Search

ABSTRACT OBJECTIVE Tenecteplase (TNK) is a third-generation thrombolytic agent. We evaluated the safety and feasibility of intra-arterial (IA) administration of TNK in patients with acute ischemic stroke. METHODS Patients who received endovascular treatment for acute ischemic stroke were identified from prospectively collected databases at three university hospitals. We compared clinical and radiological outcomes of patients treated with TNK to those treated with other IA thrombolytics or mechanical thrombectomy alone. Primary outcome measures were favorable functional outcome at 30 days (modified Rankin Scale score of 0-2), and rate of intracranial hemorrhage (ICH). Early neurological improvement, angiographic recanalization, time to recanalization, and mortality at 30 days were additional outcome measures. RESULTS We identified 114 patients (mean age 67 ± 15 years, 54 were women). Thirty-three patients received IA TNK, 48 received alteplase ( n = 11) or reteplase ( n = 37), and 33 patients had mechanical thrombectomy alone. Stroke severity was similar among the three groups. No difference between the groups was found in the secondary outcome measures and ICH. Borderline statistical significance was seen toward favorable functional outcome at 1 month in the TNK-treated patients [odds ratio (OR) = 2.8; 95% confidence interval (CI) .96-8.1, P = .063 vs. other thrombolytics, and OR = 3.0, 95% CI .97-9.5, P = .06 vs. mechanical thrombectomy alone]. CONCLUSION Our study demonstrates that administration of IA TNK in acute stroke is safe and results in rates of favorable outcomes that are comparable to those observed with currently used drugs. Additional studies are needed to further determine the safety and efficacy of IA TNK in acute stroke treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the treatment of acute ischemic stroke, intravenous (IV) recombinant tissue plasminogen (rt-PA) and intraarterial (IA) interventions are often combined. However, the optimal dose of IV rt-PA preceding endovascular treatment has not been established. METHODS: Studies that used combined IV and IA thrombolysis were identified from a search of the MEDLINE, PubMed, and Cochrane databases. We compared the rates of angiographic recanalization, symptomatic intracerebral hemorrhage (sICH), and favorable functional outcome between patients who had been treated with .6 mg/kg IV rt-PA and those who had received .9 mg/kg rt-PA. RESULTS: Eleven studies met our criteria. In 7 studies, .6 mg/kg IV rt-PA had been administered to 317 patients, whereas 140 patients in 4 studies had received .9 mg/kg of IV rt-PA. The weighted mean of median National Institutes of Health Stroke Scale score at presentation was 18.3 in the .6 mg/kg group (median range 9-34), and 17.3 in the .9 mg/kg group (median range 4-39). Patients in the .9 mg/kg group had higher rates of favorable outcome [odds ratio (OR) = 1.60, 95% confidence interval (CI) = (1.07 2.40), P = .022] and similar rates of sICH [OR = .86 (95% CI .41-1.83), P = .70]. Depending on the statistics used, the higher angiographic recanalization rate among patients treated with .9 mg/kg was significant (P = .03, events/trial syntax logistic regression) or borderline significant (P = .07, random effects model). CONCLUSION: Our analysis suggests that using .9 mg/kg IV rt-PA prior to IA thrombolysis is safe and may be associated with higher recanalization rates and better functional outcome at 3 months. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE Statins have been shown to have lipid-independent (pleiotropic) effects that may be beneficial in the management of vascular disease. We evaluated the effect of premorbid statin use on recanalization in patients with acute ischemic stroke undergoing endovascular treatment. METHODS We retrospectively reviewed the charts of all patients who had undergone endovascular treatment for acute ischemic stroke at our institution. Computed tomography scans obtained after treatment were assessed for the presence of hemorrhagic transformation by an independent reviewer. The primary endpoint was partial or complete recanalization (at least 1 grade improvement in the Qureshi scale). Secondary endpoints were hemorrhagic transformation and neurological improvement. Multivariate analysis was performed to evaluate the effect of premorbid statin use after adjusting for potential confounders. RESULTS Seventy-seven patients fulfilled our inclusion criteria (mean age 66 ± 14, 38 were men) and among them 12 were on statins. The patients who were on statins had a higher recanalization rate (11/12 vs. 33/65, P= .02). This finding was confirmed by logistic regression analysis (odds ratio 17.25, 95% confidence interval 1.67-177.43). There was no significant difference between the two groups regarding neurological improvement and hemorrhagic transformation. CONCLUSION This study demonstrates that patients on statins have higher recanalization rates when they undergo endovascular procedures for acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Percutaneous stenting techniques are becoming more commonly used for treatment of carotid artery disease. One outcome of particular concern is in-stent restenosis. Indications for treatment of in-stent restenosis are not clearly defined. Use of traditional balloon angioplasty with or without stent placement is still considered the first option. Cutting balloon angioplasty has recently been used as an alternative treatment option for revascularization of in-stent restenosis with higher procedural success rates and without the use of additional stents. We report our experience with cutting balloon angioplasty in treating 2 patients with carotid in-stent restonosis, and review previous cases reported in the literature. A total of 16 patients have been treated with cutting balloon angioplasty. Among 11 patients for whom the clinical and angiographic information were available, 63% of patients were asymptomatic at the time of treatment, and more than 90% of patients showed either complete angiographic resolution or residual stenosis of less than 30%. Additional stent placement or angioplasty was required in only half of the patients, and 1 patient had recurrent stenosis. The review suggests that the procedure is safe and effective. [ABSTRACT FROM AUTHOR]

The article investigates the restricting factors which differentiate tropical cyclogenesis climatology in south-east Caribbean by analyzing eight environmental variables using principal component analysis. Previous studies reveal that the south-western sector of the Caribbean dominates the tropical cyclone formation activity of the basin while its south-eastern sector shows distinct suppression in cyclogenesis. Analysis suggests association between the genesis pattern in the Caribbean and the low level wind field and absolute vorticity. Findings reveal that the background conditions of the basin's eastern sector of the Caribbean, being less prone to hurricane disturbances, is rendered by the divergence of flow combined with the vorticity of the wind-field over the Caribbean.