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Is higher body temperature beneficial in ischemic stroke patients with normal admission CT angiography of the cerebral arteries?

https://arctichealth.org/en/permalink/ahliterature105115
Source
Vasc Health Risk Manag. 2014;10:49-54
Publication Type
Article
Date
2014
Author
Christopher Elnan Kvistad
Andrej Khanevski
Aliona Nacu
Lars Thomassen
Ulrike Waje-Andreassen
Halvor Naess
Author Affiliation
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Source
Vasc Health Risk Manag. 2014;10:49-54
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Body Temperature Regulation
Brain Ischemia - drug therapy - physiopathology - radiography
Cerebral Angiography - methods
Cerebral Arteries - radiography
Chi-Square Distribution
Disability Evaluation
Female
Fibrinolytic Agents - therapeutic use
Humans
Linear Models
Logistic Models
Male
Middle Aged
Norway
Odds Ratio
Patient Admission
Predictive value of tests
Prospective Studies
Registries
Stroke - physiopathology - radiography
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator - therapeutic use
Tomography, X-Ray Computed
Treatment Outcome
Abstract
Low body temperature is considered beneficial in ischemic stroke due to neuroprotective mechanisms, yet some studies suggest that higher temperatures may improve clot lysis and outcomes in stroke patients treated with tissue plasminogen activator (tPA). The effect of increased body temperature in stroke patients treated with tPA and with normal computed tomography angiography (CTA) on admission is unknown. We hypothesized a beneficial effect of higher body temperature in the absence of visible clots on CTA, possibly due to enhanced lysis of small, peripheral clots.
Patients with ischemic stroke admitted to our Stroke Unit between February 2006 and April 2013 were prospectively registered in a database (Bergen NORSTROKE Registry). Ischemic stroke patients treated with tPA with normal CTA of the cerebral arteries were included. Outcomes were assessed by the modified Rankin Scale (mRS) after 1 week. An excellent outcome was defined as mRS=0, and a favorable outcome as mRS=0-1.
A total of 172 patients were included, of which 48 (27.9%) had an admission body temperature =37.0°C, and 124 (72.1%) had a body temperature
Notes
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PubMed ID
24482573 View in PubMed
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NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population.

https://arctichealth.org/en/permalink/ahliterature282585
Source
Stroke. 2017 Feb;48(2):335-341
Publication Type
Article
Date
Feb-2017
Author
Aliona Nacu
Christopher E Kvistad
Halvor Naess
Halvor Øygarden
Nicola Logallo
Jörg Assmus
Ulrike Waje-Andreassen
Kathinka D Kurz
Gesche Neckelmann
Lars Thomassen
Source
Stroke. 2017 Feb;48(2):335-341
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Ischemia - diagnostic imaging - drug therapy - epidemiology
Female
Humans
Male
Middle Aged
Norway - epidemiology
Phospholipids - administration & dosage
Population Surveillance - methods
Prospective Studies
Single-Blind Method
Stroke - diagnostic imaging - drug therapy - epidemiology
Sulfur Hexafluoride - administration & dosage
Thrombolytic Therapy - methods
Tissue Plasminogen Activator - administration & dosage
Ultrasonography, Doppler, Transcranial - methods
Abstract
The NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study) aimed to assess effect and safety of contrast-enhanced ultrasound treatment in an unselected acute ischemic stroke population.
Patients treated with intravenous thrombolysis within 4.5 hours after symptom onset were randomized 1:1 to either contrast-enhanced sonothrombolysis (CEST) or sham CEST. A visible arterial occlusion on baseline computed tomography angiography was not a prerequisite for inclusion. Pulse-wave 2 MHz ultrasound was given for 1 hour and contrast (SonoVue) as an infusion for ˜30 minutes. Magnetic resonance imaging and angiography were performed after 24 to 36 hours. Primary study end points were neurological improvement at 24 hours defined as National Institutes of Health Stroke Scale score 0 or reduction of =4 National Institutes of Health Stroke Scale points compared with baseline National Institutes of Health Stroke Scale and favorable functional outcome at 90 days defined as modified Rankin scale score 0 to 1.
A total of 183 patients were randomly assigned to either CEST (93 patient) or sham CEST (90 patients). The rates of symptomatic intracerebral hemorrhage, asymptomatic intracerebral hemorrhage, or mortality were not increased in the CEST group. Neurological improvement at 24 hours and functional outcome at 90 days was similar in the 2 groups both in the intention-to-treat analysis and in the per-protocol analysis.
CEST is safe among unselected ischemic stroke patients with or without a visible occlusion on computed tomography angiography and with varying grades of clinical severity. There was, however, statistically no significant clinical effect of sonothrombolysis in this prematurely stopped trial.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01949961.
Notes
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PubMed ID
27980128 View in PubMed
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The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature259874
Source
BMC Neurol. 2014;14:106
Publication Type
Article
Date
2014
Author
Nicola Logallo
Christopher E Kvistad
Aliona Nacu
Halvor Naess
Ulrike Waje-Andreassen
Jörg Asmuss
Anne Hege Aamodt
Christian Lund
Martin W Kurz
Ole Morten Rønning
Rolf Salvesen
Titto T Idicula
Lars Thomassen
Source
BMC Neurol. 2014;14:106
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Brain Ischemia - drug therapy
Embolectomy
Endovascular Procedures
Fibrinolytic Agents - adverse effects - therapeutic use
Humans
Middle Aged
Norway
Prospective Studies
Stroke - drug therapy
Tissue Plasminogen Activator - adverse effects - therapeutic use
Treatment Outcome
Young Adult
Abstract
Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase.
NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4?mg/kg (single bolus) as compared with alteplase 0.9?mg/kg (10% bolus?+?90% infusion/60?minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted
Notes
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PubMed ID
24886064 View in PubMed
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