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However, despite successful revascularization, microvascular obstruction (MVO) remains a major challenge, contributing to adverse clinical outcomes. This article explores the potential role of intracoronary thrombolysis, in conjunction with thrombus aspiration, in improving microcirculatory perfusion during PCI for STEMI patients.
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.,
In this case report, we demonstrated that thrombus aspiration and in situ thrombolysis through the Guidezilla GEC are applicable to patients with PE in whom systemic thrombolysis is contraindicated, resulting in successful reperfusion and positive clinical outcomes.
BACKGROUND:Prior clinical trials have demonstrated the efficacy of ultrasound-facilitated catheter-directed thrombolysis (USCDT) for the treatment of acute intermediate-risk pulmonary embolism (PE) using reduced thrombolytic doses and shorter infusion durations.
Background and Purpose:Thrombolysis can improve outcome in patients with acute ischemic stroke. Properties of the formed thrombus may influence thrombolysis efficiency and impede recanalization success. Higher thrombin generation may influence thrombus properties, reducing effectiveness of thrombolysis, and impairing recanalization.
BackgroundIntravenous thrombolysis (IVT) is an effective stroke therapy that remains underused. Outcomes included symptomatic intracranial hemorrhage, any intracranial hemorrhage, serious systemic bleeding, and 90‐day functional independence (modified Rankin scale score 0–2). Journal of the American Heart Association, Ahead of Print.
In our study population of 1000 thrombectomy‐eligible patients (513 women; median age, 77 years [interquartile range, 67–84]), IVT emerged as a predictor of favorable functional outcome (modified Rankin Scale score, 0–2) independent of modified mTICI score (adjusted odds ratio, 0.49 [95% CI, 0.32–0.75];P=0.001). 0.75];P=0.001).
Intracoronary (IC) thrombolytic therapy can reduce microvascular thrombotic burden; however, contemporary studies have produced conflicting outcomes. The primary outcome was major adverse cardiac events (MACE). IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51
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.
Introduction:Trials using advanced imaging have shown a benefit from intravenous thrombolysis in patients with wake-up stroke, but real-world data is limited. In this study, we compared discharge outcomes and hospital length of stay for patients with ischemic stroke selected for wake-up protocol with vs. without thrombolytic therapy.
What is the association of treatment with intravenous thrombolysis (IVT) plus thrombectomy versus thrombectomy alone and outcomes modification by the time from stroke symptom onset to treatment?
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.
nationwide quality initiative Target: Stroke (TS) is associated with improvement in thrombolysis frequency, timeliness, and outcome, according to a study published online Feb. 7 in JAMA Network Open.
We performed sensitivity analysis using propensity score matching.Results:In our study population of 1000 thrombectomy-eligible patients (513 females, median age 77 [67-84, interquartile range]) IVT emerged as predictor of favorable functional outcome (mRS 0-2) independent of mTICI (adjusted OR 0.49; 95% CI [0.32;0.75]; p=0.001).
Introduction:Emergency-department-based implementation strategies to increase thrombolysis are promising. We sought to quantify the number of hospitals with opportunities to increase thrombolysis under various tPA treatment thresholds.Methods:We used data from the 2018 State Inpatient Databases (SID) from 17 states.
Background and Purpose:Whether imaging markers of cerebral small vessel disease on computed tomography (CT-CSVD) relates to early clinical outcomes after intravenous thrombolysis for acute ischemic stroke remains not well understood. 1.02; score 2: OR 0.46, 95%CI 0.26-0.83; 0.83; score 3: OR 0.16, 95%CI 0.03-0.76, 1.95, p = 0.019).Conclusion:This
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 (..)
To compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both.
Introduction:Large vessel recanalization (LVR) is a well described phenomenon following intravenous thrombolysis (IVT). The secondary endpoint was 90-day modified Rankin Scale (mRS) outcomes. Conclusions:LVR with IVT prior to EVT was significantly associated with lower odds of infarct progression and better clinical outcomes.
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.
Introduction:Reducing door-to-needle (DTN) times lead to improved patient outcomes in acute ischemic stroke. 2) Creation of a multidisciplinary Thrombolysis Focus Group to analyze data and improve processes. 2) Creation of a multidisciplinary Thrombolysis Focus Group to analyze data and improve processes. in 2020, to 31.9%
NETs are proposed as a mechanism of resistance to thrombolysis. Thrombolysis was remarkably associated with higher NE positivity (average marginal effect, 6.461 [95% CI, 0.7901–12.13];P=0.02555), regardless of the origin of thrombi. BACKGROUND:Thrombosis is linked to neutrophil release of neutrophil extracellular traps (NETs).
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.
Introduction:In acute stroke patients who receive revascularization with endovascular thrombectomy (EVT) alone vs intravenous thrombolysis (IVT) followed by EVT, combination treatment has shown improved outcomes measured by the modified Rankin Scale (mRS). The TICI revascularization score of 2c had the highest mean MoCA (22.1;
We aim to provide an overview of cervical artery dissection in the setting of minor or no reported mechanical trigger with a focus on summarizing the available evidence and providing suggestions on the diagnostic evaluation, treatment approaches, and outcomes. The diagnosis can be challenging both clinically and radiologically.
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: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
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.
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.
A good clinical outcome (mRS 90day 2) was achieved by 61.4%. There were also no other complications.Conclusion:Rescue therapy in the form of prolonged low-dose thrombolysis seems to be an effective and safe alternative to therapeutic nihilism in ultra-early stroke recurrence. Improvement occurred in 70.5% of patients.
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
Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.Methods:This was an explorative analysis of a nationwide database of hospitalizations in the United States. Primary outcome was routine discharge to home with self-care. 4.16], p=0.001).
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.
BACKGROUND:The international trial AVERT (A Very Early Rehabilitation Trial) found that very early mobilization (VEM; commenced <24 hours after stroke) negatively affected functional outcome (modified Rankin Scale [mRS]). The drivers of this effect remain unclear. Of 689 participants (37.2% female; median age, 74.5
IntroductionOver the past decade, stroke management has significantly improved with the widespread use of intravenous thrombolysis (IVT) and the establishment of endovascular thrombectomy (EVT) as the standard of care for increasing patients. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.
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
Introduction:Telestroke has the potential to revolutionize acute stroke treatment by improving access to optimal stroke care, including time-sensitive care such as thrombolysis. presented 4 hours of last known well, no contraindications to thrombolysis). presented 4 hours of last known well, no contraindications to thrombolysis).
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.
Despite successful reperfusion, many patients still have unfavorable outcomes even in the presence of favorable arterial collaterals. These patients were dichotomized into favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups. In a multivariable regression analysis, intravenous thrombolysis administration (OR 3.27 [95% CI: 1.04-10.33];
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).
Background:Mechanical thrombectomy (MT) as treatment for acute ischemic stroke (AIS) has demonstrated superior functional outcomes compared to intravenous thrombolysis (IVT). Yet AIS survivors often experience a range of unstudied post-stroke complications which negatively affect patient reported outcomes.
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