17 research outputs found
Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.
BACKGROUND
In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors.
METHODS
The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MTâor MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.
RESULTS
We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.
CONCLUSION
In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors
Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial
Background: In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors.
Methods: The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MTâor MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0â2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.ResultsWe included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65â81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13â20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.
Conclusion: In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors
Identification des facteurs retardant la prise en charge de l accident vasculaire cérébral en phase aiguë aux urgences
PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF
Hyperglycémie à la phase aiguë de l'infarctus cérébral
PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF
Pronostic des patients admis en unité neuro-vascumaire pour un accident vasculaire cérébral et transférés en réanimation
LIMOGES-BU MĂ©decine pharmacie (870852108) / SudocSudocFranceF
Prévention des resténoses intra
La pose de stents est devenue la principale technique dâangioplastie coronaire percutanĂ©e en France, comme dans les autres pays occidentaux. La principale limite de cette technique est la survenue de restĂ©noses au site dâimplantation du stent. Les techniques mĂ©dicamenteuses de prĂ©vention, inefficaces dans lâensemble, souffrent autant dâune mĂ©connaissance de la physiopathologie des restĂ©noses intrastent que dâune inadĂ©quation entre des traitements systĂ©miques et un phĂ©nomĂšne biologique Ă©minemment focal. Des traitement locaux prenant en compte ces donnĂ©es physiopathologiques sont donc en cours dâĂ©valuation chez lâhomme. Les premiers rĂ©sultats cliniques des stents imprĂ©gnĂ©s actifs, qui permettent de dĂ©livrer localement de fortes concentrations de substances antiprolifĂ©rantes (sirolimus, paclitaxelâŠ), sont trĂšs prometteurs et suggĂšrent que ces nouveaux stents devraient probablement rĂ©volutionner la pratique de la cardiologie interventionnelle. Quant Ă la thĂ©rapie gĂ©nique, son application au problĂšme des restĂ©noses nĂ©cessite une simplification et une amĂ©lioration de lâefficacitĂ© des techniques de transfert gĂ©nique
The Smoking Paradox: Impact of Smoking on Recanalization in the Setting of Intra-Arterial Thrombolysis
Background: The smoking paradox refers to a better outcome in smokers eligible for thrombolytic treatment in myocardial infarction or ischemic stroke. Recent findings suggest that current smokers may present higher recanalization rates after intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA). We evaluated the impact of smoking in a consecutive series of patients treated with intra-arterial (IA) rt-PA. Methods: We analyzed data collected between April 2007 and December 2012 in our prospective registry. All acute ischemic stroke patients with an arterial occlusion treated by IA rt-PA (± IV, ± thrombectomy) were included. Arterial status was monitored with conventional angiography during the IA procedure. The primary study outcome was a complete recanalization achieved immediately after termination of IA rt-PA infusion. Secondary outcomes included complete recanalization after the end of the endovascular therapy (including complete recanalization achieved after adjunctive thrombectomy), favorable outcome (90-day modified Rankin Score â€2), 90-day all-cause mortality, and any intracerebral hemorrhage. Results: Among the 227 included patients, 18.5% (n = 42) were current smokers and 16.7% (n = 38) former smokers. Compared with nonsmokers, current smokers were younger, more often men, had less frequently hypertension, and cardioembolic etiology, whereas former smokers were more often men and had more frequently hypercholesterolemia. The rate of complete recanalization was 30% (n = 68) after IA rt-PA infusion and 49% after adjunctive thrombectomy. A higher complete recanalization rate was found both in current smokers (45.2%) and former smokers (42.1%) compared to nonsmokers (22.5%). After adjustment for potential confounders, the adjusted odds ratio (OR) for complete recanalization associated with ever-smokers was 2.51 [95% confidence interval (CI) 1.26-4.99; p = 0.009]. A similar adjusted OR was found when the complete recanalization achieved after thrombectomy was included (OR 2.18, 95% CI 1.13-4.19; p = 0.019). However, smoking status was not independently associated with favorable outcome (adjusted OR 1.41, 95% CI 0.62-3.22 for former smokers, and adjusted OR 1.35, 95% CI 0.59-3.05 for current smokers), 90-day all-cause mortality (adjusted OR 0.68, 95% CI 0.25-1.81 for former smokers, and adjusted OR 1.55, 95% CI 0.54-4.48 for current smokers) or intracerebral hemorrhage (adjusted OR 0.72, 95% CI 0.29-1.76 for former smokers, and adjusted OR 0.80, 95% CI 0.32-1.96 for current smokers). Conclusions: IA rt-PA administration was more effective to achieve complete arterial recanalization in current as well as former smokers. The characterization of the smoking paradox pathophysiology may lead to the identification of a patient-target population with a favorable response to rt-PA therapy. However, the smoking paradox should not be misinterpreted and not be used to promote smoking
On the constitutive model of nitrogen-containing austenitic stainless steel 316LN at elevated temperature.
The nitrogen-containing austenitic stainless steel 316LN has been chosen as the material for nuclear main-pipe, which is one of the key parts in 3rd generation nuclear power plants. In this research, a constitutive model of nitrogen-containing austenitic stainless steel is developed. The true stress-true strain curves obtained from isothermal hot compression tests over a wide range of temperatures (900-1250°C) and strain rates (10(-3)-10 s(-1)), were employed to study the dynamic deformational behavior of and recrystallization in 316LN steels. The constitutive model is developed through multiple linear regressions performed on the experimental data and based on an Arrhenius-type equation and Zener-Hollomon theory. The influence of strain was incorporated in the developed constitutive equation by considering the effect of strain on the various material constants. The reliability and accuracy of the model is verified through the comparison of predicted flow stress curves and experimental curves. Possible reasons for deviation are also discussed based on the characteristics of modeling process