Stroke; a journal of cerebral circulation
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A major limitation of tissue plasminogen activator (tPA) thrombolysis for ischemic stroke is the narrow time window for safe and effective therapy. Delayed tPA thrombolysis increases the risk of cerebral hemorrhage and mortality, which, in part, is related to neurovascular proteolysis mediated by matrix metalloproteinases (MMPs). We recently showed that normobaric hyperoxia treatment reduces MMP-9 expression and blood-brain barrier disruption in the ischemic brain. Therefore, we hypothesized that normobaric hyperoxia could increase the safety of delayed tPA thrombolysis in stroke. ⋯ Our results suggest that early normobaric hyperoxia treatment may represent an important strategy to increase the safety of delayed tPA thrombolysis in ischemic stroke.
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Controlled Clinical Trial
Blood volume measurement to guide fluid therapy after aneurysmal subarachnoid hemorrhage: a prospective controlled study.
Conventional parameters used to guide fluid therapy after aneurysmal subarachnoid hemorrhage (SAH) are poorly related to blood volume. In a prospective controlled study we assessed whether fluid management guided by daily measurements of blood volume (BV) reduces the incidence of severe hypovolemia compared to conventional fluid balance guided fluid therapy. ⋯ Guiding fluid management on daily measurements of blood volume reduces the incidence of severe hypovolemia after SAH. The effects on neurological outcome should be studied.
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Comparative Study
Performance of bedside transpulmonary thermodilution monitoring for goal-directed hemodynamic management after subarachnoid hemorrhage.
Early goal-directed hemodynamic therapy is of particular importance for adequate cerebral circulation of patients with vasospasm after subarachnoid hemorrhage but is often precluded by the invasiveness of established cardiac output determination using a pulmonary artery catheter. This study was undertaken to validate the usefulness of less invasive goal-directed hemodynamic monitoring by transpulmonary thermodilution technique in patients after subarachnoid hemorrhage. ⋯ Goal-directed hemodynamic management guided by transpulmonary thermodilution appears to have a therapeutic advantage for optimizing the prognosis of patients with subarachnoid hemorrhage with vasospasm over conventional methods.
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Comparative Study
Prior use of statins improves outcome in patients with intracerebral hemorrhage: prospective data from the National Acute Stroke Israeli Surveys (NASIS).
Intracerebral hemorrhage (ICH) is a deadly form of stroke. Pretreatment with statins exerts protective effects in patients with ischemic stroke, but their effects in patients with ICH remains unclear. ⋯ Use of statins before ICH is associated with reduced mortality and neurological disability and with a higher chance for good outcome, suggesting that statins may be protective in the setting of ICH.