Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

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.

Hemorrhage 40

Hemorrhage Thrombolysis Stroke Strokes 40

DAIC

FEBRUARY 26, 2024

Contemporary treatments to remove the clot include intravenous thrombolysis or mechanical thrombectomy using a catheter. The rapid reperfusion that followed caused brain hemorrhage and increased mortality,” says Wegener. However, even with timely clot removal, many stroke patients only recover poorly.

Stroke 105

Stroke Strokes Blood Clot Outcomes 105

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

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.

Hemorrhage 40

Hemorrhage Thrombolysis Stroke Strokes 40

Stroke Journal

FEBRUARY 1, 2024

Definitions of symptomatic HT developed during the intravenous thrombolysis (IVT) era are outdated in the endovascular thrombectomy (EVT) era but continue to be widely used.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.

Hemorrhage 40

Hemorrhage Outcomes Thrombolysis Stroke 40

Stroke Journal

FEBRUARY 1, 2024

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. Goal blood pressure was defined as systolic blood pressure <160.

Hemorrhage 40

Hemorrhage Blood Pressure Stroke Strokes 40

Stroke Journal

FEBRUARY 1, 2024

The role of adjunctive intravenous thrombolysis, such as intravenous tissue plasminogen activator (IVtPA), with MT remains unclear, especially for medium vessel occlusion (MeVO). Background:Mechanical thrombectomy (MT) has demonstrated superiority over medical therapy for acute ischemic stroke (AIS) with large vessel occlusion (LVO).

Thrombolysis 40

Thrombolysis Academic Hemorrhage Outcomes 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionEfficacy and safety of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) is still debatable. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. However, IVT's efficacy on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes specifically remain unclear.

Thrombolysis 40

Thrombolysis Outcomes Embolism Stents 40

DAIC

FEBRUARY 7, 2024

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. 9 Phoenix, AZ. Adeoye, M.D.,

Stroke 105

Stroke Strokes Outcomes Thrombolysis 105

Stroke Journal

FEBRUARY 1, 2024

Introduction:Intravenous thrombolysis (IVT) is efficacious treatment of acute ischemic stroke (AIS). Outcomes of interest were symptomatic intracranial hemorrhage (sICH), any ICH, serious systemic bleeding (SSB), and 90-day functional independence (mRS 0-2). Stroke, Volume 55, Issue Suppl_1 , Page A25-A25, February 1, 2024.

Thrombolysis 40

Thrombolysis Stroke Strokes Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

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

Thrombolysis 40

Thrombolysis Outcomes Hemorrhage Stroke 40

Medical Xpress - Cardiology

OCTOBER 30, 2024

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 (..)

Embolism 52

Embolism Pulmonary Outcomes ICU 52

Stroke Journal

FEBRUARY 1, 2024

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.

Hemorrhage 40

Hemorrhage Thrombolysis Diabetes Stroke 40

Stroke Journal

FEBRUARY 1, 2024

Studies suggest increased hemorrhage risk in patients with BP ≥170 mmHg and greater BP variability.Methods:We performed a retrospective study with data from the Get with The Guidelines database and electronic medical record of all adult AIS patients treated with TNK at a Comprehensive Stroke Center from 6/2021 to 6/2023. vs 4.9%; p=0.3)

Hemorrhage 40

Hemorrhage Blood Pressure Stroke Strokes 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionThe risk of tandem occlusion treatment in the setting of intravenous thrombolysis is unclear. Patients who received thrombolysis and subsequently underwent endovascular therapy for acute ischemic stroke between 2012 and 2022 were included. Baseline demographics and clinical characteristics were compared.

Thrombolysis 40

Thrombolysis Angioplasty Hemorrhage Stents 40

Stroke Journal

FEBRUARY 1, 2024

We defined two binary outcomes: (1) functional clinical outcome (modified Rankin Scale 0-2) and (2) early symptomatic intracerebral hemorrhage (sICH).

Stents 40

Stents Stent Thrombolysis Angioplasty 40

Stroke Journal

FEBRUARY 1, 2024

vs. 6.1%, p = 0.0326), and symptomatic intracerebral hemorrhage (7.3% Patients receiving thrombolysis prior to thrombectomy were less likely to have a prolonged LOS (27.8% p = 0.0002), not receiving IV thrombolysis (OR 2.3, p = 0.0027), and symptomatic intracranial hemorrhage (OR 5.2, vs. 1.9%, p = 0.0109). p = 0.0157).Conclusions:Almost

ICU 40

ICU Stroke Strokes Thrombolysis 40

Stroke Journal

FEBRUARY 1, 2024

Primary safety outcome was parenchymal hematoma type 2 (PH2) intracerebral hemorrhage. A t-test was used to examine association between outcomes and thrombolysis type. Fischer’s exact test was used to determine differences in recanalization and hemorrhage rates.Results:Of the 284 patients included, 213 received TPA and 71 received TNK.

Stroke 40

Stroke Strokes Thrombolysis Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Although prior antiplatelet therapy (APT) could potentially contribute to bleeding risk, the influence of prior APT on intravenous thrombolysis outcomes remains controversial. A favorable outcome was defined as a modified Rankin Scale of 0 to 1 at 90-days.

Stroke 40

Stroke Strokes Thrombolysis Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

Rates of Thrombolysis were alarming, but with an increasing tendency: 22969 were performed, from 1.6% Data was obtained through DataSUS, a public database. For the search, we utilized the CID-10 notification system from I60 until I64, including admissions, deaths, treatments and costs related to each CID-10.Results:Between were Male and 47.6%

Cerebrovascular Disease 40

Cerebrovascular Disease Thrombolysis Hemorrhage Public Health 40

Stroke Journal

DECEMBER 21, 2023

METHODS:We conducted an international multicenter retrospective cohort study of consecutive AIS tested for SARS-CoV-2, receiving intravenous thrombolysis and endovascular treatment between 2020 and 2021. We compared COVID-negative controls, AS-COVID, and S-COVID using multivariable regression. 1.99]; aOR, 1.63 [95% CI, 1.14–2.32],

COVID-19 40

COVID-19 Outcomes Stroke Strokes 40

Stroke Journal

FEBRUARY 1, 2024

Background:Prior studies have shown that individuals who have an in-hospital stroke are less likely to receive thrombolysis. Overall, in-hospital strokes were more likely to be hemorrhagic in 2015 than in 1993/94; 12 % in 2015 vs. 3.6% Stroke, Volume 55, Issue Suppl_1 , Page AWMP42-AWMP42, February 1, 2024. in1993/94 (p=0.003).

Hospital 40

Hospital Stroke Strokes Thrombolysis 40

Stroke Journal

MARCH 11, 2024

Background:The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0–5) remains inconclusive. 2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55–15.76]), 15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40–9.34]). Stroke, Ahead of Print.

Stroke 40

Stroke Strokes Hemorrhage Thrombolysis 40

Stroke Journal

FEBRUARY 1, 2024

Main Outcome Measures:The primary outcome measures assessed include the rate of favorable 90-day functional outcomes (modified Rankin Scale 0-2), successful reperfusion (Thrombolysis in Cerebral Infarction scale grade 2b or 3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. vs. 70.6 ± 14.5). min vs. 394.5

Stroke 40

Stroke Strokes Thrombolysis ICU 40

Journal of the American Heart Association

JANUARY 31, 2024

BackgroundMicrovascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well‐established imaging biomarkers of failed myocardial tissue reperfusion in patients with ST‐segment elevation–myocardial infarction treated with percutaneous coronary intervention. Journal of the American Heart Association, Ahead of Print.

Myocardial Infarction 40

Myocardial Infarction Thrombolysis Biomarkers Hemorrhage 40

Stroke: Vascular and Interventional Neurology

JANUARY 31, 2024

Secondary outcomes were in‐hospital mortality, intracerebral hemorrhage, and length of stay. In multivariable models, intravenous thrombolysis was independently associated with higher odds of routine discharge (adjusted OR, 1.78; 95% CI, 1.57–2.01;P<0.001) The primary outcome was routine discharge (home or self‐care).

Inpatient 40

Inpatient Circulation Stroke Strokes 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:ACTIMIS (NCT03803007) was a randomized phase 1b/2a clinical trial evaluating glenzocimab, a monoclonal antibody fragment targeting platelet receptor glycoprotein VI in patients with acute ischemic stroke treated by thrombolysis. Day-7 imaging was available for 9 fewer placebo patients and 1 glenzocimab patient.

Hemorrhage 40

Hemorrhage Thrombolysis Biomarkers Stroke 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

However, rates of symptomatic intracranial hemorrhages have been inconclusive. There is no standardized data on antithrombotic therapy use during CAS and MT procedures with less associated rates of symptomatic hemorrhagic transformation. Seven (26%) patients had symptomatic intracranial hemorrhages.

Stents 40

Stents Stent Hemorrhage Inpatient 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 2, 2023

Rates of successful aspiration catheter delivery without adjunctive devices and of successful reperfusion (Thrombolysis in Cerebral Infarction≥2B) were collected.RESULTSForty‐five patients met inclusion criteria (mean age 72.2±13.2 female; 71.1% M1 occlusions). Of these, 29 (82.9%) underwent successful contact aspiration.

Thrombolysis 40

Thrombolysis Academic Hemorrhage Stroke 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Also, we compared favorable outcomes following EVT in those with a core infarct at baseline of more than 70 ml, delayed thrombectomy of more than 6 hours, older than 75 years, and those who received concomitant IV thrombolysis. However, EVT was not associated with better outcomes in those who received IV thrombolysis (RR: 1.37, 95% CI: [0.93‐2.01].

Stroke 40

Stroke Strokes Thrombolysis Hemorrhage 40

Journal of the American Heart Association

JANUARY 31, 2024

The proportion of patients with mRS 0 or 1 was lower in patients with WUS who underwent thrombolysis versus those with known‐onset stroke (50.4% Symptomatic intracranial hemorrhage after thrombolytic treatment occurred in 4.4% Symptomatic intracranial hemorrhage after thrombolytic treatment occurred in 4.4% 2.41];P=0.726).ConclusionsThrombolytic

Stroke 40

Stroke Strokes Hemorrhage Thrombolysis 40

Stroke Journal

DECEMBER 28, 2023

Patients with acute ischemic stroke aged between 18 and 80 years who were eligible for standard intravenous thrombolysis were enrolled from 17 centers in China and randomly assigned (1:1:1) to receive intravenous reteplase 12+12 mg, intravenous reteplase 18+18 mg, or intravenous alteplase 0.9 Four patients did not receive the study agent.

Stroke 40

Stroke Strokes Hemorrhage Thrombolysis 40

Stroke Journal

FEBRUARY 1, 2024

Forty-four percent of the no AC group received intravenous thrombolysis (IVT). In the anticoagulated group, only patients on NOACs were included. In the NOAC group, 59.5% of patients achieved 90-day mRS of 0-2 vs 49.3% in the no AC group (aOR=1.32, p=0.57). The rate of successful reperfusion in the NOAC group was 98.7%

Atrial Fibrillation 40

Atrial Fibrillation Outcomes Thrombolysis Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

Intravenous thrombolysis was administered in 55 patients (22.1%) while general anesthesia was used in 94/248 patients (37.9%). years [SD 11.7], 208 [83.5%] male) were included. Basilar artery occlusions were recorded in 179 patients (71.9%) followed by V4 occlusions in 64 patients (25.7%) and PCA occlusions in 6 patients (2.4%).

Circulation 40

Circulation Outcomes Thrombolysis Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

Patients who underwent MT for ICA, M1, or M2 with unsuccessful recanalization (modified Thrombolysis in Cerebral Infarction ≤ 2a) were included. Secondary outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH). Primary outcome was 90- day modified Rankin Scale (mRS) 0-2.

Stroke 40

Stroke Strokes Thrombolysis Aneurysm 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 21, 2023

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. However, symptomatic intracranial hemorrhage was not significantly different between the groups. We also compared procedure time, separated by 30 minutes.

Outcomes 40

Outcomes Stroke Strokes Hemorrhage 40

Stroke Journal

FEBRUARY 1, 2024

While DM can reduce the effect of intravenous thrombolysis, metformin can have a positive outcome on AIS patients. Stroke, Volume 55, Issue Suppl_1 , Page AWP5-AWP5, February 1, 2024. Background:Diabetes mellitus (DM) is one of the risk factors for acute ischemic stroke, usually leading to poor prognosis.

Diabetes 40

Diabetes Stroke Strokes Outcomes 40

Stroke Journal

FEBRUARY 1, 2024

Outcomes included sICH, and inpatient mortality, adjusted for confounders which included age, gender, baseline NIHSS, perfusion grade (TICI) intravenous thrombolysis, history of diabetes and HBA1c.Results:A total of 224 patients (mean age was 68.7 years (±14.3); 44.2% were women) underwent endovascular treatment.

Inpatient 40

Inpatient Stroke Strokes Outcomes 40