Thrombolytic Treatment Research Articles

Safety and Efficacy of Dual Thrombolytic Therapy With Mutant Prourokinase and Small Bolus Alteplase for Ischemic Stroke

Dual thrombolytic treatment with small bolus alteplase and mutant prourokinase has the potential to be a safer and more efficacious treatment for ischemic stroke than alteplase alone because mutant prourokinase is designed to act only on degraded fibrin without affecting circulating fibrinogen. To assess the safety and efficacy of this dual thrombolytic treatment compared with alteplase. This controlled, open-label randomized clinical trial with a blinded end point was conducted from August 10, 2019, to March 26, 2022, with a total follow-up of 30 days. Adult patients with ischemic stroke from 4 stroke centers in the Netherlands were enrolled. Patients were randomized (1:1) to receive a bolus of 5 mg of intravenous alteplase and 40 mg of an intravenous infusion of mutant prourokinase (intervention) or usual care with 0.9 mg/kg of intravenous alteplase (control). The primary outcome was any intracranial hemorrhage (ICH) on neuroimaging at 24 hours. Secondary outcomes included functional outcome at 30 days, symptomatic ICH, and fibrinogen levels within 24 hours. Analyses were by intention to treat. Treatment effects were adjusted for baseline prognostic factors. A total of 268 patients were randomized, and 238 (median [IQR] age, 69 [59-77] years; 147 [61.8%] male) provided deferred consent and were included in the intention-to-treat population (121 in the intervention group and 117 in the control group). The median baseline score on the National Institutes of Health Stroke Scale was 3 (IQR, 2-5). Any ICH occurred in 16 of 121 patients (13.2%) in the intervention group and 16 of 117 patients (13.7%) in the control group (adjusted odds ratio, 0.98; 95% CI, 0.46-2.12). Mutant prourokinase led to a nonsignificant shift toward better modified Rankin Scale scores (adjusted common odds ratio, 1.16; 95% CI, 0.74-1.84). Symptomatic ICH occurred in none of the patients in the intervention group and 3 of 117 patients (2.6%) in the control group. Plasma fibrinogen levels at 1 hour remained constant in the intervention group but decreased in the control group (β = 65 mg/dL; 95% CI, 26-105 mg/dL). In this trial, dual thrombolytic treatment with small bolus alteplase and mutant prourokinase was found to be safe and did not result in fibrinogen depletion. Further evaluation of thrombolytic treatment with mutant prourokinase in larger trials to improve outcomes in patients with larger ischemic strokes is needed. Overall, in patients with minor ischemic stroke who met indications for treatment with intravenous thrombolytics but were not eligible for treatment with endovascular therapy, dual thrombolytic therapy with intravenous mutant prourokinase was not superior to treatment with intravenous alteplase alone. ClinicalTrials.gov Identifier: NCT04256473.

In Vitro Thrombolytic Activity Test On Ethyl Acetate Fraction of Herb Phyllanthus niruri L

Atherothrombotic, which is an atherosclerotic inflammation with thrombus, is characterized by damage to blood vessels that causes myocardial infarction and isemic stroke with thrombolytic treatment. The side effects of thrombolytic treatment are the cause of the importance of alternative medicine from natural ingredients. The ethyl acetate fraction in Phyllanthus niruri L. is suspected to have thrombolytic activity due to the content of coumarin and flavonoid bioactive compounds based on research that has been done. The purpose of this study was to determine the thrombolytic activity of the ethyl acetate fraction of Phyllanthus niruri L. Thrombolytic activity test is done by measuring the percentage of clot lysis. This study used a true experimental method with a Post Test Only Control Group Design model in 6 treatments, positive control, negative control (PBS and 0.5% DMSO) and four samples for both tests, namely 250 g/mL, 500 g/mL, 1000 g/mL, 2000 g/mL. The results of statistical analysis showed that the data were normally distributed (Shapiro Wilk, p>0.05). The result of the largest clot lysis thrombolytic test was 24.43% (2000ppm) smaller than the positive control 46.33%. The results of the thrombolytic ANOVA test showed that there was no significant difference between treatments, p<0.05, namely 0.017 and F Count > F Table, namely 0.937>3.11. Based on the results, it was found that the ethyl acetate fraction of the herb Phyllanthus niruri L. had a thrombolytic substance with low potency.

Effects of acupuncture on neurologic function and serum inflammatory factors after thrombolysis in acute ischemic stroke

To observe the effects of acupuncture on neurologic function and serum inflammatory factors in patients after thrombolysis in acute ischemic stroke (AIS).A total of 102 AIS patients with onset to treatment time (OTT) ≤3 h were randomly divided into an observation group and a control group, 51 cases each group. In the control group, thrombolysis and conventional medical treatment were applied. On the basis of the treatment as the control group, acupuncture at Shuigou (GV 26), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), etc. was applied in the observation group, 30 min each time, once a day. Both groups were treated for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Rankin scale (mRS), modified Barthel index (MBI) and serum level of homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) were compared, and the clinical efficacy was evaluated in the two groups.After treatment, the scores of NIHSS, mRS and serum level of Hcy, hs-CRP were decreased compared with those before treatment (P<0.05), while the MBI scores were increased (P<0.05) in the two groups. The scores of NIHSS, mRS and serum level of Hcy, hs-CRP in the observation group were lower than those in the control group (P<0.05, P<0.01), the MBI score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 88.2% (45/51) in the observation group, which was superior to 70.6% (36/51) in the control group (P<0.05).Acupuncture could promote the recovery of neurologic function in patients after thrombolysis in AIS, improve the ability of daily living, which may be related to reducing the level of inflammatory factors, thus inhibiting inflammatory response and improving cerebral ischemia reperfusion injury.目的：观察针刺对急性缺血性脑卒中（AIS）溶栓患者神经功能及血清炎性因子水平的影响。方法：将102例发病至进行溶栓的治疗时间（OTT）≤3 h的AIS患者随机分为观察组和对照组，每组51例。对照组采用溶栓与内科常规治疗；在对照组治疗基础上，观察组予针刺治疗，穴取水沟、中脘、气海、内关等，每次30 min，每日1次，两组均治疗2周。比较两组患者治疗前后美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）、改良Barthel指数（MBI）评分及血清同型半胱氨酸（Hcy）、超敏C反应蛋白（hs-CRP）水平，并评定两组临床疗效。结果：治疗后，两组患者NIHSS、mRS评分及血清Hcy、hs-CRP水平均较治疗前降低（P<0.05），MBI评分较治疗前升高（P<0.05）；观察组患者NIHSS、mRS评分及血清Hcy、hs-CRP水平均低于对照组（P<0.05，P<0.01），MBI评分高于对照组（P<0.01）。观察组总有效率为88.2%（45/51），高于对照组的70.6%（36/51，P<0.05）。结论：针刺可促进AIS溶栓患者神经功能恢复，改善日常生活能力，可能与降低炎性因子水平从而抑制炎性反应、改善脑血管缺血后再灌注损伤有关。.

Clinical profiles of acute arterial ischemic neonatal stroke.

Perinatal stroke includes a heterogeneous group of early focal neurological injuries affecting subsequent brain development, often resulting in motor sequelae, symptomatic epilepsies, and cognitive, language and behavioral impairment. The incidence of perinatal stroke is about 1/3500 live birth. A PubMed and SCOPUS search strategy included the entries "neonatal ischemic stroke" OR "perinatal ischemic stroke" and the age of the filter under 18 years and January 2000-August 2022. The cumulative literature analysis highlighted 3880 published patients (from 98 articles) with stroke, mainly presenting with clinical or electro-graphical seizures (2083 patients). The mean age at presentation was 2,5±2,4 days (data available for 1182 patients). Stroke occurred in the first week of life in 1164 newborns. The mainly involved ischemic areas were within the territories of the middle cerebral artery (1403 patients). Predisposing risk factors included fetal/newborn factors (1908 patients), dystocial birth (759 patients), maternal (678 patients), and placental factors (63 patients). No thrombolysis and/or endovascular treatments were performed, while data about other pharmacological treatments were restricted to a single article. The death occurred in 29 newborns. Motor, neurocognitive and language impairment were cumulatively reported in 875 patients. Epileptic seizures during the follow-up were reported in 238 cases. The literature analysis highlighted that every term newborn presenting with acute neurological signs and symptoms during the first week of life should always be considered for the identification of an ischemic stroke.

Meta-Analysis of the Association Between Atrial Fibrillation, Hypertension, Sleep-Disordered Breathing, and Wake-Up Stroke.

The occurrence of atrial fibrillation, circadian fluctuation in blood pressure, and oxygen desaturation at night is likely associated with the pathophysiology of wake-up stroke. Whether patients who experience wake-up strokes are candidates for thrombolysis treatment is a serious dilemma. The aim is to investigate the association between risk factors and wake-up stroke and to determine variations that are associated with the pathophysiology of wake-up stroke. Five major electronic databases were searched using a fitted search strategy to identify relevant studies. Odds ratios with 95% CIs were used to calculate estimates, and the Quality Assessment for Diagnostic Accuracy Studies-2 tool was used to conduct the assessment quality. A total of 29 studies were included in this meta-analysis. Hypertension is not associated with wake-up stroke (odds ratio, 1.14 [95% CI, 0.94-1.37]; P = .18). Atrial fibrillation is an independent risk factor to wake-up stroke, with a statistically significant difference (odds ratio, 1.28 [95% CI, 1.06-1.55]; P = .01). Subgroup analysis showed a different result in patients with sleep-disordered breathing, although no significant difference was assessed. This study revealed that atrial fibrillation is an independent risk factor for wake-up stroke and that patients with atrial fibrillation who also experience sleep-disordered breathing tend to have fewer wake-up strokes.

Expediting emergent MRI in acute ischemic stroke by extending CT scout image: a simple intervention to decrease time to treatment (P11-5.010)

<h3>Objective:</h3> We revised our acute stroke CT protocol to reduce time to MRI in acute ischemic stroke. <h3>Background:</h3> “Time is brain” in acute stroke. Patients requiring emergent MR imaging in the emergency department prior to thrombolytic treatment (e.g. wake-up strokes, iodinated contrast allergy, assessment of DWI/FLAIR mismatch) must undergo the MRI safety screen for implantable devices and foreign metallic bodies. Patient factors including neurologic deficits, language barrier, or lack of information on implantable devices make the screening process time-consuming. If patients cannot complete the safety checklist, radiographic clearance with chest and abdomen x-rays is pursued which delays time to treatment. <h3>Design/Methods:</h3> We revised our CT acute stroke radiology protocol to include scout images from the head to the femur to screen for foreign bodies, implantable devices or metallic objects. Standard CTA head and neck scout images previously only extended to the mid-chest. The new protocol obviates need for MRI screening checklist in emergent situations and allows to proceed directly from CT to MRI with the assistance of the radiologist interpreting the scout image. <h3>Results:</h3> Our multidisciplinary stroke team has implemented this change in our emergency department CT acute stroke protocol. The difference in additional radiation exposure is minimal to non-significant; the estimated total radiation dose of the topogram for the head, neck, chest, abdomen, and pelvic regions is approximately 0.24mSv (of which only the abdomen and pelvis are additional in this protocol). In comparison, the radiation dose of a standard abdomen/pelvis radiograph is 0.7mSv. Data collection is ongoing to measure impact on door to needle time. <h3>Conclusions:</h3> Revision of the CT stroke protocol to extend the CT scout from the head to the femur can expedite clearance for emergent MRI in patients who are candidates for thrombolysis or thrombectomy at no significant expense or radiation. This has potential to reduce time to acute stroke treatment. <b>Disclosure:</b> Dr. Aghajan has nothing to disclose. Dr. Gupta has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for •

Progress in the treatment of acute pulmonary embolism and chronic thrombo-embolic pulmonary hypertension/disease.

The combination of an initial clinical approach aimed at evaluating the early risk of mortality with subsequent diagnostic and therapeutic approaches articulated on the overall patient's profile is recommended in acute pulmonary embolism (PE). The presence of pulmonary hypertension associated with the persistence of chronic vascular obstructions in the pulmonary arteries after one or more acute thrombo-embolic events identifies a condition defined as chronic thrombo-embolic pulmonary hypertension (CTEPH). The evolution of technology and knowledge in the field of imaging has allowed us to qualify the computed tomography angiography of the pulmonary arteries as the gold standard for the diagnostic confirmation of both acute PE and CTEPH. In both these conditions, the first therapeutic step is the immediate initiation of anticoagulant therapy. In acute high-risk PE, in addition to anticoagulant therapy, thrombolytic therapy is recommended; in the event of contraindications to thrombolysis, surgical embolectomy or percutaneous catheter-directed treatment represents viable treatment options. In CTEPH, the combination of data collected from cardiac catheterization, computed tomography angiography, and conventional angiography of pulmonary arteries allows a team of experts to identify candidates for pulmonary endarterectomy surgery. Inoperable patients should be considered for percutaneous balloon angioplasty of the pulmonary arteries which can improve patients' symptoms, quality of life, and prognosis.

Thrombolysis Outcomes in Acute Ischaemic Stroke Patients with Pre-Existing Cognitive Impairment.

Thrombolysis treatment for ischaemic stroke in patients with pre-existing disabilities, including cognitive impairment, remains controversial. Previous studies have suggested functional outcomes post-thrombolysis are worse in patients with cognitive impairment. This study aimed to compare and explore factors contributing to thrombolysis outcomes, including haemorrhagic complications, in cognitively and non-cognitively impaired patients with ischaemic stroke. A retrospective analysis of 428 ischaemic stroke patients who were thrombolysed between January 2016 and February 2021 was performed. Cognitive impairment was defined as a diagnosis of dementia, mild cognitive impairment, or clinical evidence of the condition. The outcome measures included morbidity (using NIHSS and mRS), haemorrhagic complications, and mortality, and were analysed using multivariable logistic regression models. The analysis of the cohort revealed that 62 patients were cognitively impaired. When compared to those without cognitive impairment, this group showed worse functional status at discharge (mRS 4 vs. 3, p < 0.001) and a higher probability of dying within 90 days (OR 3.34, 95% CI 1.85-6.01, p < 0.001). A higher risk of a fatal ICH post-thrombolysis was observed in the cognitively impaired patients, and, after controlling for covariates, cognitive impairment remained a significant predictor of a fatal haemorrhage (OR 4.79, 95% CI 1.24-18.45, p = 0.023). Cognitively impaired ischaemic stroke patients experience increased morbidity, mortality, and haemorrhagic complications following thrombolytic therapy. However cognitive status is not independently predictive of most outcome measures. Further work is required to elucidate contributing factors to the poor outcomes observed in these patients and help guide thrombolysis decision-making in clinical practice.

The impact of race and ethnicity on acute telestroke care: A multistate experience

Previous analyses suggest that ethnic and racial differences exist in acute stroke care including thrombolytic treatment rates. The current study evaluates ethnic or racial differences in acute stroke treatment within a multi-state telestroke program. Acute telestroke consultations seen in the Emergency Department in 203 facilities and 23 states were extracted from the Telecare by TeleSpecialistsTM database. Cases were reviewed for age, race, ethnicity, sex, last known normal time, arrival time, treatment with thrombolytic therapy, door-to-needle (DTN) time, and baseline National Institutes of Health Stroke Scale score. Race was defined as Black, White, or Other; ethnicity was defined as Hispanic or non-Hispanic. The current study included 13,221 acute telestroke consultations consisting of 9890 White, 2048 Black, and 1283 patients classified as Other. A total of 934 patients were Hispanic and 12,287 patients were non-Hispanic. There were no statistically significant differences noted in thrombolytic treatment rates when comparing White (7.9%) patients with non-White patients (7.4%), p = 0.36, or comparing Black (8.1%) with non-Black patients (7.8%), p = 0.59. In addition, there were no statistically significant differences in treatment rates comparing Hispanic (6.3%) with non-Hispanic (7.9%) patients, p = 0.072. We noted no measurable differences in DTN times by race or ethnicity. Contrary to previous reports, we failed to detect any significant differences in thrombolytic treatment rates and DTN times by race or ethnicity among stroke patients in a multistate telestroke program. These findings support the hypothesis that telestroke may mitigate racial and ethnic disparities which may be attributable to local variability in stroke procedures or access to healthcare.

ADDED UTILITY OF COMPUTED TOMOGRAPHY PERFUSION STUDY IN THE ASSESSMENT OF EARLY ISCHEMIC STROKE IN COMPARISON WITH NONCONTRAST COMPUTED TOMOGRAPHY - A PROSPECTIVE OBSERVATIONAL STUDY

Objective: 1. T o study the added utility of computed tomography perfusion study in the assessment of early ischemic stroke in comparison with non-contrast computed tomography. 2. To study the role of computed tomography perfusion study in deciding thrombolytic treatment/ therapeutic protocols aimed at reversing the cerebral ischemic insult. Conclusions and Results: It was observed that 15 (46.68%) patients were in the 61-70 years of age group followed by 8 (25%) in the age group of 51-60 years. The mean age of the patients was 58.87 ±12.14 years. Ÿ Females were affected more i.e. 18 (56.25%) compared to the male patients 14 (43.75%). Ÿ Most observed co-morbid condition was hypertension in 9 (28.13%) patients followed by hypertension and diabetes in 7 (21.87%) patients and diabetes in 6 (18.75%) patients. Ÿ Among the study participants 4 (12.50%) were smokers followed by 6 (18.75%) were alcoholic and smokers &amp; alcoholic (15.62%) respectively. Ÿ It was observed that the symptoms of palsy were present among 23 (71.88%) patients Ÿ The most commonly observed time of onset of symptoms was 3-5 hours in 23 (71.88%) patients followed by 1-3 hours (21.87%) and &gt;5 hours in 2 (6.25%) patients. Ÿ NCCT ndings observed was denite signs of stroke in 12 (37.5%) patients followed by suspected signs of stroke on NCCT (25%) Ÿ It was observed that no sign of stroke was observed in 12 (37.5%) patients. Ÿ CT perfusion ndings observed was increased mean transient time (MTT) in all (100%) patients followed by decreased blood ow in all (100%) patients. It was observed that cerebral blood volume decreased in 12 (37.5%) patients, increased in 8 (25%) and normal in 12 (37.5%) patients. Ÿ The correlation of NCCT and CT perfusion ndings observed that out of total 32 patients NCCT study identies 20 patients while all 32 patients were identied by CT perfusion study with sensitivity of 100%. Ÿ CT perfusion provides early diagnosis of ischemic stroke thus helps in management of stroke patients. Inference : The present study concludes that CT-perfusion had more sensitivity compared to NCCT in identifying early ischemic stroke. CT perfusion has additional utility in management of early ischemic stroke. CT Perfusion study provides important information to the neurologist and neuro-interventionalist when evaluating patients for endovascular reperfusion therapy by identifying the size of core infarction and penumbra

Cuffed-tunneled catheters in hemodialysis patients: problems and solution methods: A single-center retrospective cohort study

Background/Aim: Cuffed-tunneled catheter patients encounter various problems during their catheterization period. Early detection and resolution of these problems prolong the life of the catheter. The purpose of the present study was to investigate the problems and solution methods of cuffed-tunneled catheters in hemodialysis patients during their use in light of our experience and literature. Methods: The study was designed as a retrospective cohort study. Twenty-four months of patient data who had a diagnosis of renal failure and who received cuffed-tunneled hemodialysis catheters between January 2013 and June 21 in the Department of Cardiovascular Surgery of Adiyaman University Faculty of Medicine were analyzed electronically based on the hospital data recording system. The demographic characteristics, localization of the inserted catheter, and duration of catheter use were determined. Primary and secondary patency ratios were calculated and recorded along with the complications in the patients and our treatment approaches to these complications. Finally, the collected data were discussed with reference to the literature data. Results: The data from 322 cuffed-tunneled catheters were collected in a total of 228 patients during the observation period. It was found that no revision procedure was applied to 73 patients (catheter) during the 24-month period, and a total of 204 revision procedures were applied to 155 patients. The revision procedure consisted of 110 thrombolytic treatments, 64 vein exchanges, 18 tunnel changes, and 12 catheter changes. Primary and secondary patency ratios at 6, 12, 18, and 24 months were calculated as 90.79%, 63.60%, 40.11%, and 32.02% and 96.05%, 89.91%, 72.37%, and 58.33%, respectively. The most common factors that affected primary and secondary patency ratios were determined to be gender (P&lt;0.001 and P=0.056, respectively), body mass index (P&lt;0.001 and P&lt;0.001, respectively) and diabetes mellitus (P=0.018 and P=0.690, respectively). Conclusion: Thrombolytic treatment is an effective and safe method in catheter thrombosis, which is one of the most important factors rendering the cuffed-tunneled hemodialysis catheters dysfunctional. Also, in tunnel infections, tunnel replacement is a salvage procedure in patients with vascular access problems.

Thrombus formation in the suprahepatic inferior vena cava after microwave ablation in patients with hepatic metastasis: a case report

BackgroundMicrowave ablation (MWA) via ultrasound guidance is an important tool in the treatment of liver metastases. The most common postoperative complications are abdominal hemorrhage and bile leakage, whereas thrombosis in the suprahepatic inferior vena cava (IVC) is very rare, and clinical management is very difficult when the head end of the thrombus reaches the right atrium.Case presentationThis is a case report of a 52-year-old man with hepatic metastasis 21 months after radical resection of rectal cancer. After chemotherapy combined with targeted therapy, metastasis in segment IV (S4) of the liver was treated with microwave ablation. Two months after treatment, the hepatic metastasis in S4 showed a microwave ablation zone on MRI.Enhanced MRI showed venous thrombosis located in the left hepatic vein and IVC, and the head of the thrombus reached the right atrium. After two weeks of anticoagulation and thrombolytic treatment, the follow-up MRI showed that the venous thrombus had nearly disappeared.ConclusionWhen liver metastases are close to the hepatic vein, clinicians should pay attention to the occurrence of hepatic vein and IVC thrombosis following MWA; through early diagnosis and anticoagulation, pulmonary thromboembolism (PTE) can be minimized.

Drivers of Ischemic Stroke Hospital Cost Trends Among Older Adults in the United States.

The increased use of neuroimaging and innovations in ischemic stroke (IS) treatment have improved outcomes, but the impact on median hospital costs is not well understood. A retrospective study was conducted using Medicare 5% claims data for 75,525 consecutive index IS hospitalizations for patients aged ≥65 years from 2012 to 2019 (values in 2019 dollars). IS episode cost was calculated in each year for trend analysis and stratified by cost components, including neuroimaging (CT angiography [CTA], CT perfusion [CTP], MRI, and MR angiography [MRA]), treatment (endovascular thrombectomy [EVT] and/or intravenous thrombolysis), and patient sociodemographic factors. Logistic regression was performed to analyze the drivers of high-cost episodes and median regression to assess drivers of median costs. The median IS episode cost increased by 4.9% from $9,509 in 2012 to $9,973 in 2019 (P= .0021). Treatment with EVT resulted in the greatest odds of having a high-cost (>$20,000) hospitalization (odds ratio [OR], 71.86; 95% confidence interval [CI], 54.62-94.55), as did intravenous thrombolysis treatment (OR, 3.19; 95% CI, 2.90-3.52). Controlling for other factors, neuroimaging with CTA (OR, 1.72; 95% CI, 1.58-1.87), CTP (OR, 1.32; 95% CI, 1.14-1.52), and/or MRA (OR, 1.26; 95% CI, 1.15-1.38) had greater odds of having high-cost episodes than those without CTA, CTP, and MRA. Length of stay > 4 days (OR, 4.34; 95% CI, 3.99-4.72) and in-hospital mortality (OR, 1.85; 95% CI, 1.63-2.10) were also associated with high-cost episodes. From 2012 to 2019, the median IS episode cost increased by 4.9%, with EVT as the main cost driver. However, the increasing treatment cost trends have been partially offset by decreases in median length of stay and in-hospital mortality.

The effects of pharmacomechanical thrombolysis treatment administered to patients with iliofemoral deep vein thrombus

Aim: In this study, the mid-term results of the pharmacomechanical thrombolysis treatment administered in patients with iliofemoral acute-subacute (patients with symptoms less than 21 days old whose DVT was diagnosed with physical examination and duplex ultrasonography) deep vein thrombus (DVT) were investigated. The cases were evaluated in terms of disease-related quality of life, and the presence of post-thrombotic syndrome (PTS) which occurred in patients after previous DVT and treatment, and if present, its severity was determined. Material and Methods: Disease-related status of 40 patients (24 males, 16 females; mean age 44; age interval 20-80 years) treated due to iliofemoral acute-subacute DVT with interventional method between July 2013 and January 2017 were retrospectively analyzed two years after the interventional treatment. These patients were considered as mid-term patients. The patients were evaluated with VEINES-QOL/Sym quality of life scale and the Villalta scale. The occurrence and severity of PTS, the presence of venous ulcer, and the diameter difference between legs were evaluated. Results: No venous ulcer was present in our cases. In the evaluation made with Villalta scale, PTS was not observed in 20 out of 40 cases, mild PTS was found in 15, moderate PTS in 4, and severe PTS was observed in 1 case. Conclusion: We have concluded that pharmacomechanical thrombolysis treatment administered in well-selected patients reduced the severity of PTS and increased the quality of life associated with disease in DVT treatment.

Impact of the COVID-19 pandemic on emergent stroke care in Beijing, China

The coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented disruption to health care systems around the globe. Stroke is still an ongoing issue during the pandemic. We investigated the impact of the COVID-19 outbreak on emergent stroke care in Beijing, China. This is a retrospective analysis of two groups of patients with acute ischaemic stroke (AIS) registered in the Beijing Emergency Care Database between January 1, 2019, and December 31, 2020. Based on a database including 77 stroke centres, the quantity and quality of emergency care for stroke were compared. Subgroup analyses based on hospitals in different areas (high-risk and low/medium-risk areas) were carried out. A total of 6440 and 8699 admissions with suspected stroke were recorded in 2020 and 2019, respectively. There were no significant differences in the mean age and sex distribution for the patients between the two observational periods. The number of AIS admissions decreased by approximately 23.9% during the COVID-19 pandemic compared to that during the prepandemic period. The proportions of intravenous thrombolysis and endovascular treatment were 76.4% and 13.1%, respectively, in 2020, which were higher than those in 2019 (71.7% and 9.3%, respectively). There was no statistically significant difference in the time from stroke onset to arrival at the hospital (97.97 ± 23.09 min vs. 99.40 ± 20.76 min, p = 0.832) between the two periods. The door-to-needle time for thrombolysis (44.92 ± 9.20 min vs. 42.37 ± 9.06 min, p < 0.001) and door-to-thrombectomy time (138.56 ± 32.45 min vs. 120.55 ± 32.68 min, p < 0.001) were increased significantly in the pandemic period compared to those in the prepandemic period, especially in hospitals in high-risk areas. The decline in the number of patients with AIS and delay in treatment started after the launch of the level-1 public health emergency response and returned to stability after the release of professional protocols and consensus statements. Disruptions to medical services during the COVID-19 pandemic have substantially impacted AIS patients, with a clear drop in admission and a decline in the quality of emergent AIS care, especially in hospitals in high-risk areas and at the time of the initial outbreak of COVID-19. Health care systems need to maintain rapid adaptation to possible outbreaks of COVID-19 or similar crises in the future.

Thrombolytic treatment of life-threatening pulmonary embolism in times of alteplase shortage.

Journal Article Thrombolytic treatment of life-threatening pulmonary embolism in times of alteplase shortage Get access Frederikus A Klok, Frederikus A Klok Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCenter for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany Corresponding author. Tel: +31 715269111, Email: f.a.klok@lumc.nl https://orcid.org/0000-0001-9961-0754 Search for other works by this author on: Oxford Academic PubMed Google Scholar Piotr Pruszczyk, Piotr Pruszczyk Department of Internal Medicine and Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0000-0002-9768-0000 Search for other works by this author on: Oxford Academic PubMed Google Scholar Stavros V Konstantinides on behalf of the Working Group on Pulmonary Circulation & Right Ventricular Function Stavros V Konstantinides Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, GermanyDepartment of Cardiology, Democritus University of Thrace, Campus 691 00, 68100 Alexandroupolis, Greece https://orcid.org/0000-0001-6359-7279 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, ehad120, https://doi.org/10.1093/eurheartj/ehad120 Published: 14 March 2023 Article history Received: 16 August 2022 Revision received: 21 December 2022 Accepted: 19 January 2023 Published: 14 March 2023

Elevated Blood Alcohol Concentration Is Associated with Improved Clinical Outcomes of Intravenous Thrombolysis Treatment in Acute Ischemic Stroke Patients—A Retrospective Study

Intravenous thrombolysis (IVT) improves acute ischemic stroke (AIS) outcomes, but with limited success. In addition, ethanol potentiates the effect of r-tPA in ischemia models. The effect of acute alcohol consumption on IVT outcomes was investigated in a retrospective cohort study. AIS patients with detectable blood alcohol concentration (BAC) during IVT were included (alcohol group; n = 60). For each case, 3 control subjects who underwent IVT but denied alcohol consumption were matched in terms of age, sex, affected brain area, and stroke severity. Outcomes were determined using the NIHSS at 7 days and the modified Rankin scale (mRS) at 90 days. Patients were younger and had a less severe stroke than in a standard stroke study. Favorable long-term outcomes (mRS 0-2) occurred significantly more frequently in the alcohol group compared to controls (90% vs. 63%, p < 0.001). However, the rates of hemorrhagic transformation were similar. Multiple logistic regression models identified elevated BAC as a significant protective factor against unfavorable short-term (OR: 0.091, 95% CI: 0.036-0.227, p < 0.001) and long-term outcomes (OR: 0.187, 95% CI: 0.066-0.535, p = 0.002). In patients with BAC > 0.2%, significantly lower NIHSS was observed at 3 and 7 days after IVT vs. in those with 0.01-0.2% ethanol levels. Elevated BAC is associated with improved outcomes in IVT-treated AIS without affecting safety.

Intraarterial Thrombolytic Treatment for Visual Deficits Caused by Hyaluronic Acid Filler: Efficacy, Safety, and Prognostic Factors.

The benefits of intraarterial thrombolytic treatment (IATT) in reversing hyaluronic acid (HA)-related visual deficits remain unclear. This study aimed to report a 5-year experience in the treatment of visual deficits resulting from HA embolization by IATT in a tertiary medical center. From December of 2015 to June of 2021, the medical records of consecutive patients with HA-related visual deficits who underwent IATT were reviewed retrospectively. The demographics, clinical features, imaging data, treatment details, and follow-up results of the patients were analyzed. A total of 72 consecutive patients were analyzed, including five men (6.9%) men and 67 women (3.1%), aged 29.3 ± 7.6 years (range, 17 to 50 years). Thirty-two patients (44.4%) showed preserved visual acuity, and 40 (55.6%) exhibited no light perception on admission. Ocular motility disorders were detected in 63 patients (87.5%), ptosis was detected in 61 patients (84.7%), and facial skin changes were detected in 54 patients (75%). The technical success rate of IATT was 100%, with successful recanalization of the occlusive artery. No procedure-related complications were detected, and all skin injuries, ptosis, and ocular motility disorders were healed. Improved visual acuity was detected in 26 cases (36.1%). In the binary logistic regression model, only preoperative preserved visual acuity was independently associated with a good outcome. IATT for selective patients with HA-related visual deficits is efficient and safe. Preoperative preserved visual acuity was independently associated with a good outcome after IATT. Therapeutic, IV.

Treating a limb-threatening arterial clot in a newborn with catheter-directed thrombolysis.

Non-catheter related arterial thromboembolism in the neonatal population is rare and carries a significant risk of organ damage or limb loss. Thrombolysis, whether systemic or catheter- directed, is reserved either for limb or life-threatening thrombosis due to risk of bleeding especially in premature neonates. In this case, an infant male born at 34weeks and 4days gestational age presented with limb-threatening clot in the distal right subclavian artery and proximal right axillary artery with no known cause. After discussion of risks and benefits of various treatment options, he received thrombolysis treatment with low dose recombinant TPA via an umbilical artery catheter. There was complete resolution of the thrombus with this treatment and the patient had no significant bleeding while receiving treatment. Further investigation is needed to identify the patient population that will benefit from catheter-directed thrombolytic therapy and how to best monitor these patients.

Predictors of Early Neurological Improvement and Its Relationship to Thrombolysis Treatment and Long-Term Outcome in the WAKE-UP Study

Introduction: The aims of this study were to evaluate the relationship of clinical and imaging baseline factors and treatment on the occurrence of early neurological improvement (ENI) in the WAKE-UP trial of MRI-guided intravenous thrombolysis in unknown onset stroke and to examine the association of ENI with long-term favorable outcome in patients treated with intravenous thrombolysis. Methods: We analyzed data from all patients with at least moderate stroke severity, reflected by an initial National Institutes of Health Stroke Scale (NIHSS) score ≥4 randomized in the WAKE-UP trial. ENI was defined as a decrease in NIHSS of ≥8 or a decline to zero or 1 at 24 h after initial presentation to the hospital. Favorable outcome was defined as a modified Rankin Scale score of 0–1 at 90 days. We performed group comparison and multivariable analysis of baseline factors associated with ENI and performed mediation analysis to evaluate the effect of ENI on the relationship between intravenous thrombolysis and favorable outcome. Results: ENI occurred in 93 out of 384 patients (24.2%) and was more likely to occur in patients who received treatment with alteplase (62.4% vs. 46.0%, p = 0.009), had smaller acute diffusion-weighted imaging lesion volume (5.51 mL vs. 10.9 mL, p ≤ 0.001), and less often large-vessel occlusion on initial MRI (7/93 [12.1%] versus 40/291 [29.9%], p = 0.014). In multivariable analysis, treatment with alteplase (OR 1.97, 95% confidence interval [CI] 0.954–1.100), lower baseline stroke volume (OR 0.965, 95% CI: 0.932–0.994), and shorter time from symptom recognition to treatment (OR 0.994, 95% CI: 0.989–0.999) were independently associated with ENI. Patients with ENI had higher rates of favorable outcome at 90-day follow-up (80.6% vs. 31.3%, p ≤ 0.001). The occurrence of ENI significantly mediated the association of treatment with a good outcome, with ENI at 24 h explaining 39.4% (12.9–96%) of the treatment effect. Conclusion: Intravenous alteplase increases the odds of ENI in patients with at least moderate stroke severity, especially when given early. In patients with large-vessel occlusion, ENI is rarely observed without thrombectomy. ENI represents a good surrogate early marker of treatment effect as more than a third of good outcome at 90 days is explained by ENI at 24 h.