medical College New York-Presbyterian Hospital mfink@med.cornell.edu Disclosures Consultant
More informationPredictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke
THIEME Original Article 139 Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke Yosuke Tajima 1 Michihiro Hayasaka 1 Koichi Ebihara 1
More informationLack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke JAMA. 2001;286:
ORIGINAL CONTRIBUTION Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke Suresh C. Patel, MD Steven R. Levine, MD Barbara C. Tilley, PhD James C. Grotta, MD
More informationParameter Optimized Treatment for Acute Ischemic Stroke
Heart & Stroke Barnett Memorial Lectureship and Visiting Professorship Parameter Optimized Treatment for Acute Ischemic Stroke December 2, 2016, Thunder Bay, Ontario Adnan I. Qureshi MD Professor of Neurology,
More informationFibrinolytic Therapy in Acute Stroke
218 Current Cardiology Reviews, 2010, 6, 218-226 Fibrinolytic Therapy in Acute Stroke Mònica Millán*, Laura Dorado and Antoni Dávalos Stroke Unit, Department of Neurosciences, Germans Trias i Pujol University
More informationMichael Horowitz, MD Pittsburgh, PA
Michael Horowitz, MD Pittsburgh, PA Introduction Cervical Artery Dissection occurs by a rupture within the arterial wall leading to an intra-mural Hematoma. A possible consequence is an acute occlusion
More informationPerils of Mechanical Thrombectomy in Acute Asymptomatic Large Vessel Occlusion
Perils of Mechanical Thrombectomy in Acute Asymptomatic Large Vessel Occlusion Aman B. Patel, MD Robert & Jean Ojemann Associate Professor Director, Cerebrovascular Surgery Director, Neuroendovascular
More informationENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning
More informationStrokecenter Key lessons of MR CLEAN study
Strokecenter Key lessons of MR CLEAN study Diederik Dippel Disclosures Funded by the Dutch Heart Foundation Nominal, unrestricted grants from AngioCare BV Medtronic/Covidien/EV3 MEDAC Gmbh/LAMEPRO Penumbra
More informationCarotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article
More informationDiagnostic and Therapeutic Consequences of Repeat Brain Imaging and Follow-up Vascular Imaging in Stroke Patients
AJNR Am J Neuroradiol 0:7, January 999 Diagnostic and Therapeutic Consequences of Repeat Brain Imaging and Follow-up Vascular Imaging in Stroke Patients Birgit Ertl-Wagner, Tobias Brandt, Christina Seifart,
More informationAngiographic Assessment of Pial Collaterals as a Prognostic Indicator Following Intra-arterial Thrombolysis for Acute Ischemic Stroke
AJNR Am J Neuroradiol 26:1789 1797, August 2005 Angiographic Assessment of Pial Collaterals as a Prognostic Indicator Following Intra-arterial Thrombolysis for Acute Ischemic Stroke Gregory A. Christoforidis,
More informationPrognostic Value of the Hyperdense Middle Cerebral Artery Sign and Stroke Scale Score before Ultraearly Thrombolytic Therapy
Prognostic Value of the Hyperdense Middle Cerebral Artery Sign and Stroke Scale Score before Ultraearly Thrombolytic Therapy Thomas Tomsick, Thomas Brott, William Barsan, Joseph Broderick, E. Clarke Haley,
More informationNHL Journal of Medical Sciences/July 2014/Vol 3/Issue 2 18
Research article NIHSS Score: A handy tool to predict vascular occlusion in acute ischemic stroke Ronak Shah*, Chintal Vyas**, Jyoti Vora*** *Senior Resident, **Assistant Professor, ***Associate Professor,
More informationDisclosure. Advances in Interventional Neurology. Disclosure. Natural History of Disease 3/15/2018. Vishal B. Jani MD
Advances in Interventional Neurology Disclosure Vishal B. Jani MD Medical Director Vascular Neurology Consultant Interventional Neurology CHI Health Assistant Professor, Creighton University School of
More information