The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2 1/2 hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours... more
The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2 1/2 hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours after onset for seven of the patients and 100 hours after onset for the eighth patient. In four patients, the second CT scan was obtained prospectively. The mean percentage of increase in the volume of hemorrhage between the first and second CT scans was 107% (range 1% to 338%). In each of the six patients with a greater than 40% increase in hemorrhage volume, neurological deterioration occurred soon after the first CT. A systolic blood pressure of 195 mm Hg or greater was recorded during the first 6 hours in five of the same six patients. The data from this study indicate that, in ICH, bleeding may continue after the 1st hour post-hemorrhage, particularly in patients with early clinical deterioration.
Research Interests:
Research Interests: Brain Imaging, Treatment Outcome, Emergency Management, Humans, Female, and 17 moreMale, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination(Male, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination)
(Male, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination)
Follow-up imaging data from stroke patients without angiographically apparent arterial occlusions at symptom onset are lacking. We reviewed our Emergency Management of Stroke (EMS) trial experience to determine the clinical and imaging... more
Follow-up imaging data from stroke patients without angiographically apparent arterial occlusions at symptom onset are lacking. We reviewed our Emergency Management of Stroke (EMS) trial experience to determine the clinical and imaging outcomes of patients with ischemic stroke who showed no arterial occlusion on angiograms obtained within 4 hours of symptom onset. All patients in this report were participants in the EMS trial that was designed to address the safety and potential efficacy of combined IV and intraarterial thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke. Thirty-five patients were randomized to receive either IV rt-PA (n = 17) or placebo (n = 18), followed by cerebral angiography. No symptomatic arterial occlusion was evident in 10 (29%) of the 34 patients. Eight (80%) of 10 patients without angiographically apparent clot within 4 hours of symptom onset had a new cerebral infarction confirmed on follow-up...
Research Interests: Brain Imaging, Treatment Outcome, Emergency Management, Humans, Female, and 17 moreMale, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination(Male, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination)
(Male, Follow-up studies, American, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Tissue Plasminogen Activator, Pilot Projects, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Cerebral Infarction, Functional Disability, Cerebral Angiography, Barthel Index, and Neurologic Examination)
Research Interests:
RESULTS: During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal... more
RESULTS: During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal ACA emboli were identified in 3 subjects. At 24 hours, 8 (32%) T occlusions demonstrated CT-ACA infarct, typically of small volume. Infarcts were less common following sonography microcatheter-assisted thrombolysis compared with standard micro- catheter thrombolysis (P.05). Lower extremity weakness was present in 9 of 10 subjects with ACA embolus/infarct at 24 hours. The modified Rankin 0 to 2 outcomes were achieved in 4 of 25 (16%) subjects with T occlusion overall, but in 0 of 10 subjects with distal ACA emboli or ACA CT infarcts (P .07). CONCLUSIONS: With IV/IA recombinant tissue plasminogen activator treatment for MCA emboli, new ACA emboli are uncommon events. Distal ACA emboli during T-occlusion thrombolysis are not uncommon, typically lead to s...
Research Interests:
The hyperdense middle cerebral artery sign (HMCAS) is recognized as a CT finding that indicates thrombus or embolus within the middle cerebral artery. The incidence and significance of this sign are quantitatively evaluated in 50 patients... more
The hyperdense middle cerebral artery sign (HMCAS) is recognized as a CT finding that indicates thrombus or embolus within the middle cerebral artery. The incidence and significance of this sign are quantitatively evaluated in 50 patients entered into experimental drug studies for treatment of cerebral infarction.
Research Interests:
The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2 1/2 hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours... more
The authors evaluate eight patients with intracerebral hemorrhage (ICH) who underwent computerized tomography (CT) within 2 1/2 hours after symptom onset and then again several hours later. The second CT scan was performed within 12 hours after onset for seven of the patients and 100 hours after onset for the eighth patient. In four patients, the second CT scan was obtained prospectively. The mean percentage of increase in the volume of hemorrhage between the first and second CT scans was 107% (range 1% to 338%). In each of the six patients with a greater than 40% increase in hemorrhage volume, neurological deterioration occurred soon after the first CT. A systolic blood pressure of 195 mm Hg or greater was recorded during the first 6 hours in five of the same six patients. The data from this study indicate that, in ICH, bleeding may continue after the 1st hour post-hemorrhage, particularly in patients with early clinical deterioration.
Research Interests:
Anterior cerebral artery (ACA) emboli may occur before or during fibrinolytic revascularization of middle cerebral artery (MCA) and internal carotid artery (ICA) T occlusions. We sought to determine the incidence and effect of baseline... more
Anterior cerebral artery (ACA) emboli may occur before or during fibrinolytic revascularization of middle cerebral artery (MCA) and internal carotid artery (ICA) T occlusions. We sought to determine the incidence and effect of baseline and new embolic ACA occlusions in the Interventional Management of Stroke (IMS) studies. Case report forms, pretreatment and posttreatment arteriograms, and CTs from 142 subjects entered into IMS I & II were reviewed to identify subjects with baseline ACA occlusion, new ACA emboli occurring during fibrinolysis, subsequent CT-demonstrated infarction in the ACA distribution, and to evaluate global and lower extremity motor clinical outcome. During M1/M2 thrombolysis procedures, new ACA embolus occurred in 1 of 60 (1.7%) subjects. Baseline distal emboli were identified in 3 of 20 (15%) T occlusions before intra-arterial (IA) treatment, and new posttreatment distal ACA emboli were identified in 3 subjects. At 24 hours, 8 (32%) T occlusions demonstrated CT-ACA infarct, typically of small volume. Infarcts were less common following sonography microcatheter-assisted thrombolysis compared with standard microcatheter thrombolysis (P = .05). Lower extremity weakness was present in 9 of 10 subjects with ACA embolus/infarct at 24 hours. The modified Rankin 0 to 2 outcomes were achieved in 4 of 25 (16%) subjects with T occlusion overall, but in 0 of 10 subjects with distal ACA emboli or ACA CT infarcts (P = .07). With IV/IA recombinant tissue plasminogen activator treatment for MCA emboli, new ACA emboli are uncommon events. Distal ACA emboli during T-occlusion thrombolysis are not uncommon, typically lead to small ACA-distribution infarcts, and may limit neurologic recovery.
Research Interests:
Research Interests:
Research Interests: Neurology, Rehabilitation, Clinical Trial, Stroke, Humans, and 19 moreUnited States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation(United States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation)
(United States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation)
Research Interests:
Research Interests: Computed Tomography, Evolution, Multivariate Analysis, Stroke, Prospective studies, and 19 moreHumans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease(Humans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease)
(Humans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease)
Treatment with tissue plasminogen activator (rt-PA) for acute stroke requires intensive care of the patient. The risk of thrombolytic therapy and the need for rapid interventions make it clear that the nursing role during this time is... more
Treatment with tissue plasminogen activator (rt-PA) for acute stroke requires intensive care of the patient. The risk of thrombolytic therapy and the need for rapid interventions make it clear that the nursing role during this time is crucial. Nurses should be familiar with safe dosage and administration of rt-PA for stroke, which is clearly different than administration of rt-PA for myocardial infarction. Furthermore, thrombolytic stroke treatment must be accompanied by intensive neurological monitoring to observe for complications. Intracerebral hemorrhage is usually accompanied by an acute change in neurological status and vital sign instability. Intensive monitoring of neurologic condition, vital signs, cardiac status and other standard critical care practices must be initiated immediately to optimize patient outcome.
Research Interests:
We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. The pooled analysis of the... more
We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. The pooled analysis of the Interventional Management of Stroke III (IMS III) and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trials included participants with an National Institutes of Health Stroke Scale score of ≥20 before intravenous tissue-type plasminogen activator (tPA) treatment (IMS III) or randomization (MR CLEAN) who were treated with intravenous tPA ≤3 hours of stroke onset. Our hypothesis was that participants with severe stroke randomized to endovascular therapy after intravenous tPA would have improved 90-day outcome (distribution of modified Rankin Scale scores), when compared with those who received intravenous tPA alone. Among 342 participants in the pooled analysis (194 from IMS III and 148 from MR CLEAN), an ordinal logistic regression model showed that the endovascular group had superior 90-day outcome compared with the intravenous tPA group (adjusted odds ratio, 1.78; 95% confidence interval, 1.20-2.66). In the logistic regression model of the dichotomous outcome (modified Rankin Scale score, 0-2, or functional independence), the endovascular group had superior outcomes (adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.56). Functional independence (modified Rankin Scale score, ≤2) at 90 days was 25% in the endovascular group when compared with 14% in the intravenous tPA group. Endovascular therapy after intravenous tPA within 3 hours of symptom onset improves functional outcome at 90 days after severe ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424 (IMS III) and ISRCTN10888758 (MR CLEAN).
Research Interests:
Research Interests:
Randomized trials have indicated a benefit for endovascular therapy in appropriately selected stroke patients at 3 months, but data regarding outcomes at 12 months are currently lacking. We compared functional and quality-of-life outcomes... more
Randomized trials have indicated a benefit for endovascular therapy in appropriately selected stroke patients at 3 months, but data regarding outcomes at 12 months are currently lacking. We compared functional and quality-of-life outcomes at 12 months overall and by stroke severity in stroke patients treated with intravenous tissue-type plasminogen activator followed by endovascular treatment as compared with intravenous tissue-type plasminogen activator alone in the Interventional Management of Stroke III Trial. The key outcome measures were a modified Rankin Scale score ≤2 (functional independence) and the Euro-QoL EQ-5D, a health-related quality-of-life measure. 656 subjects with moderate-to-severe stroke (National Institutes of Health Stroke Scale ≥8) were enrolled at 58 centers in the United States (41 sites), Canada (7), Australia (4), and Europe (6). There was an interaction between treatment group and stroke severity in the repeated measures analysis of modified Rankin Scale...
Research Interests:
To determine the relationship between the hyperdense middle cerebral artery sign (HMCAS) and neurologic deficit, as evidenced by the National Institutes of Health (NIH) stroke scale score, and to determine the relationship of the HMCAS... more
To determine the relationship between the hyperdense middle cerebral artery sign (HMCAS) and neurologic deficit, as evidenced by the National Institutes of Health (NIH) stroke scale score, and to determine the relationship of the HMCAS and the NIH stroke scale score to arteriographic findings after thrombolytic therapy. Fifty-five patients with acute ischemic stroke were rated on the NIH stroke scale, were examined with CT, and were treated with intravenous alteplase within 90 minutes of symptom onset. Presence of the HMCAS was determined on the baseline CT scan by a neuroradiologist blinded to the patient's neurologic deficit. Patients with the HMCAS were compared with those without HMCAS with regard to baseline NIH stroke scale score, 2-hour NIH stroke scale score, findings at posttreatment arteriography, 3-month residual neurologic deficit, and 3-month ischemia volumes as evidenced on CT scans. Eighteen patients (33%) had the HMCAS. These patients had a median baseline NIH st...
Research Interests:
We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial. Changes in baseline characteristics, use of baseline CT angiography,... more
We explored changes in the patient population and practice of endovascular therapy during the course of the Interventional Management of Stroke (IMS) III Trial. Changes in baseline characteristics, use of baseline CT angiography, treatment times and specifics, and outcomes were compared between the first 4 protocols and the fifth and final protocol. Compared with subjects treated in the first 4 protocol versions (n=610), subjects treated in fifth and final protocol (n=46) were older (75 versus 68 years, P<0.0002) and less likely to have a pretreatment Rankin of 0 (76% versus 89%, P=0.01), were more likely to have a pretreatment CT angiography (65% versus 45%, P=0.009), had quicker median times in the endovascular arm from onset to start of intra-arterial therapy (209 versus 250 minutes, P=0.002) and to reperfusion (269 versus 344 minutes, P<0.0001), had a higher mean dose of total tissue-type plasminogen activator in the…
Research Interests:
Interventional Management of Stroke III did not show that combining IV recombinant tissue plasminogen activator (rt-PA) with endovascular therapies (EVTs) is better than IV rt-PA alone. To report efficacy and safety results for EVT of... more
Interventional Management of Stroke III did not show that combining IV recombinant tissue plasminogen activator (rt-PA) with endovascular therapies (EVTs) is better than IV rt-PA alone. To report efficacy and safety results for EVT of intracranial internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion. Five revascularization methods for persistent occlusions after IV rt-PA treatment were evaluated for prespecified primary and secondary endpoints, after accounting for differences in key baselines variables using propensity scores. Revascularization was scored using the arterial occlusive lesion (AOL) and the modified Thrombolysis in Cerebral Ischemia (mTICI) scores. EVT of 200 subjects with intracranial ICA or M1 occlusion resulted in 81.5% AOL 2-3 recanalization, in addition to 76% mTICI 2-3 and 42.5% mTICI 2b-3 reperfusion. Adverse events included symptomatic intracranial hemorrhage (SICH) (8.0%), vessel perforations (1.5%), and new emboli (14.9%). EVT techni...
Research Interests:
A positive correlation between large parenchymal hematoma (PH) volume and large CT lesion volume in subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) as well as placebo controls was identified in the... more
A positive correlation between large parenchymal hematoma (PH) volume and large CT lesion volume in subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) as well as placebo controls was identified in the European Cooperative Acute Stroke Study II (ECASS II). A study was undertaken to examine the relationship between PH volume and total lesion volume (including both cerebral infarction and hemorrhage) in subjects with symptomatic parenchymal hematoma (sPH) treated with combined IV and intra-arterial (IA) rtPA in the Interventional Management of Stroke (IMS) studies. Hematoma and lesion volumes were measured planimetrically and by the ABC/2 method in 105 subjects from IMS studies I and II following combined IV and IA rtPA treatment. PH type 1 or 2 was determined by dichotomizing at >30% of lesion volume. Hematoma and lesion volumes for both symptomatic PH1 (sPH1) and PH2 (sPH2) types were compared using both measurement methods. Both sPH types were ...
Research Interests:
The goal of the present study was to prospectively determine how frequently early growth of intracerebral hemorrhage occurs and whether this early growth is related to early neurological deterioration. We performed a prospective... more
The goal of the present study was to prospectively determine how frequently early growth of intracerebral hemorrhage occurs and whether this early growth is related to early neurological deterioration. We performed a prospective observational study of patients with intracerebral hemorrhage within 3 hours of onset. Patients had a neurological evaluation and CT scan performed at baseline, 1 hour after baseline, and 20 hours after baseline. Substantial growth in the volume of parenchymal hemorrhage occurred in 26% of the 103 study patients between the baseline and 1-hour CT scans. An additional 12% of patients had substantial growth between the 1- and 20-hour CT scans. Hemorrhage growth between the baseline and 1-hour CT scans was significantly associated with clinical deterioration, as measured by the change between the baseline and 1-hour Glasgow Coma Scale and National Institutes of Health Stroke Scale scores. No baseline clinical or CT prediction of hemorrhage growth was identified. Substantial early hemorrhage growth in patients with intracerebral hemorrhage is common and is associated with neurological deterioration. Randomized treatment trials are needed to determine whether this early natural history of ongoing bleeding and frequent neurological deterioration can be improved.
Research Interests:
Research Interests: Treatment Outcome, Stroke, Humans, Female, Male, and 14 moreIschemic Stroke, Clinical Sciences, Aged, Middle Aged, Adult, Time Factors, Retrospective Studies, Intracerebral Hemorrhage, Tissue Plasminogen Activator, Carotid Artery, Acute Ischemic Stroke, Neurosciences, Severity of Illness Index, and Acute Disease
Research Interests: Computed Tomography, Evolution, Multivariate Analysis, Stroke, Prospective studies, and 19 moreHumans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease(Humans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease)
(Humans, Population based study, Glasgow Coma Scale, Volume, Ct Scan, Logistic Regression Analysis, Clinical Sciences, Incomplete Data, Odds ratio, Retrospective Studies, Prognosis, Intracerebral Hemorrhage, Cerebral Hemorrhage, Neurosciences, Logistic Models, Predictive value of tests, Brain Edema, Barthel Index, and Acute Disease)
Research Interests: Computed Tomography, Natural History, Evolution, Stroke, Prospective studies, and 12 moreHumans, Clinical Sciences, Time Factors, Retrospective Studies, Intracerebral Hemorrhage, Disease Progression, Hematoma, X ray Computed Tomography, Cerebral Hemorrhage, Neurosciences, Brain Edema, and Acute Disease
Research Interests: Neurology, Rehabilitation, Clinical Trial, Stroke, Humans, and 19 moreUnited States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation(United States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation)
(United States, Physicians, Nurses, Digital Video, Real Time, Clinical Sciences, Intraclass Correlation Coefficient, Certification, Observer Variation, Time Factors, Videotape Recording, Reproducibility of Results, Cerebrovascular Disorders, Neurosciences, Emergency Department, Confidence Interval, Clinical Trials as Topic, Severity of Illness Index, and Disability Evaluation)
Research Interests: Quality of life, Treatment, Treatment Outcome, Emergency Management, Stroke, and 19 moreHumans, Female, Feasibility Studies, Male, Clinical Sciences, Aged, Pilot study, Time Factors, Cerebral Ischemia, Drug Therapy, Intracerebral Hemorrhage, Tissue Plasminogen Activator, Pilot Projects, Cerebrovascular Disorders, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Barthel Index, and Severity of Illness Index(Humans, Female, Feasibility Studies, Male, Clinical Sciences, Aged, Pilot study, Time Factors, Cerebral Ischemia, Drug Therapy, Intracerebral Hemorrhage, Tissue Plasminogen Activator, Pilot Projects, Cerebrovascular Disorders, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Barthel Index, and Severity of Illness Index)
(Humans, Female, Feasibility Studies, Male, Clinical Sciences, Aged, Pilot study, Time Factors, Cerebral Ischemia, Drug Therapy, Intracerebral Hemorrhage, Tissue Plasminogen Activator, Pilot Projects, Cerebrovascular Disorders, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Barthel Index, and Severity of Illness Index)
Research Interests:
Research Interests:
The IMS III trial did not show a clinical benefit of endovascular treatment compared with intravenous alteplase (recombinant tissue plasminogen activator) alone for moderate or severe ischaemic strokes. Late reperfusion of tissue that was... more
The IMS III trial did not show a clinical benefit of endovascular treatment compared with intravenous alteplase (recombinant tissue plasminogen activator) alone for moderate or severe ischaemic strokes. Late reperfusion of tissue that was no longer salvageable could be one explanation, as suggested by previous exploratory studies that showed an association between time to reperfusion and good clinical outcome. We sought to validate this association in a preplanned analysis of data from the IMS III trial. We used data for patients with complete proximal arterial occlusions in the anterior circulation who received endovascular treatment and achieved angiographic reperfusion (score on Thrombolysis in Cerebral Infarction scale of grade 2-3) during the endovascular procedure (within 7 h of symptom onset). We used logistic regression to model good clinical outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) as a function of the time to reperfusion. We prespecified variables to be considered for adjustment, including age, baseline National Institutes of Health Stroke Scale score, sex, and baseline blood glucose concentration. Of 240 patients who were otherwise eligible for inclusion in our analysis, 182 (76%) achieved angiographic reperfusion. Mean time from symptom onset to reperfusion (ie, procedure end) was 325 min (SD 52). Increased time to reperfusion was associated with a decreased likelihood of good clinical outcome (unadjusted relative risk for every 30-min delay 0·85 [95% CI 0·77-0·94]; adjusted relative risk 0·88 [0·80-0·98]). Delays in time to angiographic reperfusion lead to a decreased likelihood of good clinical outcome in patients after moderate to severe stroke. Rapid reperfusion could be crucial for the success of future acute endovascular trials. US National Institutes of Health and National Institute of Neurological Disorders and Stroke.
Research Interests:
Treatment with tissue plasminogen activator (rt-PA) for acute stroke requires intensive care of the patient. The risk of thrombolytic therapy and the need for rapid interventions make it clear that the nursing role during this time is... more
Treatment with tissue plasminogen activator (rt-PA) for acute stroke requires intensive care of the patient. The risk of thrombolytic therapy and the need for rapid interventions make it clear that the nursing role during this time is crucial. Nurses should be familiar with safe dosage and administration of rt-PA for stroke, which is clearly different than administration of rt-PA for myocardial infarction. Furthermore, thrombolytic stroke treatment must be accompanied by intensive neurological monitoring to observe for complications. Intracerebral hemorrhage is usually accompanied by an acute change in neurological status and vital sign instability. Intensive monitoring of neurologic condition, vital signs, cardiac status and other standard critical care practices must be initiated immediately to optimize patient outcome.
Research Interests:
In the National Institutes of Neurologic Disorders and Stroke (NINDS) recombinant tissue plasminogen activator (rt-PA) stroke trial, the primary adverse events monitored were intracranial hemorrhage (ICH), systemic bleeding, death and new... more
In the National Institutes of Neurologic Disorders and Stroke (NINDS) recombinant tissue plasminogen activator (rt-PA) stroke trial, the primary adverse events monitored were intracranial hemorrhage (ICH), systemic bleeding, death and new stroke. Nurses caring for the study patients noted these adverse events and other complications. In addition to what is known about acute ischemic stroke (AIS), the NINDS trial provides further information for optimal care of this specific group of patients. The complications found in this trial require expert nursing care to monitor, prevent and intervene, making clinical decisions relevant to the patients needs. The critical decision-making process must be grounded in knowledge of acute stroke physiology and thrombolysis.
Research Interests:
ABSTRACT : Ischemic stroke remains a significant problem in the United States. Complex intracellular metabolic events occur leading to cell death. A search for treatments to prevent this ischemic process continues. Thrombolytic agents,... more
ABSTRACT : Ischemic stroke remains a significant problem in the United States. Complex intracellular metabolic events occur leading to cell death. A search for treatments to prevent this ischemic process continues. Thrombolytic agents, recently developed and tested, may lessen the disabling effects of stroke.
Research Interests:
Patients delay in responding to stroke as an emergency in part because they have deficient information about the disease and treatment. Healthcare providers may also have a lack of information about stroke assessment and management, which... more
Patients delay in responding to stroke as an emergency in part because they have deficient information about the disease and treatment. Healthcare providers may also have a lack of information about stroke assessment and management, which could attribute to delays in patient care. In order to provide early, rapid stroke treatment in eligible persons, the public and the healthcare community must be informed. Information on stroke risk, symptoms and treatment should be provided to those likely to experience stroke, the general public and the emergency and medical communities who may witness and intervene when stroke occurs. Programs developed at the eight centers of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA stroke trial provide a sampling of approaches that increase awareness in these groups. Lessons learned include: 1. Program planning should start with a community needs assessment. 2. A variety of strategies can be applied to meet the community needs and resources. 3. Educational principles and models should be utilized in planning effective programs. 4. The message must be simple: &quot;Stroke is an emergency. Time is brain&quot;.
Research Interests:
The stroke patient is acutely ill within minutes of symptom onset. Typically, he or she is awake and thus requires a focal neurologic exam to evaluate vision, movement, sensation and language. With the advent of acute stroke treatments... more
The stroke patient is acutely ill within minutes of symptom onset. Typically, he or she is awake and thus requires a focal neurologic exam to evaluate vision, movement, sensation and language. With the advent of acute stroke treatments that need to be rapidly implemented, it is critical that the nurse be able to assess patients and relay the information accurately and efficiently to other members of the health care team. Performing and documenting the awake stroke exam in the most efficient and useful manner is key to the nursing care of the stroke patient. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool designed to measure the neurologic deficits most often seen with acute stroke patients. Originally designed as a research tool, it is a nonlinear ordinal scale, with possible scores ranging form 0-42. Exam performance has been timed to take 5-8 minutes. Use of the NIHSS includes documentation of neurologic status and outcome, data collection for planning safe nursing care and standardization of information exchanges between nurse caregivers and other health care professionals.
Research Interests:
Stroke is a leading cause of death and disability among Americans. The recent US Food and Drug Administration approval of recombinant tissue plasminogen activator (rt-PA, Activase) for the treatment of acute ischemic stroke offers the... more
Stroke is a leading cause of death and disability among Americans. The recent US Food and Drug Administration approval of recombinant tissue plasminogen activator (rt-PA, Activase) for the treatment of acute ischemic stroke offers the first proven therapy to reverse or ameliorate stroke symptoms. rt-PA is thought to restore circulation in the patient with acute ischemic stroke by dissolving an occluding thrombus or embolus. A basic understanding of cerebral circulation and the mechanism by which stroke compromises brain tissue is fundamental to appreciating this new therapy. The importance of prompt stroke diagnosis and treatment cannot be underestimated.
Research Interests:
Research Interests: Neuroscience, Neurology, Metabolism, Inflammation, Gene expression, and 29 moreStroke, Neurovascular, Humans, Flow, Brain Circulation, Female, Blood sampling, Male, Peptides, Brain Ischemia, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Neutrophils, Cerebral, Carbonic anhydrase, Adult, Monocytes, Time Factors, Combination drug therapy, Tissue Plasminogen Activator, Calcium Binding Protein, Neurosciences, White Blood Cell, Gene Expression Regulation, Gene expression profiling, Matrix Metalloproteinase, and Inflammatory response(Stroke, Neurovascular, Humans, Flow, Brain Circulation, Female, Blood sampling, Male, Peptides, Brain Ischemia, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Neutrophils, Cerebral, Carbonic anhydrase, Adult, Monocytes, Time Factors, Combination drug therapy, Tissue Plasminogen Activator, Calcium Binding Protein, Neurosciences, White Blood Cell, Gene Expression Regulation, Gene expression profiling, Matrix Metalloproteinase, and Inflammatory response)
(Stroke, Neurovascular, Humans, Flow, Brain Circulation, Female, Blood sampling, Male, Peptides, Brain Ischemia, Ischemic Stroke, Clinical Sciences, Aged, Middle Aged, Neutrophils, Cerebral, Carbonic anhydrase, Adult, Monocytes, Time Factors, Combination drug therapy, Tissue Plasminogen Activator, Calcium Binding Protein, Neurosciences, White Blood Cell, Gene Expression Regulation, Gene expression profiling, Matrix Metalloproteinase, and Inflammatory response)
Research Interests:
Research Interests:
Ancrod has been used in Europe for over 15 years for peripheral vascular disease, deep vein thrombosis, and central retinal venous thrombosis, and in patients at risk for thromboembolism. In a double-blind, randomized, placebo-controlled... more
Ancrod has been used in Europe for over 15 years for peripheral vascular disease, deep vein thrombosis, and central retinal venous thrombosis, and in patients at risk for thromboembolism. In a double-blind, randomized, placebo-controlled study at University Hospitals in Cincinnati, 20 acute cerebral infarction patients received a series of IV infusions of ancrod (ten) or placebo (ten) for seven days. Early fibrinolysis with a small decrease in fibrinogen was observed, and d-dimers were elevated at four hours, indicating early clot lysis. At three months, patients with moderate to severe strokes (less than 40 on the Scandinavian Stroke Scale) in the ancrod group showed average improvement by a factor of 3 over the placebo group. No bleeding, abnormal laboratory results, or deaths occurred, but ancrod was discontinued in one patient who had seizures. As a result of this study, a double-blind multicenter international clinical trial to further assess the safety and effectiveness of ancrod is being planned.