Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jul 2014
Proposed approach to thrombolysis in dabigatran-treated patients presenting with ischemic stroke.
Acute ischemic stroke thrombolysis in patients taking dabigatran is controversial because of a presumed increased risk of symptomatic hemorrhagic transformation. Using data from our local hematopathology laboratory, we developed a thrombolysis protocol for acute ischemic stroke patients taking dabigatran. ⋯ Administration of intravenous tPA in dabigatran-treated patients is feasible. Although, the relationship between dabigatran concentrations and coagulation measures varies between laboratories, individual protocols, preferably based on TT, can be developed at acute stroke treatment centers.
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J Stroke Cerebrovasc Dis · Jul 2014
Case ReportsEndovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.
Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. ⋯ With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.
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J Stroke Cerebrovasc Dis · Jul 2014
Mdivi-1 prevents apoptosis induced by ischemia-reperfusion injury in primary hippocampal cells via inhibition of reactive oxygen species-activated mitochondrial pathway.
Apoptosis is one of the major mechanisms of neuronal injury during ischemic-reperfusion (I/R). Mitochondrial division inhibitor (mdivi-1) is a selective inhibitor of mitochondrial fission protein Drp1. The previous experiments support that mdivi-1 reduce I/R injury in the heart model of rat, but the neuroprotective effect of the mdivi-1 is not yet clearly defined at the cellular levels in brain. ⋯ The redox state, cell apoptosis, and expression of Drp1, Bcl-2, Bax, and cytochrome C proteins were measured. The data showed that administration of mdivi-1 at the doses of 50 μM significantly reduced oxidative stress, attenuated cell apoptosis, upregulated Bcl-2 expression, and downregulated Drp1, Bax, and cytochrome C expression. The results suggested that mdivi-1 protected brain from OGD reperfusion injury, which through suppressing the ROS initiated mitochondrial pathway.
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J Stroke Cerebrovasc Dis · Jul 2014
The effects of exercise preconditioning on cerebral blood flow change and endothelin-1 expression after cerebral ischemia in rats.
Stroke is an acute cerebrovascular disease with high incidence, morbidity, and mortality. Preischemic treadmill training has been shown to be effective in improving behavioral and neuropathologic indices after cerebral ischemia. However, the exact neuroprotective mechanism of preischemic treadmill training against ischemic injury has not been elucidated clearly. ⋯ It is worth noting that ET-1 expression is increased at 24 hours of reperfusion in the pretreadmill group compared with the level of the time after middle cerebral artery occlusion. These changes were followed by significant changes in neurologic deficits and cerebral infarct volume. This study indicated that preconditioning exercise protected brain from ischemic injury through the improvement of CBF and regulation of ET-1 expression, which may be a novel component of the neuroprotective mechanism of preischemic treadmill training against brain injury.
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J Stroke Cerebrovasc Dis · Jul 2014
Improvement of cognitive function after carotid endarterectomy--a new strategy for the evaluation of cognitive function.
Significant carotid stenosis is known to cause ischemic stroke and cognitive impairment. However, it remains controversial whether carotid endarterectomy (CEA) can improve cognitive function in patients with carotid stenosis. We used the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) to compare cognitive function between before and after CEA. ⋯ After surgery, the MoCA score improved in patients who were 73 years or younger, who underwent CEA in the left side of their carotid lesion, who had severe carotid stenosis of more than 80%, who had bilateral lesion, who did not have abnormal lesion on diffusion-weighted imaging after surgery, or who had cerebral blood flow of pre-CEA over 34.5 mL. In conclusion, MoCA was feasible in patients soon after undergoing CEA. Using MoCA not MMSE, CEA may improve cognitive function in patients with significant carotid stenosis.