Stroke Thrombolysis Protocol Shortens “Door-to-Needle Time” and Improves Outcomes—Experience at a Tertiary Care Center in Qatar

Ibrahim, F.; Akhtar, Naveed; Salam, Abdul; Kamran, Saadat; Deleu, Dirk; D’Souza, Atlantic; Imam, Yahya; Bourke, Paula; Joseph, Sujatha; Santos, Mark; Khan, Raheel; Bhutta, Zulfiqar A; Bhagat, Anjushri; Shuaib, Ashfaq

doi:10.1016/j.jstrokecerebrovasdis.2016.03.047

Cited by 17 publications

(33 citation statements)

References 7 publications

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“…22 Low mortality rates have also been attributed to a young Qatar population together with improvements in stroke management and care. 26 Although the findings of low incidence and mortality of stroke in Qatar suggest a low burden in the country, it is expected that as the population ages stroke will become a more prominent issue.…”

Section: Mortalitymentioning

confidence: 99%

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Current status of stroke in Qatar: Including data from the BRAINS study

Jallow

Hail

Han

et al. 2019

JRSM Cardiovascular Disease

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Background Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce. Method We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients. Results Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians. Conclusion The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.

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Section: Mortalitymentioning

confidence: 99%

“…Reducing ‘door-to-needle time’ may lead to considerable benefits including higher rates of thrombolysis, fewer complications, shorter length of stay in hospitals and improved prognosis for patients. 26…”

Section: Stroke Care and Outcomementioning

confidence: 99%

Current status of stroke in Qatar: Including data from the BRAINS study

Jallow

Hail

Han

et al. 2019

JRSM Cardiovascular Disease

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“…Infarction in the middle cerebral artery (MCA) territory is a common and severe ischemic stroke (1,2). The lesion volume, as assessed on diffusion-weighted imaging (DWI), is a recognized imaging biomarker for outcome forecasting; it is also an indicator which can guide the patient’s thrombolytic and endovascular treatment (3,4).…”

Section: Introductionmentioning

confidence: 99%

Maximum lesions area and orthogonal values accessed from DWI images would be alternative imaging markers for predicting the outcome of acute ischemia in the middle cerebral artery territory

2018

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Background Evaluating the acute ischemic volume on diffusion-weighted imaging (DWI) in the middle cerebral artery (MCA) territory would predict outcome. Purpose To investigate the correlations between maximum area with restricted diffusion (MaxA), the orthogonal diameters (OD) as well as lesion volume on DWI, and to explore the role of MaxA and OD on predicting unfavorable outcome after an acute MCA ischemic stroke. Material and Methods Sixty consecutive adult patients, including modified Rankin Scale score (mRS) ≤2 (n = 31) and mRS > 2 (n = 29) groups, were retrospectively enrolled. The MaxA and OD of lesions were assessed at the slice containing the largest infarction size on DWI images. We compared the prediction efficiencies of these methods on unfavorable outcomes. Results The correlation coefficients between the MaxA and infarction volume and OD and infarction volume were 0.982 ( P < 0.001) and 0.952 ( P < 0.001), respectively. The times required for measuring MaxA (150 s [130-160]) and OD (30 s [20-60]) were much shorter than that for infarction volume measurement (1240 s [180-1480]) ( P = 0.001, P = 0.004). With thresholds of ≥57.3 mL for infarction volume, ≥15.2 cm for MaxA, and ≥38.1 for the arithmetic product of OD, the AUCs of infarction volume, MaxA, and OD for predicting an unfavorable outcome were 0.818, 0.821, and 0.820, respectively. Conclusion Since they correlated well with the infarction volume, MaxA and OD assessed on DWI were time-saving and achieved comparable diagnostic efficiencies; thus, they may represent alternative imaging markers for predicting unfavorable outcomes of acute ischemic stroke in MCA territory.

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“…Currently, one of a few evidence-based acute stroke treatments is thrombolysis induced by intravenous administration of recombinant tissue plasminogen activator (tPA). Unfortunately, only a small percentage of patients benefit from this treatment primarily due to a narrow therapeutic time window of 4.5 hours [1–3]. …”

Section: Introductionmentioning

confidence: 99%

Mesenchymal Stromal Cells Promote Axonal Outgrowth Alone and Synergistically with Astrocytes via tPA

2016

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We reported that mesenchymal stromal cells (MSCs) enhance neurological recovery from experimental stroke and increase tissue plasminogen activator (tPA) expression in astrocytes. Here, we investigate mechanisms by which tPA mediates MSC enhanced axonal outgrowth. Primary murine neurons and astrocytes were isolated from wild-type (WT) and tPA-knockout (KO) cortices of embryos. Mouse MSCs (WT) were purchased from Cognate Inc. Neurons (WT or KO) were seeded in soma side of Xona microfluidic chambers, and astrocytes (WT or KO) and/or MSCs in axon side. The chambers were cultured as usual (normoxia) or subjected to oxygen deprivation. Primary neurons (seeded in plates) were co-cultured with astrocytes and/or MSCs (in inserts) for Western blot. In chambers, WT axons grew significantly longer than KO axons and exogenous tPA enhanced axonal outgrowth. MSCs increased WT axonal outgrowth alone and synergistically with WT astrocytes at both normoxia and oxygen deprivation conditions. The synergistic effect was inhibited by U0126, an ERK inhibitor, and receptor associated protein (RAP), a low density lipoprotein receptor related protein 1 (LRP1) ligand antagonist. However, MSCs exerted neither individual nor synergistic effects on KO axonal outgrowth. Western blot showed that MSCs promoted astrocytic tPA expression and increased neuronal tPA alone and synergistically with astrocytes. Also, MSCs activated neuronal ERK alone and synergistically with astrocytes, which was inhibited by RAP. We conclude: (1) MSCs promote axonal outgrowth via neuronal tPA and synergistically with astrocytic tPA; (2) neuronal tPA is critical to observe the synergistic effect of MSC and astrocytes on axonal outgrowth; and (3) tPA mediates MSC treatment-induced axonal outgrowth through the LRP1 receptor and ERK.

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Stroke Thrombolysis Protocol Shortens “Door-to-Needle Time” and Improves Outcomes—Experience at a Tertiary Care Center in Qatar

Cited by 17 publications

References 7 publications

Current status of stroke in Qatar: Including data from the BRAINS study

Current status of stroke in Qatar: Including data from the BRAINS study

Maximum lesions area and orthogonal values accessed from DWI images would be alternative imaging markers for predicting the outcome of acute ischemia in the middle cerebral artery territory

Mesenchymal Stromal Cells Promote Axonal Outgrowth Alone and Synergistically with Astrocytes via tPA

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