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Fargen, Kyle M; Jauch, Edward C.; Khatri, Pooja; Baxter, Blaise; Schirmer, Clemens M.; Turk, Aquilla S; Mocco, J

doi:10.1161/strokeaha.114.008167

Cited by 17 publications

(2 citation statements)

References 82 publications

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“…The time from stroke onset to arterial recanalization significantly impacts outcomes [44], prompting discussion on reorganizing the stroke system of care to facilitate rapid reperfusion and improve prompt access of these therapies to patients in need [45]. Intraarterial infusion of UCB MNCs immediately after mechanical thrombectomy could be a potential adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Intraarterial transplantation of human umbilical cord blood mononuclear cells in hyperacute stroke improves vascular function

Huang

Liu

et al. 2017

Stem Cell Res Ther

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BackgroundHuman umbilical cord blood (hUCB) cell therapy is a promising treatment for ischemic stroke. The effects of hyperacute stem cell transplantation on cerebrovascular function in ischemic stroke are, however, not well understood. This study evaluated the effects of hyperacute intraarterial transplantation of hUCB mononuclear cells (MNCs) on cerebrovascular function in stroke rats using serial magnetic resonance imaging (MRI).MethodsHUCB MNCs or vehicle were administered to stroke rats via the internal carotid artery immediately after reperfusion at 60 min following ischemia onset. Lesion volumes were longitudinally evaluated by MRI on days 0, 2, 14, and 28 after stroke, accompanied by behavioral tests. Cerebral blood flow (CBF) and cerebrovascular reactivity were measured by perfusion MRI and CO2 functional MRI (fMRI) at 28 days post-stroke; corresponding vascular morphological changes were also detected by immunohistology in the same animals.ResultsWe found that CBF to the stroke-affected region at 28 days was improved (normalized CBF value: 1.41 ± 0.30 versus 0.49 ± 0.07) by intraarterial transplantation of hUCB MNCs in the hyperacute stroke phase, compared to vehicle control. Cerebrovascular reactivity within the stroke-affected area, measured by CBF fMRI, was also increased (35.2 ± 3.5% versus 12.8 ± 4.3%), as well as the corresponding cerebrovascular density. Some engrafted cells appeared with microvascular-like morphology and stained positive for von Willebrand Factor (an endothelial cell marker), suggesting they differentiated into endothelial cells. Some engrafted cells also connected to host endothelial cells, suggesting they interacted with the host vasculature. Compared to the vehicle group, infarct volume at 28 days in the stem cell treated group was significantly smaller (160.9 ± 15.7 versus 231.2 ± 16.0 mm3); behavioral deficits were also markedly reduced by stem cell treatment at day 28 (19.5 ± 1.0% versus 30.7 ± 4.7% on the foot fault test; 68.2 ± 4.6% versus 86.6 ± 5.8% on the cylinder test). More tissue within initial perfusion-diffusion mismatch was rescued in the treatment group.ConclusionsIntraarterial hUCB MNC transplantation during the hyperacute phase of ischemic stroke improved cerebrovascular function and reduced behavioral deficits and infarct volume.

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Section: Discussionmentioning

confidence: 99%

Intraarterial transplantation of human umbilical cord blood mononuclear cells in hyperacute stroke improves vascular function

Huang

Liu

et al. 2017

Stem Cell Res Ther

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“…Increasingly, there are calls to develop regional solutions to modern acute stroke care similar to those that have been developed for acute conditions such as trauma to evaluate acute stroke outcomes on the population level 28 29. Thrombolysis treatment rates increased after the establishment of primary stroke centers, and there may be an even greater association with thrombectomy certification and ET given the resource-intensive and interdisciplinary nature of ET care 30.…”

Section: Discussionmentioning

confidence: 99%

Variation in US acute ischemic stroke treatment by hospital regions: limited endovascular access despite evidence

Stein

Maillie

Erdman

et al. 2023

J NeuroIntervent Surg

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BackgroundAlthough national organizations recognize the importance of regionalized acute ischemic stroke (AIS) care, data informing expansion are sparse. We assessed real-world regional variation in emergent AIS treatment, including growth in revascularization therapies and stroke center certification. We hypothesized that we would observe overall growth in revascularization therapy utilization, but observed differences would vary greatly regionally.MethodsA retrospective cross-sectional analysis was carried out of de-identified national inpatient Medicare Fee-for-Service datasets from 2016 to 2019. We identified AIS admissions and treatment with thrombolysis and endovascular thrombectomy (ET) with International Classification of Diseases, 10th Revision, Clinical Modification codes. We grouped hospitals in Dartmouth Atlas of Healthcare Hospital Referral Regions (HRR) and calculated hospital, demographic, and acute stroke treatment characteristics for each HRR. We calculated the percent of hospitals with stroke certification and AIS cases treated with thrombolysis or ET per HRR.ResultsThere were 957 958 AIS admissions. Relative mean (SD) growth in percent of AIS admissions receiving revascularization therapy per HRR from 2016 to 2019 was 13.4 (31.7)% (IQR −6.1–31.7%) for thrombolysis and 28.0 (72.0)% (IQR 0–56.0%) for ET. The proportion of HRRs with decreased or no difference in ET utilization was 38.9% and the proportion of HRRs with decreased or no difference in thrombolysis utilization was 32.7%. Mean (SD) stroke center certification proportion across HRRs was 45.3 (31.5)% and this varied widely (IQR 18.3–73.4%).ConclusionsOverall growth in AIS treatment has been modest and, within HRRs, growth in AIS treatment and the proportion of centers with stroke certification varies dramatically.

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