Ischemia, Outcomes and Thrombolysis - Cardiovascular Update

Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study

Stroke Journal

JANUARY 4, 2024

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.

Thrombolysis

Thrombolysis Circulation Hemorrhage Outcomes

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Dr. S. Venkatesan MD

NOVEMBER 8, 2024

08/11, 12:07] Dr S Venkatesan: Is the therapeutic time window for primary PCI and thrombolysis same ? [08/11, Thrombolysis has a broader time window, but efficacy decreases significantly after 6 hours. [ 08/11, 12:13] Dr S Venkatesan: Time windows are related to time taken for myocardial cell death because of ischemia.

Thrombolysis

Thrombolysis Ischemia Hospital Outcomes

Abstract TP195: Impact of Intracranial Atherosclerotic Disease on Thrombectomy Outcomes in Acute Cerebral Infarction With Large Vessel Occlusion

Stroke Journal

FEBRUARY 1, 2024

However, clinical outcomes remain similar. This study compares post-thrombectomy outcomes in both groups, matched by initial NIHSS scores.Method:From October 2017 to March 2023, we studied LVO cases undergoing thrombectomy for acute ischemic stroke. Successful recanalization was defined as Thrombolysis in Cerebral Ischemia score ≥2b.

Outcomes

Outcomes Embolism Atrial Fibrillation Thrombolysis

Abstract TP193: Impact of Number of Passes on Outcomes of Mechanical Thrombectomy in Stroke Patients With Low ASPECTS

Stroke Journal

FEBRUARY 1, 2024

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.

Outcomes

Outcomes Stroke Strokes Hemorrhage

Abstract WP205: Development and Validation of a Prediction Model for Outcome in Mechanical Thrombectomy for Large-Vessel Occlusion Anterior Circulation Stroke With Low ASPECTS

Stroke Journal

FEBRUARY 1, 2024

Introduction:Recent randomized control trials suggested that mechanical thrombectomy (MT) was associated with good functional outcomes after acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS) (defined as ASPECTS 2-5). with a score of 2, 17.7%

Stroke

Stroke Strokes Circulation Outcomes

Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Stroke Journal

NOVEMBER 9, 2023

A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed.

Stroke

Stroke Strokes Thrombolysis Academic

Abstract WP192: Impact of Second Line Thrombectomy Technique Following Failed First Pass Thrombectomy for Anterior Circulation Stroke: To Switch or Not to Switch?

Stroke Journal

FEBRUARY 1, 2024

Introduction:Despite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first pass is unsuccessful. 3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15-3.85,

Stroke

Stroke Strokes Circulation Thrombolysis

Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD

Circulation

OCTOBER 18, 2023

BACKGROUND:Rivaroxaban plus aspirin compared with aspirin alone reduced major cardiac and ischemic limb events after lower extremity revascularization (LER) in the VOYAGER PAD (Vascular Outcomes Study of ASA Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease) trial. at 6 months and 2.0%

Peripheral Arterial Disease

Peripheral Arterial Disease Myocardial Infarction Thrombolysis Ischemia

Abstract TP188: Diving MCA and First-Pass Reperfusion: A Subgroup Analysis of the Arise II Study

Stroke Journal

FEBRUARY 1, 2024

MCA tortuosity was calculated using Inflection Count Metric(ICM) by two blinded readers to angiographical/clinical outcomes. The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b on first pass.

Atrial Fibrillation

Atrial Fibrillation Thrombolysis Stroke Strokes

Abstract 225: Rescue Stenting for Posterior Circulation Strokes

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. ConclusionPTAS appears to be an effective and safe treatment for ICAD after MT in the posterior circulation both improving likelihood of good outcomes and overall survival.

Stents

Stents Stent Circulation Stroke

Central Retinal Artery Occlusion: A Review of Pathophysiological Features and Management

Stroke: Vascular and Interventional Neurology

AUGUST 16, 2023

In CRAO, the time between initial insult to presentation is significant because, analogous to ischemic stroke, the duration of ischemia is inversely related to viable retinal tissue. Intravenous thrombolysis is a compelling therapeutic approach, with current limited data suggesting early intervention (4.5

Article

Article Thrombolysis Ischemia Risk Factors

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. His response: “subendocardial ischemia. Anything more on history? POCUS will be helpful.”

Ischemia

Ischemia STEMI Stenosis Chest Pain

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

For those who depend on echocardiogram to confirm the ECG findings of ischemia, this should be sobering. I have seen cases of Wellens' syndrome that were ignored because of either negative troponins or normal echo or both and the patient did not get an angiogram and had a bad outcome. Wellen's syndrome is a Reperfusion syndrome.

Myocardial Infarction

Myocardial Infarction Chest Pain Ischemia Angina

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Abstract TMP88: Impact of Tandem Vertebrobasilar Occlusion on Outcome of Mechanical Thrombectomy for Basilar Artery Occlusion

Stroke Journal

FEBRUARY 1, 2024

Objective:To investigate the treatment outcomes of MT in tVBO.Method:This international, multicenter, retrospective cohort included patients with MT for tVBO and isolated BAO from 2013 to 2023. The primary outcome was the 90-day modified Rankin Scale (mRS) score 0-2. These outcomes were compared between tVBO and isolated BAO groups.

Outcomes

Outcomes Thrombolysis Ischemia Stroke

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Blinded physicians adjudicated angiogram reports for coronary lesions and thrombolysis in myocardial infarction (TIMI) flow score.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. During the 48 hours of angina, such reversible ischemia often leads to myocardial stunning with akinesis of the myocardial wall that puts it at risk for thrombus.

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

Abstract 221: EARLY EXPERIENCE OF EMBOGUARD BALLOON GUIDE CATHETER IN LARGE VESSEL OCCLUSION THROMBECTOMY

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

With the evolving technology and newer generation of catheters and devices, the interest in improving the technical and procedural factors that can help better the recanalization success, clinical outcomes, and efficiency is ever‐growing. Most of the patients had MCA occlusion (68.4% with 50.9% of cases.

Thrombolysis

Thrombolysis Ischemia Hemorrhage Stroke

Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study

AI machines are hot & hungry : Let us learn, teach, and train them in cardiology

Abstract TP195: Impact of Intracranial Atherosclerotic Disease on Thrombectomy Outcomes in Acute Cerebral Infarction With Large Vessel Occlusion

Abstract TP193: Impact of Number of Passes on Outcomes of Mechanical Thrombectomy in Stroke Patients With Low ASPECTS

Abstract WP205: Development and Validation of a Prediction Model for Outcome in Mechanical Thrombectomy for Large-Vessel Occlusion Anterior Circulation Stroke With Low ASPECTS

Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Abstract WP192: Impact of Second Line Thrombectomy Technique Following Failed First Pass Thrombectomy for Anterior Circulation Stroke: To Switch or Not to Switch?

Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD

Abstract TP188: Diving MCA and First-Pass Reperfusion: A Subgroup Analysis of the Arise II Study

Abstract 225: Rescue Stenting for Posterior Circulation Strokes

Central Retinal Artery Occlusion: A Review of Pathophysiological Features and Management

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Right precordial ST depression in a patient with chest pain

Abstract TMP88: Impact of Tandem Vertebrobasilar Occlusion on Outcome of Mechanical Thrombectomy for Basilar Artery Occlusion

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Abstract 221: EARLY EXPERIENCE OF EMBOGUARD BALLOON GUIDE CATHETER IN LARGE VESSEL OCCLUSION THROMBECTOMY

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