Article
Clinical Neurology
Eivind Berge, William Whiteley, Heinrich Audebert, Gian Marco De Marchis, Ana Catarina Fonseca, Chiara Padiglioni, Natalia Perez de la Ossa, Daniel Strbian, Georgios Tsivgoulis, Guillaume Turc
Summary: Intravenous thrombolysis is the approved systemic reperfusion treatment for acute ischaemic stroke patients, with the ESO guidelines providing evidence-based recommendations. The guidelines highlight the importance of timely thrombolysis within 4.5 hours for improving functional outcomes, and recommend its use for specific patient subgroups such as those waking from sleep.
EUROPEAN STROKE JOURNAL
(2021)
Review
Clinical Neurology
David J. Seiffge, Thomas Meinel, Jan Christoph Purrucker, Johannes Kaesmacher, Urs Fischer, Duncan Wilson, Teddy Y. Wu
Summary: This review discusses the primary therapeutic option for stroke prevention in atrial fibrillation patients, Direct Oral Anticoagulants (DOACs); it evaluates different approaches to patient selection, including time since last DOAC intake, drug-specific coagulation assays, and the use of reversal agents; precision medicine using a tailored approach seems to be a reasonable choice based on clinicoradiological information, anticoagulant activity, and the use of specific reversal agents only if necessary.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2021)
Review
Cardiac & Cardiovascular Systems
Petr Widimsky, Kenneth Snyder, Jakub Sulzenko, Leo Nelson Hopkins, Ivana Stetkarova
Summary: Significant progress has been made in reperfusion treatment of acute ischaemic stroke in the past few years. This review summarizes the latest evidence and discusses future perspectives, including endovascular treatment and the expanding role of cardiologists in acute stroke therapy.
EUROPEAN HEART JOURNAL
(2023)
Article
Clinical Neurology
D. Campo-Caballero, P. de la Riva, A. de Arce, M. Martinez-Zabaleta, J. Rodriguez-Antiguedad, J. Ekiza, P. Iruzubieta, F. Purroy, B. Fuentes, M. de Lera Alfonso, J. Krupinski, J. J. Mengual Chirife, E. Palomeras, D. Guisado-Alonso, M. Rodriguez-Yanez, X. Ustrell, J. Tejada Garcia, A. de Felipe Mimbrera, M. Pare-Curell, J. Tembl, S. Cajaraville, M. Garces, J. Serena
Summary: This study analyzed the use of reperfusion therapies in patients with ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD). The results showed that reperfusion therapy was frequently used in CAD patients and demonstrated efficacy and safety comparable to patients with IS due to other causes.
Review
Clinical Neurology
Angelos Sharobeam, Brett Jones, Dianne Walton-Sonda, Christian J. Lueck
Summary: This systematic review found that pre-hospital factors and in-hospital factors contribute to delays in thrombolysis administration, with long onset-to-needle times more common in certain patient groups. Various strategies exist to reduce delays, with processes integrating out-of-hospital and in-hospital processes showing the greatest improvements in time to thrombolysis.
JOURNAL OF NEUROLOGY
(2021)
Article
Neurosciences
Antoine Anfray, Camille Brodin, Antoine Drieu, Fanny Potzeha, Basile Dalarun, Veronique Agin, Denis Vivien, Cyrille Orset
Summary: The commercial form of rtPA has similar effects in promoting fibrinolysis and tissue reperfusion, with two-chains rtPA showing less efficiency compared to single chain rtPA, and associated with more severe blood brain barrier damage.
EXPERIMENTAL NEUROLOGY
(2021)
Article
Multidisciplinary Sciences
Giovanni Merlino, Carmelo Smeralda, Gian Luigi Gigli, Simone Lorenzut, Sara Pez, Andrea Surcinelli, Alessandro Marini, Valentina Maniaci, Mariarosaria Valente
Summary: The study found that recanalisation therapy may be effective for AIS patients with nonmetastatic cancer and remote cancer. When compared with patients without cancer, those with active cancer had a higher risk of three-month mortality when receiving intravenous thrombolysis. Further research is needed to explore the outcomes of AIS patients with metastatic cancer undergoing recanalisation therapy.
SCIENTIFIC REPORTS
(2021)
Review
Clinical Neurology
Jiacheng Sun, Christina Lam, Lauren Christie, Christopher Blair, Xingjuan Li, Freda Werdiger, Qing Yang, Andrew Bivard, Longting Lin, Mark Parsons
Summary: This systematic review and meta-analysis aimed to identify risk factors for hemorrhagic transformation (HT) following reperfusion therapies for acute ischemic stroke, and how these factors vary with different treatments. The results showed that atrial fibrillation and the NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies, while a hyperdense artery sign and number of thrombectomy passes were predictors of ICH after intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), respectively. Age and serum glucose level were common predictors for symptomatic ICH (sICH) after reperfusion therapies.
FRONTIERS IN NEUROLOGY
(2023)
Article
Neurosciences
Tao Tang, Di Li, Man-Hong Zhao, Aline M. M. Thomas, Chuang Chuang, Tie-Ping Fan, Shen Li
Summary: This study investigates the effects of intravenous thrombolysis (IVT) on patients who undergo successful thrombectomy and finds that IVT benefits patients with incomplete reperfusion grade but has no effect on patients with complete reperfusion grade.
CNS NEUROSCIENCE & THERAPEUTICS
(2023)
Article
Clinical Neurology
Li Zhang, Hao Luo, Chao Li, Hua Teng, Brianna Powell, Mei Lu, Michael Chopp, Zheng Gang Zhang
Summary: The combination treatment of tPA and Vepoloxamer at 4 hours after stroke onset effectively reduces ischemic neurovascular damage in aged rats by accelerating thrombolysis and reducing the potentiated side effects of tPA.
FRONTIERS IN NEUROLOGY
(2023)
Review
Clinical Neurology
Imad Derraz
Summary: Mechanical thrombectomy is highly effective in treating acute ischemic stroke. The use of intravenous thrombolysis before mechanical thrombectomy remains controversial, but achieving complete reperfusion is the primary goal. However, it is unclear whether additional endovascular attempts or local lytics administration are needed.
Article
Clinical Neurology
Young Dae Kim, Hyo Suk Nam, Joonsang Yoo, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Byung Moon Kim, Dong Joon Kim, Oh Young Bang, Woo-Keun Seo, Jong-Won Chung, Kyung-Yul Lee, Yo Han Jung, Hye Sun Lee, Seong Hwan Ahn, Dong Hoon Shin, Hye-Yeon Choi, Han-Jin Cho, Jang-Hyun Baek, Gyu Sik Kim, Kwon-Duk Seo, Seo Hyun Kim, Tae-Jin Song, Jinkwon Kim, Sang Won Han, Joong Hyun Park, Sung Ik Lee, JoonNyung Heo, Jin Kyo Choi, Ji Hoe Heo
Summary: A prediction model using clot volume and collateral status was developed to predict early recanalization after intravenous t-PA treatment in stroke patients with large-vessel occlusion. The model showed high performance and may aid in deciding recanalization treatment strategy for these patients.
Article
Clinical Neurology
Renjie Ji, Bing Li, Ziqi Xu
Summary: Vertebral artery stump syndrome (VASS) is a rare disease that can cause posterior circulation stroke after occlusion of the vertebral artery. We presented a case of VASS that was effectively treated with endovascular intervention using retrograde recanalisation, and the mechanism of VASS in our patient was believed to be a thrombus formed by stagnant flow.
STROKE AND VASCULAR NEUROLOGY
(2022)
Review
Medicine, General & Internal
Ajay Bhalla, Mehool Patel, Jonathan Birns
Summary: This article provides a comprehensive overview of key advances in the hyper-acute management of acute ischaemic stroke, including neuroimaging, acute stroke unit care, blood pressure management, and reperfusion therapy. The challenge now is to ensure the delivery and implementation of these evidence-based treatments to maximize benefits across the population.
Article
Clinical Neurology
Yangyang Zhou, Wenqiang Li, Chao Wang, Ruhang Xie, Yongnan Zhu, Qichen Peng, Limin Zhang, Hongqi Zhang, Yuxiang Gu, Shiqing Mu, Jian Liu, Xinjian Yang
Summary: ADP-MPA can predict ischaemic complications during endovascular treatment of intracranial aneurysms. Patients with flow diverters require stronger antiplatelet medication than patients with traditional stents.
STROKE AND VASCULAR NEUROLOGY
(2023)
Article
Clinical Neurology
T. Hashimoto, T. Kunieda, T. Honda, F. Scalzo, L. Ali, J. D. Hinman, N. M. Rao, M. Nour, M. Bahr-Hosseini, J. L. Saver, R. Raychev, D. Liebeskind
Summary: This study found that reduced leukoaraiosis, noncardiac embolisms, and shorter thrombus length in cardioembolism are indicators of good collateral flow in patients with embolic large-vessel occlusion.
AMERICAN JOURNAL OF NEURORADIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Raed A. Joundi, Jie-Lena Sun, Ying Xian, Brooke Alhanti, Raul G. Nogueira, Deepak L. Bhatt, Gregg C. Fonarow, Jeffrey Saver, Lee H. Schwamm, Eric E. Smith
Summary: This study investigated the relationship between time to endovascular therapy (EVT) and treatment outcomes in patients with basilar artery occlusion (BAO). The results showed that early treatment after symptom onset was associated with improved outcomes. Therefore, rapid implementation of EVT is crucial for patients with BAO.
Editorial Material
Neuroimaging
Jeffrey L. Saver, Eva Mistry
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Letter
Neuroimaging
Chun-Hsien Lin, Jeffrey L. Saver, Meng Lee
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Clinical Neurology
Scott J. Mendelson, Shuaiqi Zhang, Roland Matsouaka, Ying Xian, Shreyansh Shah, Barbara L. Lytle, Nicole Solomon, Lee H. Schwamm, Eric E. Smith, Jeffrey L. Saver, Gregg Fonarow, Jane Holl, Shyam Prabhakaran
Summary: This study aimed to investigate the prevalence of tPA declination among patients with acute ischemic stroke (AIS) and the differences by race/ethnicity. The study found that although the overall prevalence of tPA declination is low, non-Hispanic Black patients are more likely to decline tPA, while Asian patients are less likely. Reducing rates of tPA declinations among non-Hispanic Black patients may provide an opportunity to address disparities in stroke care.
Article
Emergency Medicine
Nichole Bosson, Jeffrey Eric Rollman, Robert A. Kloner, David M. Shavelle, Jeffrey L. Saver, James T. Niemann, Asim M. Rafique, Xiaoyan Wang, Christine Clare, Marianne Gausche-Hill
Summary: This study evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system in Los Angeles County. The study found a significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies, with an increase in EMS responses corresponding to an increase in COVID-19 hospitalizations.
PREHOSPITAL EMERGENCY CARE
(2023)
Article
Clinical Neurology
Johanna M. Ospel, Wolfgang G. Kunz, Rosalie McDonough, Wim van Zwam, Floor Pinckaers, Jeffrey L. Saver, Michael D. Hill, Andrew M. Demchuk, Tudor G. Jovin, Peter Mitchell, Bruce C. Campbell, Phil White, Keith Muir, Hamza Achit, Serge Bracard, Scott Brown, Mayank Goyal
Summary: This study aimed to investigate the clinical and economic benefit of endovascular treatment (EVT) in stroke patients with mild preexisting symptoms/disability. The results showed that EVT, in addition to best medical management, was a superior treatment strategy, resulting in cost savings and improved quality of life.
Article
Cardiac & Cardiovascular Systems
Shumei Man, Nicole Solomon, Brian Mac Grory, Brooke Alhanti, Ken Uchino, Jeffrey L. Saver, Eric E. Smith, Ying Xian, Deepak L. Bhatt, Lee H. Schwamm, Muhammad Shazam Hussain, Gregg C. Fonarow
Summary: Shorter door-to-needle times are associated with better long-term functional outcomes and lower mortality among older stroke patients treated with IVT only or IVT+EVT. These findings support efforts to accelerate thrombolytic administration in all eligible patients, including those receiving EVT.
Article
Clinical Neurology
Hongfei Sang, Dongjing Xie, Yan Tian, Thanh N. Nguyen, Jeffrey L. Saver, Raul G. Nogueira, Junxiong Wu, Chen Long, Zhenxuan Tian, Zhizhou Hu, Tao Wang, Rongzong Li, Yingbing Ke, Xiurong Zhu, Daizhou Peng, Mingze Chang, Lingfei Li, Jie Ruan, Deping Wu, Wenjie Zi, Qingwu Yang, Fengli Li, Zhongming Qiu
Summary: This study investigated the efficacy and safety of IV infusion of tirofiban before endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerotic disease. The results showed that patients in the tirofiban group had higher rates of functional independence at 90 days without increased risk of mortality or symptomatic intracranial hemorrhage. The reduction of thrombectomy passes mediated a significant portion of the effect of tirofiban on functional independence.
Letter
Clinical Neurology
Mersedeh Bahr-Hosseini, Nina Meissner, Paul Reidler, Jeffrey L. Saver, Steffen Tiedt
Article
Clinical Neurology
Jeffrey B. Saver, Elizabeth M. Klerman, Alastair Buchan, Patricia Calleja, Ignacio Lizasoain, Mersedeh Bahr-Hosseini, Sarah S. Lee, David Liebeskind, Philipp T. Mergenthaler, Katherine Mun, MingMing Ning, David Pelz, David M. Ray, Peter Rothwell, Pierre Seners, Anirudh Sreekrishnan, Eleanor Mina Sung, Steffen Tiedt, Alastair J. S. Webb, Teresa W. Woelfer, Gregory Albers
Summary: There is increasing evidence that circadian and diurnal rhythms have a strong influence on stroke onset, mechanism, progression, recovery, and response to therapy. To enhance our understanding, standardized definitions and coding guides for data collection are needed, as well as advanced imaging techniques and large data registries. The development of standardized data structures will aid researchers in studying the impact of circadian/diurnal biology on stroke.
Article
Clinical Neurology
Jian Miao, Hongfei Sang, Fengli Li, Jeffrey L. Saver, Bo Lei, Jinglun Li, Raul Gomes Nogueira, Bo Song, Shudong Liu, Thanh N. Nguyen, Zhenglong Jin, Hongliang Zeng, Changming Wen, Guangxiong Yuan, Weilin Kong, Weidong Luo, Shuai Liu, Dongjing Xie, Jiacheng Huang, Chang Liu, Jie Yang, Jinrong Hu, Jiaxing Song, Chengsong Yue, Linyu Li, Yan Tian, Xiao Zhang, Dan Feng, Yani Gao, Huiying Fu, Wenjie Zi, Qingwu Yang, Zhongming Qiu, Shaojun Wang
Summary: This study pooled data from two randomized clinical trials in China to assess the impact of basic imaging versus advanced imaging on clinical outcomes after endovascular thrombectomy in patients with acute ischemic stroke. The results showed no significant differences between the two imaging modalities in both the early and extended time windows.
Review
Neuroimaging
Nien-chen Liao, Mersedeh Bahr Hosseini, Jeffrey L. Saver
Summary: This study aimed to determine the correlation between the effect size of infarct growth reduction and clinically meaningful differences in clinical global disability outcomes. The results showed that each 1 mL reduction in infarct growth was associated with an increase in functional independence, providing guidance for clinical trials of neuroprotective agents.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Neuroimaging
Diego J. Ojeda, Malik Ghannam, Sebastian Sanchez, Mohammad Almajali, Prateeka Koul, Jeffrey L. Saver, Rishi Gupta, Santiago Ortega-Gutierrez, Edgar A. Samaniego
Summary: The Tigertriever device shows high success rate and short puncture to reperfusion time in patients with large vessel occlusion and underlying intracranial atherosclerotic disease, without device-related complications.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Review
Clinical Neurology
Joachim Fladt, Johanna M. Ospel, Nishita Singh, Jeffrey L. Saver, Marc Fisher, Mayank Goyal
Summary: In recent decades, with continuous technological advances and the availability of novel therapies, there has been a growing interest in shifting advanced acute care from hospitals to the prehospital setting. However, there are challenges related to conducting clinical trials, ambulance design and costs. Utilizing new technologies and customized software applications can help overcome these challenges and establish efficient, targeted care strategies in the prehospital setting.