BACKGROUND AND PURPOSE In thrombolytic therapy for acute ischemic stroke, it is essential to obtain rapid thrombolysis before ischemic neuronal injury occurs. To develop a new technique of thrombolysis for acute ischemic stroke, the effect of transcranially applied ultrasound (TUS) on thrombolysis was examined. METHODS An occlusion model of rabbit femoral artery was produced with thrombin aft...

BACKGROUND Catheter-based therapeutic ultrasound thrombolysis was recently shown to be effective and safe. The purpose of this work was to study the safety and efficacy of external high-intensity focused ultrasound thrombolysis guided by ultrasound imaging in experimental settings. METHODS AND RESULTS A therapeutic transducer was constructed from an acoustic lens and integrated with an ultras...

Thrombolytic stroke therapy is based on the "re-canalization hypothesis," i.e., that reopening of occluded vessels improves clinical outcome in acute ischemic stroke through regional reperfusion and salvage of threatened tissues. Re-canalization is an important predictor of stroke outcome in all the modalities of thrombolysis. Thrombolysis in acute ischemic stroke evolved from clinical trials w...

BACKGROUND AND PURPOSE Transient elevation of arterial blood pressure (BP) is frequent in acute ischemic stroke and may help to increase perfusion of tissue jeopardized by ischemia. If this is true, recanalization may eliminate the need for this BP elevation. METHODS We analyzed BP in 149 patients with acute ischemic stroke on admission to the hospital and 1 and 12 hours after intraarterial t...

BACKGROUND AND PURPOSE Patients with low estimated glomerular filtration rate (eGFR) and proteinuria may be at increased risk for stroke. This study investigated whether low eGFR and proteinuria are outcome predictors in stroke patients treated with intravenous thrombolysis. METHODS We studied 432 consecutive stroke patients who received thrombolysis from January 2006 to December 2012, in Tai...

Pearls 1. Patient workup and evaluation is key to a successful intervention while limiting complications. In addition to physical exam and laboratory evaluation, review of prior imaging studies and surgical interventions is important to understanding the etiology of the occlusion and to guide therapy. 2. Use of arterial thrombolysis should be avoided in patients with evidence of irreversible li...

Indications for carotid endarterectomy (CEA) have evolved as stroke services have improved. Hyperacute stroke units are referring more patients with a significant carotid stenosis, some within hours of thrombolysis. In their metaanalysis, Mandavia et al. pooled the evidence to date to attempt to assess 30-day safety of urgent CEA for these patients. However, care must be taken with the interpre...

BACKGROUND Shorter time to treatment is associated with lower mortality in acute coronary syndromes (ACS). A previous (1994) survey showed substantial delays for acute myocardial infarction (AMI) in Ireland. The present study compared current practice with 1994 and surveyed acute coronary syndromes as a more complete contemporary evaluation of critical cardiac care than assessing AMI alone. M...