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Findings from the highly-anticipated MOST (Multi-Arm Optimization of Stroke Thrombolysis) trial were presented on the first day of the American Stroke Association’s International Stroke Conference, ISC 2024, being held through Feb. The study was looking for improvement in functional outcomes at 90 days. 9 Phoenix, AZ. Adeoye, M.D.,
BACKGROUND:Timely intravenous thrombolysis and endovascular thrombectomy are the standard reperfusion treatments for large vessel occlusion stroke. METHODS:We enrolled consecutive patients in the multicenter Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke who had received combined thrombolysis (within 4.5
Findings from the first international randomized controlled trial to compare patient outcomes following treatment with large-bore mechanical thrombectomy (LBMT) versus catheter-directed thrombolysis (CDT) for intermediate-risk pulmonary embolism (PE) show that LBMT is superior with respect to the hierarchically-tested aggregated outcome of all-cause (..)
Introduction:Stroke is a leading cause of disability and mortality worldwide, with thrombolysis as a critical treatment. Studies aiming to assess the outcomes of thrombolysis after ischemic stroke in LMIC were selected. Seven randomized controlled trials (RCTs) were included and analyzed independently.
IntroductionEfficacy and safety of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) is still debatable. However, IVT's efficacy on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes specifically remain unclear. ResultsWe included four randomized controlled trials with 1176 patients.
The safety of the treatment was evaluated based on the occurrence of any complications, the occurrence of intracerebral hemorrhage, and the occurrence of symptomatic intracerebral hemorrhage (assessed according to SITS-MOST criteria).Results:44 A good clinical outcome (mRS 90day 2) was achieved by 61.4%. men, average age 71.512.2
Background:The prognostic significance of the affected hemisphere in hemorrhagic stroke remains uncertain. We aimed to determine the relationship between the affected hemisphere (right or left) and differences in non-motor outcomes (pain, mood) in patients with acute intracerebral hemorrhage (ICH).
Definitions of symptomatic HT developed during the intravenous thrombolysis (IVT) era are outdated in the endovascular thrombectomy (EVT) era but continue to be widely used. Symptomatic hemorrhages were due to subarachnoid hemorrhage in more than half and PH-2 in only one-quarter of symptomatic hemorrhages in this EVT series.
Background:Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is thought to be due to excess protein deposition in vessel walls that lead to fragility and increase the risk of rupture. Primary outcome was routine discharge to home with self-care. to 5.75], p<0.001), and SAH (aOR 2.42 [95%CI 1.41-4.16],
hour window, and reperfusion through thrombolysis has been shown to enhance functional outcomes in patients with salvageable brain tissue beyond this timeframe.Objective:The aim of this study is to assess the efficacy and safety of thrombolysis administered more than 4.5 h to standard of care. h to standard of care.
BACKGROUND:The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Stroke, Ahead of Print.
The primary efficacy outcome was good 3-month functional outcome, defined as a modified Rankin scale (mRS) 0-2. The primary efficacy outcome was good 3-month functional outcome, defined as a modified Rankin scale (mRS) 0-2. Safety outcomes were any intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) at 24-36hrs.
We evaluated the risk of hemorrhage associated with newer, more potent antiplatelet medications and dual antiplatelet regimens among patients treated with intravenous tissue plasminogen activator (IV-tPA).Methods:Using The primary outcome of interest was symptomatic intracranial hemorrhage (sICH) within 36 hours of tPA administration.
Intracerebral hemorrhage (ICH) is a main complication of IVT, with prevalence reported around 3.2% Additionally, extravasation of contrast was seen within the left basal ganglia region, concerning for hemorrhagic transformation from IV‐tPA. Left ICA stenting was not completed secondary to hemorrhagic transformation.
Introduction:Current guidelines suggest using intravenous thrombolysis (IVT) for patients experiencing acute ischemic stroke within 4.5 The efficacy outcomes were the 3-months modified Rankin Scale (mRS) 0-1 or return to baseline mRS and an improvement of two points in the 24hrs-NIHSS or a 24hrs-NIHSS of 0. hours of symptom onset.
However, there is conflicting data in terms of intracranial hemorrhage risk.Objective: We are reporting the rate of symptomatic intracranial hemorrhage(sICH) in TNK and tPA treated stroke populations across two large hospital systems.MethodsDesign: Retrospective cohort observational study. A total of 431 patients were included.
Introduction:The tenecteplase versus standard of care for minor ischemic stroke with proven occlusion (TEMPO-2) trial showed that patients presenting with minor deficits up to 12 h do not benefit from intravenous thrombolysis. h, if they were not eligible for standard-of-care thrombolysis. mg/kg) or non-thrombolytic standard of care.
The effectiveness and safety of intravenous thrombolysis (IVT) for acute ischemic stroke in these cases, particularly those involving large vessel occlusions, are debated. However, IVT was associated with a significantly higher odds of good functional outcome at 90-days (aOR, 1.53 [95% CI, 1.14-2.05])
Median time from the onset of visual change to thrombolysis was 6.0 [4.5-10.5] One (5.3%) patient had intra-ocular hemorrhage post thrombolysis.Conclusion:Compared to central retinal artery occlusion, patient with branched retinal occlusion have better visual recovery following IA or IV thrombolysis. VA improvement of ≥0.1
Background and Aims:Endovascular treatment (EVT) alone has been confirmed to be non-inferior to intravenous thrombolysis (IVT) followed with EVT in acute ischemic stroke (AIS) due to large-vessel occlusion of the anterior circulation. Stroke, Volume 56, Issue Suppl_1 , Page AWP253-AWP253, February 1, 2025.
The role of adjunctive intravenous thrombolysis, such as intravenous tissue plasminogen activator (IVtPA), with MT remains unclear, especially for medium vessel occlusion (MeVO). In univariable regression, all outcomes were comparable between the two groups, except for higher mRS 0-2 rates in the MT+IVtPA group.
We defined two binary outcomes: (1) functional clinical outcome (modified Rankin Scale 0-2) and (2) early symptomatic intracerebral hemorrhage (sICH). 4.14, p=0.9502), but it was associated with a functional clinical outcome at 90 days (OR 3.39, 95% CI 1.11-10.43, 10.43, p=0.0325).Conclusions:The
Recent landmark trials BEST-MSU and B_PROUD have proven that MSUs facilitate quicker thrombolysis times and improved functional outcomes at 90 days when compared to conventional emergency medical services (EMS) for acute ischemic stroke patients. Faster time metrics convey a hypothetical benefit towards improved patient outcomes.
Background and Aims:Previous studies indicated the usual dose heparin(5000 IU bolus followed by 500~1250 IU/h) during mechanical thrombectomy(MT) is associated with an increased risk of hemorrhagic conversion without beneficial effect. This trend also seemed to be seen in patients who did not undergo intravenous thrombolysis group.
BACKGROUND:The association of COVID-19 with higher bleeding risk and worse outcomes in acute ischemic stroke (AIS) undergoing revascularization may be related to the presence of infection symptoms. The magnitude of this effect is more pronounced in symptomatic infections, which also present less favorable recanalization outcomes.
We studied the impact of intravenous thrombolysis (IVT) on the outcomes of EVT in those patients.Methods:We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Cochrane Handbook of Systematic Reviews and Interventions.
Direct-to-angiography workflow relies on CBCT to exclude intracranial hemorrhage (ICH) to determine treatment eligibility for intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Conclusion:CBCT had high specificity for ICH and hemorrhage types.
Background and objective:Perfusion imaging studies consistently show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. For this study, we included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] >0) and available baseline CT perfusion.
Introduction:Current guidelines recommend 24-hours of high-intensity monitoring (HIM) for acute ischemic stroke patients post-intravenous thrombolysis (IVT) due to risk of bleeding complications including symptomatic intracranial hemorrhage (sICH).
BACKGROUNDComorbidity burden may affect the outcome following endovascular thrombectomy (EVT) for mediumvessel occlusions. The primary outcome was a favorable outcome (modified Rankin Scale 02) at 90 days after EVT in relation to comorbidity burden. Stroke: Vascular and Interventional Neurology, Ahead of Print.
Introduction:Collateral status imaging parameters are associated with predicting hemorrhagic transformation (HT) in acute ischemic stroke caused by large vessel occlusions. Stroke, Volume 55, Issue Suppl_1 , Page ATP146-ATP146, February 1, 2024.
Introduction:Tenecteplase (TNK) is now an accepted alternative to Alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Hemorrhagic transformation (HT), a complication of IVT, is more frequent in acute hyperglycemia and diabetes (DM) and is associated with poor clinical outcomes.
We assessed the correlation of these parameters with infarct expansion, hemorrhagic transformation, and poor outcomes, defined as modified Rankin Scale scores of 4 to 6, at 3 months.RESULTS:A total of 65 cases were analyzed. Cerebral blood flow <45% (r=0.57;P<0.001)
Introduction:Outcomes after thrombolysis with alteplase (tPA) versus tenecteplase (TNK) prior to endovascular thrombectomy (EVT) have not been directly compared in real-world data (RWD). tPA was used exclusively for thrombolysis at one center (n=74), while TNK was used exclusively for thrombolysis at another center (n=130).
The patients with successful recanalization defined as modified Thrombolysis in Cerebral Infarction ≥2b at 5, 6, 7, or more passes were compared with unsuccessful recanalization. Primary outcome was a favorable 90‐day outcome (modified Rankin scale score of 0–2). We also compared procedure time, separated by 30 minutes.
The primary efficacy outcome was favorable functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at one year. We also evaluated procedural outcomes, including successful reperfusion, defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3, and complete reperfusion, defined as mTICI 3.Results:Among
Introduction:Real-world data showed that less than half of the acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (2-5) achieved favorable outcomes at 90 days after mechanical thrombectomy (MT). was related to 90-day mRS 0-3.
Intravenous thrombolysis was administered in 55 patients (22.1%) while general anesthesia was used in 94/248 patients (37.9%). Favorable clinical outcome (90-day mRS 0-3) was achieved in 99/246 patients (40.2%), with mortality affecting 98/246 patients (39.8%). years [SD 11.7], 208 [83.5%] male) were included.
Background:Atrial fibrillation (AF) has been shown to be associated with better procedural outcomes in patients with anterior circulation large vessel occlusion (aLVO) undergoing endovascular therapy (EVT). Forty-four percent of the no AC group received intravenous thrombolysis (IVT). In the NOAC group, 59.5%
While DM can reduce the effect of intravenous thrombolysis, metformin can have a positive outcome on AIS patients. The outcomes of stroke in diabetic patients receiving metformin is largely unexplored. There is a trend of favorable outcomes of mRS and Mortality, with a non-statistical significance increase of sICH.
Introduction:Tenecteplase improves reperfusion and functional outcomes in stroke patients with large vessel occlusion. Primary outcome was mRS at 90 days. Secondary outcomes were NIHSS at 24 hours and at discharge. Secondary outcomes were NIHSS at 24 hours and at discharge. Median NIHSS at presentation (18.0 versus 16.0,
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