Abstract 100: Combining Prehospital Neuroprotective Therapy With Post-Hospital Arrival Recanalization Therapies: The FAST-MAG Experience
Nerses SanossianDavid S. LiebeskindMay Kim‐TenserMarc EcksteinFranklin D PrattSamuel J. StrattonRobin ConwitSidney StarkmanJeffrey L. Saver
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Background: Prehospital neuroprotective therapy aims to preserve penumbral tissue in anticipation of recanalization therapies. We describe the population receiving recanalization treatment upon hospital arrival after enrollment in a prehospital neuroprotective trial. Methods: The Field Administration of Stroke Therapy Magnesium (FAST-MAG) phase 3 clinical trial randomized subjects with stroke symptom onset within 2 hours to prehospital treatment with intravenous magnesium sulfate vs. placebo. Subjects were eligible for all FDA-approved/cleared therapies as concomitant treatment, including intravenous thrombolysis and mechanical neurothrombectomy. Results: Among the 1223 patients with acute cerebral ischemia enrolled in the trial, mean age was 71 [SD 13] , 45% were women, 78% White race, 14% Black race and 21% Hispanic ethnicity. Among the cerebral ischemia patients, 434 [36%] received IV thrombolysis and 72 [6%] received endovascular therapy, including 46 patients who received both IV and endovascular recanalization treatment.. Patients treated with IV TPA, compared to supportive care patients, had more severe deficits on ED arrival [median NIHSS 12.5 vs. 4.0, p<0.0001], were assessed by paramedics earlier [30 vs. 50 minutes, p<0.001], and arrived in the ED earlier [63 vs. 84 minutes, p<0.001], but were of similar age and ethnicity. Those who were taken for endovascular therapy had more severe strokes [NIHSS 16, IQR 9.5-23] but were no different in race-ethnicity or time to evaluation. Conclusions: Concomitant intravenous thrombolysis and endovascular recanalization were administered at high rates in the FAST-MAG study, reflecting expanding reperfusion practice in Los Angeles and Orange Counties during the study period. The FAST-MAG population has a sufficient volume of patients concomitantly treated with recanalization therapy to explore with good power the potential benefit of neuroprotection prior to recanalization therapy.Keywords:
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Objective To study the thrombolysis of acute ischemic stroke with urokinase(UK),and to observe the clinical efficacy,looking for a safe dosage and a way fit for thrombolysis via vein Method Thrombolysis of 18 cases of acute ischemic stroke were performed with mid minidose of UK The therapy of the control group was the same as the group of thrombolysis except for not using UK Every case was scored with Europe stroke scale before and after thrombolysis and the scores were subjected to statistics to evaluat the efficacy Results The scores of ESS are higher than those before thrombolysis at the second hour,the sixth hour,the first day,the second day,the third day,the seventh day and the fourteenth day after thrombolysis The subjectives had no hemorrhage The scores of the thrombolysis group were much higher than those of control group Conclusion Compared with control group,the efficacy of thrombolysis with mid minidose is better and the side effect less [
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To explore the effect of different starting time of thrombolysis on acute myocardial infarction (AMI).Ninety-five patients of AMI were divided into prompt thrombolysis group (less then 6 h, 46 patients) and delayed thrombolysis group (6-12 hours, 49 patients), according to the different starting time of treating AMI. The incidences of reopening and side-effect, as well as mortality were compared between two groups.The reopening rate and mortality in prompt thrombolysis group were 76% and 4%, respectively. The reopening rate and mortality in delayed thrombolysis group were 49% and 12%, respectively. Compared the prompt thrombolysis group with the delayed thrombolysis group, there was a significance discrepancy (both P<0.01). The side-effect rate had not significant discrepancy (15% vs. 16%, P>0.05).The clinical reopening rate of the thrombolysis is higher in patients with thrombolysis less than 6 hours, the mortality is lower. The thrombolytic treatment should be prompt for patients adapting thrombolysis.
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Objective To investigate the dynamic change in serum matrix metalloproteinase-12(MMP-12) after thrombolysis in acute myocardial infarction(AMI) and explore its clinical significance.Methods Blood samples were collected from 60 cases of AMI before thrombolysis and 6h,24h,72h and 7d after thrombolysis.The serum MMP-12 levels of 60 cases of AMI and 18 cases of normal people(normal coronary arteriography) were measured,and at the same time,the serum MMP-12 levels of success thrombolysis group and non-success thrombolysis group were measured.Results The expression of serum MMP-12 at different periods after thrombolysis in AMI was higher than that of the normal people,and the highest level was at 72h after thrombolysis.The expression of the serum MMP-12 at 6h,24h,72h and 7d after thrombolysis in the success thrombolysis group was lower than that in the non-success thrombolysis group as if the highest level was ahead of schedule.Conclusion The expression of serum MMP-12 after thrombolysis in AMI shows dynamic change and reaches a peak at 72h after thrombolysis.The peak level of the serum MMP-12 in the success thrombolysis group seems ahead of schedule.The thrombolysis therapy has an effect on the serum MMP-12 expression.
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Neuronal cells are extremely vulnerable and have a limited capacity for self-repair in response to injury. For those reasons, there is obvious interest in limiting neuronal damage. Mechanisms and strategies used in order to protect against neuronal injury, apoptosis, dysfunction, and degeneration in the central nervous system are recognized as neuroprotection. Neuroprotection could be achieved through several classes of natural and synthetic neuroprotective agents. However, considering the side effects of synthetic neuroprotective agents, the search for natural neuroprotective agents has received great attention. Recently, an increasing number of studies have identified neuroprotective properties of chitosan and its derivatives; however, there are some significant challenges that must be overcome for the success of this approach. Hence, the objective of this review is to discuss neuroprotective properties of chitosan and its derivatives.
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