The benefit of intravenous thrombolysis prior to mechanical thrombectomy within the therapeutic window for acute ischemic stroke

Waller, Joseph; Kaur, Parveer; Tucker, Amy L.; Amer, Rami; Bae, Sonu; Kogler, Ann; Umair, Muhammad

doi:10.1016/j.clinimag.2021.03.020

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…However, further research to determine the reason for multiple EMS calls would be necessary. Based on the condition that the stroke detection rate would increase by the same amount as the OHCA detection rate increased through CORTI AI, the rate of stroke patients treated with thrombolysis will rise by 5% within the group of stroke patients calling within time-to-treatment for thrombolysis [ 24 , 54 ]. Additionally, the ASR might lead to an increase in thrombectomy of 8%, reperfusion of 8%, and surgical treatment of 2%.…”

Section: Discussionmentioning

confidence: 99%

Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point

Scholz

Collatz-Christensen

Blomberg

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background and purpose Stroke recognition at the Emergency Medical Services (EMS) impacts the stroke treatment and thus the related health outcome. At the EMS Copenhagen 66.2% of strokes are detected by the Emergency Medical Dispatcher (EMD) and in Denmark approximately 50% of stroke patients arrive at the hospital within the time-to-treatment. An automatic speech recognition software (ASR) can increase the recognition of Out-of-Hospital cardiac arrest (OHCA) at the EMS by 16%. This research aims to analyse the potential impact an ASR could have on stroke recognition at the EMS Copenhagen and the related treatment. Methods Stroke patient data (n = 9049) from the years 2016–2018 were analysed retrospectively, regarding correlations between stroke detection at the EMS and stroke specific, as well as personal characteristics such as stroke type, sex, age, weekday, time of day, year, EMS number contacted, and treatment. The possible increase in stroke detection through an ASR and the effect on stroke treatment was calculated based on the impact of an existing ASR to detect OHCA from CORTI AI. Results The Chi-Square test with the respective post-hoc test identified a negative correlation between stroke detection and females, the 1813-Medical Helpline, as well as weekends, and a positive correlation between stroke detection and treatment and thrombolysis. While the association analysis showed a moderate correlation between stroke detection and treatment the correlation to the other treatment options was weak or very weak. A potential increase in stroke detection to 61.19% with an ASR and hence an increase of thrombolysis by 5% in stroke patients calling within time-to-treatment was predicted. Conclusions An ASR can potentially improve stroke recognition by EMDs and subsequent stroke treatment at the EMS Copenhagen. Based on the analysis results improvement of stroke recognition is particularly relevant for females, younger stroke patients, calls received through the 1813-Medical Helpline, and on weekends. Trial registration This study was registered at the Danish Data Protection Agency (PVH-2014-002) and the Danish Patient Safety Authority (R-21013122).

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Section: Discussionmentioning

confidence: 99%

Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point

Scholz

Collatz-Christensen

Blomberg

et al. 2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Acute ischemic stroke (AIS), one of the two main subtypes of stroke, with an incidence of about 80%, occurs due to brain ischemia as a result of thrombosis of a cerebral blood vessel [3]. Prior to the introduction of mechanical thrombectomy devices, thrombolysis using intravenous thrombolytic drugs is considered to be the most effective treatment method, which have many benefits including improve the neurological function, reduce the disability and mortality rate, and improve the quality of life [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy evaluation of r-SaK in a novel canine acute cerebral vessel thromboembolism model

Qian¹,

Li²,

Zhang

et al. 2022

Preprint

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In order to evaluate the thrombolytic effect of Recombinant staphylokinase for injection (r-SaK) in acute ischemic cerebral infarction, an intracranial large vessel occlusion animal model was generated by pushing an autologous thrombus to the internal carotid artery under X-ray angiography. Autologous thrombi/saline were injected into the internal carotid artery, and thrombolytic agents were then administrated. Thrombus formation and dissolution were monitored by real-time digital subtraction angiography (DSA), blood coagulation and histopathologic examinations were used as subsidiary methods. The results in the present study showed that the left cerebral vascular thrombotic occlusion model was established stably after the autologous thrombus pushed through the internal carotid artery in dogs. Administration of r-SaK (0.25, 0.5, 1.0 mg/kg) produced effective thrombus dissolution with a recovery of over 80% blood flow, as effective as alteplase (1.68 mg/kg). Correspondingly, blood coagulation was changed by r-SaK, with a dramatic elongation of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) and reduction of fibrinogen (FIB). In contrast to the model group, pathological improvement in the two thrombolytic groups were mainly manifested in the improvement of the structural integrity of the gray matter, and the reduction of the infiltration of inflammatory cells and neuronal damage in the intracranial blood vessels. Besides, no adverse reactions related to bleeding in this model were found. The results indicate that intravenous infusion of r-SaK has a significant thrombolytic effect on intracranial large vessel occlusion model, and can prevents brain tissue and neuron damage induced by thromboembolism.

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Efficacy evaluation of r-SaK in a novel canine acute cerebral vessel thromboembolism model

Qian¹,

Zhang

et al. 2023

Preprint

View full text Add to dashboard Cite

In order to evaluate the thrombolytic effect of Recombinant staphylokinase for injection (r-SaK) in acute ischemic cerebral infarction, an intracranial large vessel occlusion animal model was generated by pushing an autologous thrombus to the internal carotid artery under X-ray angiography. Thirty dogs were divided into five groups: model group, alteplase group, and r-SaK group (three dosages). Autologous thrombi/saline were injected into the internal carotid artery, and thrombolytic agents were then administrated. Thrombus formation and dissolution were monitored by real-time digital subtraction angiography (DSA), blood coagulation and histopathologic examinations were used as subsidiary methods. The results in the present study showed that the left cerebral vascular thrombotic occlusion model was established stably after the autologous thrombus pushed through the internal carotid artery in dogs. Administration of r-SaK (0.25, 0.5, 1.0 mg/kg) produced effective thrombus dissolution with a recovery of over 80% blood flow, as effective as alteplase (1.68 mg/kg). Correspondingly, blood coagulation was changed by r-SaK, with a dramatic elongation of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) and reduction of fibrinogen (FIB). In contrast to the model group, pathological improvement in the two thrombolytic groups were mainly manifested in the improvement of the structural integrity of the gray matter, and the reduction of the infiltration of inflammatory cells and neuronal damage in the intracranial blood vessels. Besides, no adverse reactions related to bleeding in this model were found. The results indicate that intravenous infusion of r-SaK has a significant thrombolytic effect on intracranial large vessel occlusion model, and can prevents brain tissue and neuron damage induced by thromboembolism. We also provide a new preclinical pharmacodynamic evaluation method (DTICI) of cerebral thrombolytics using beagle dogs with an acute thrombotic cerebrovascular occlusion, The efficacy of r-SaK against acute thrombotic cerebral vessel occlusion in comparison to alteplase was also clarified for the first time, and this model could be further applied to studies of novel thrombolytic therapies.

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The benefit of intravenous thrombolysis prior to mechanical thrombectomy within the therapeutic window for acute ischemic stroke

Cited by 3 publications

References 29 publications

Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point

Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point

Efficacy evaluation of r-SaK in a novel canine acute cerebral vessel thromboembolism model

Efficacy evaluation of r-SaK in a novel canine acute cerebral vessel thromboembolism model

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