Treatment-Related Stroke

Description:

 

Up to 15% of all strokes occur in hospitalized patients, many of whom are there for surgical procedures or cardiac disorders. Outcomes can be poor, with high mortality - possibly related to co-morbidities and the complexities of hospital care. Risk factors for in-hospital stroke include specific operations and procedures (such as cardiac surgery), previous medical disorders (especially a history of stroke or transient ischemic attack), and certain physiological characteristics (including fever and dehydration). More rapid diagnosis and evaluation for interventional therapies is needed. This major new book examines the causes of treatment-related stroke in most hospital-based situations. Therapeutic approaches – including interventional therapies and intra-arterial thrombolysis – are highlighted, including experimental agents and interventions where other treatment possibilities are limited. Increasing the awareness of such interventions is an important factor in reducing delays in the assessment of patients who have strokes while in hospital, thus decreasing morbidity and reducing costs.

 

Table of Contents:

 

Section I Iatrogenic ischemic strokes: peri- and postoperative strokes

 

Chapter 1 Stroke after general surgery

 

Introduction

The prevalence and burden of stroke in general surgery patients

Risk factors for stroke in general surgery patients

Pathophysiology and etiological mechanisms of stroke in general surgery patients

Prevention of stroke in general surgery patients

Preoperative assessment

Risk factor management

Intraoperative interventions

Postoperative management

Management of acute stroke in general surgery patients

Summary

References

 

Chapter 2 Stroke after open arterial surgery

 

Methods

Results of literature search

Non-cerebrovascular arterial surgery

Surgery of the thoracic aorta

Open carotid artery surgery (CEA, carotid endarterectomy)

Swedvasc results

Discussion

Concluding remarks

References

Chapter 3 Postoperative stroke in neurosurgery

Introduction

Preoperative assessment

Intraoperative management

Postoperative follow-up

Approach-related complications

Closure-related complications

Complications associated with trauma surgery

Complications associated with brain aneurysm surgery

Complications in arteriovenous malformation (AVM) surgery

Tumor surgery complications

Intra- and postoperative stroke

References

 

Chapter 4 Vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

Introduction

Definition of vasospasm and delayed cerebral ischemia

Pathophysiology of arterial spasm and DCI in SAH

Oxyhemoglobin

Endothelin-1

Nitric oxide

Role of erythrocytes in the subarachnoid space

Vascular cell membrane

Early brain injury in aSAH

Cortical spreading depression

Microthrombosis

Apoptosis

Predictors of vasospasm in aSAH

Diagnosis and monitoring of cerebral vasospasm

Transcranial Doppler ultrasonography (TCD)

Digital cerebral angiography

CT angiography and CT brain perfusion

Monitoring DCI

Prevention of DCI

Nimodipine

Permissive arterial hypertension

Prevention of hypovolemia

Other measures to prevent DCI

Treatment of DCI

Hemodynamic management

Pharmacological treatment and angioplasty

Duration of treatment

Conclusions

References

Chapter 5 Stroke occurring on medical wards

Introduction

Stroke on the cardiology wards and coronary care unit

Acute stroke treatment issues

Secondary prevention issues

Stroke on the neurology ward

Acute stroke treatment issues

Secondary prevention issues

Stroke on the renal unit

Acute stroke treatment issues

Secondary prevention issues

Stroke on the oncology ward

Acute stroke treatment issues

Secondary prevention issues

Stroke on the hematology ward

Stroke on the respiratory ward

Stroke on the gastroenterology ward

Acute stroke treatment issues

Secondary prevention issues

Stroke in hospitalized diabetic patients

Acute stroke treatment issues

Secondary prevention issues

Stroke on the psychiatry ward

Acute stroke treatment issues

Secondary prevention issues

Stroke on other medical wards

References

Chapter 6 Stroke in trauma patients

Introduction

Stroke mechanisms in acute trauma patients

Arterial injury

Cardiac emboli

Other miscellaneous causes

Time course and recognition of stroke after trauma

Acute therapy for stroke in trauma patients

Stroke in the months after trauma

Concluding remarks

References

Section II Iatrogenic ischemic strokes: stroke after endovascular procedures

Chapter 7 Stroke associated with endovascular procedures

Introduction

Pathophysiology underlying thrombosis and endothelial repair

Platelet adhesion

Coagulation cascade

Repair

Antithrombotic agents

Platelet adhesion and aggregation

Aspirin

Ticlopidine and clopidogrel

Cilostazol

Platelet GP IIb/IIIa receptor-specific antibodies

Abciximab

Eptifibatide

Tirofiban

Inhibition of thrombin and fibrinogen activation

Heparin

Low molecular weight heparin

Direct inhibitors of thrombin

Warfarin

Use of antiplatelet vs. anticoagulant therapy in endovascular procedures

Combination antiplatelet therapy vs. monotherapy

Endovascular procedures and thrombogenic factors

Contrast agents

Angiographic devices

Fibrinolysis and thrombolytics

Fibrinolysis

Thrombolytics

t-PA

Urokinase

Pro-urokinase

Combination thrombolysis

Treatment monitoring and point of care testing (POC)

Endovascular procedures and complications

Diagnostic angiography

Endovascular coil embolization of aneurysm

Endovascular occlusion of intracranial aneurysms using balloons

Percutaneous transluminal angioplasty (PTA) and PTA with stenting (PTAS)

Embolization of AVMs

Mechanical thrombectomy

Intracranial angioplasty and stent placement

Summary

General principles

Diagnostic angiography

Coil embolization of aneurysms

Balloon occlusion of aneurysms or parent vessels harboring aneurysms

PTA and PTAS

Embolization using glue, particles, or other materials

Intra-arterial thrombolysis

Conclusions

References

Chapter 8 Stroke after diagnostic endovascular procedures

Introduction

Complications of intra-arterial cerebral angiography

Definition and prerequisites

Non-neurological complications

Clinically detectable neurological complications

Risk factors associated with clinically detectable neurological complications

Pathophysiology of stroke-related complications

Diffusion-weighted imaging abnormalities after diagnostic cerebral angiography

Diagnostic cerebral angiography in children

Conclusions

References

Chapter 9 Stroke after endovascular cardiac procedures and cardiothoracic surgery

Introduction

Stroke and endovascular cardiac procedures

Coronary intervention-related stroke

Catheter ablation of atrial fibrillation

Percutaneous closure of patent foramen ovale

Stroke after cardiac surgery

Coronary artery bypass graft (CABG) surgery

Transcatheter aortic valve implantation (TAVI)

Open valve replacement (AVR)

Pathophysiology

Risk factors for stroke after valve procedures

Combined cardiac interventions

Conclusion

References

Chapter 10 Stroke after carotid revascularization procedure

Introduction

Carotid endarterectomy

Carotid artery stenting

References

Section III Iatrogenic ischemic strokes: other causes

Chapter 11 Radiation therapy and stroke

Introduction

Epidemiology

Cavernomas

Treatment of cavernous malformations

Stenosis of the extracranial carotid arteries or vertebral arteries

Large- and medium-vessel intracranial disease

Small-vessel disease, white matter tissue changes, and microbleeds

Aneurysms

Moyamoya phenomenon development

Stroke mimics

Conclusion

References

Chapter 12 Stroke after chiropractic manipulations

Introduction

Anatomy and pathophysiology of cervical artery dissections

Clinical manifestation of cervical artery dissection

Cervical artery dissections and chiropractic treatment

Epidemiology and risk estimation

Conclusion

References

Chapter 13 Stroke due to air and fat embolism

Introduction

Fat embolism

Introduction

Epidemiology

Etiology

Pathogenesis

Clinical features

Diagnosis

Treatment

Air gas embolism

Introduction

Epidemiology and etiology

Pathogenesis

Clinical features

Diagnosis

Treatment

References

Chapter 14 Stroke after discontinuation of preventive medications

Introduction

Antiplatelet medication

Aspirin

Thienopyridines

Other

Anticoagulation therapy

Vitamin K antagonists

Direct oral anticoagulants (DOAC)

Statin therapy

Antihypertensive and antidiabetic treatment

Antidiabetic treatment

Conclusion

References

Section IV Iatrogenic hemorrhagic strokes: thrombolysis-related hemorrhagic strokes

Chapter 15 Intracranial hemorrhage: complication of endovascular therapy for acute stroke

Introduction

Definition

Frequency

Pathophysiology

Clinical predictors

Radiographic predictors

Medical management

Surgical management

References

Chapter 16 Intracranial hemorrhage: complication of intravenous thrombolysis

Introduction

Clinical predictors

Age

Clinical severity

Door-to-needle time

Blood pressure (BP)

Previous treatments

Dose of t-PA and weight

Level of blood glucose

Stroke etiology

Remote or extra-ischemic intracerebral hemorrhage

Biomarkers of SICH

Magnetic resonance imaging predictors of SICH

Lesion size

MRI hemodynamic markers

Markers of small arterial disease: microbleeds and leukoencephalopathy

Mechanical thrombectomy in addition to IV thrombolysis and bleeding risk

Poor collateral vessels and bleeding risk

Blood–brain barrier changes and bleeding

Conclusions

References

Section V Iatrogenic hemorrhagic strokes: intracranial bleeding

Chapter 17 Intracranial hemorrhages secondary to antiplatelet treatment

Introduction

Antiplatelet treatment

Aspirin

Dipyridamole and aspirin combination

Ticlopidine

P2Y12 adenosine diphosphate receptor inhibitors

Clopidogrel

Combination of clopidogrel and aspirin

Dual antiplatelet therapy for secondary stroke prevention in patients with small-vessel and large-vessel diseases

Dual antiplatelet therapy for secondary stroke prevention in patients with atrial fibrillation

Glycoprotein IIb/IIIa inhibitors

Cilostazol

Factors associated with increased risk for intracranial hemorrhage with antithrombotic use

Evidence of microhemorrhages on MRI

Concurrent anticoagulant use

Platelet function tests

Reversal of antiplatelet therapy

Management of intracranial hemorrhage

Acute management in the emergency department

Initial diagnosis

Airway protection

Reversal of anticoagulation

Blood pressure management

Treatment of mass effect

Intensive care unit care

Seizure monitoring

Blood pressure management

Glucose monitoring

Fever and infection control

Deep venous thrombosis prophylaxis

Gastric ulcer prophylaxis

Initiation of diet

Plan for tracheostomy and percutaneous endoscopic gastrostomy placement

Declaration of do not resuscitate status

Conclusions

References

Section VI Iatrogenic hemorrhagic strokes: anticoagulation-related intracranial hemorrhage

Chapter 18 Intracranial–extracerebral hemorrhage: complication of anticoagulation

Introduction

Predictors

Mortality

Subdural hemorrhage

Subarachnoid hemorrhage

Resumption

New anticoagulants

References

Chapter 19 Iatrogenic intracerebral hemorrhage due to oral anticoagulation therapy: risk factors and diagnosis

Introduction

Risk of bleeding in patients on oral anticoagulation therapy

Etiology and pathogenesis

Risk factors

Age

Race

Intensity of anticoagulation

Hypertension

History of cerebrovascular disease

Cerebral amyloid angiopathy

Genetic polymorphisms of cytochrome P45049

Concomitant antiplatelet use

Leukoaraiosis

Cerebral microbleeds

Reduced serum albumin and reduced platelet count

Clinical presentation and diagnosis

Outcome

Treatment

References

Section VII Other uncommon causes of iatrogenic stroke

Chapter 20 Stroke during pregnancy and the puerperium

Introduction

Epidemiology

Maternal physiological changes

Hemodynamic and connective tissue adaptations

Hemostatic adaptations

Diagnostic work-up of pregnancy-related stroke

Risk factors and specific causes of stroke in pregnancy

Amniotic fluid embolism

Preeclampsia and eclampsia

Peripartum cardiomyopathy

Postpartum cerebral angiopathy

Choriocarcinoma

Cerebral venous sinus thrombosis

Treatment of ischemic stroke during pregnancy

Prevention strategy: antiplatelet and anticoagulant treatments

Antiplatelet therapy

Anticoagulant therapy

Acute treatment: thrombolysis

Cerebral hemorrhage during pregnancy

Assisted reproductive technology and arterial cerebral thromboembolic complications

References

Chapter 21 Cardioversion-related stroke

Introduction

Left atrial thrombus

Embolism from preformed atrial thrombus

Embolism from de novo formed atrial thrombus

Rationale for anticoagulation therapy in cardioversion

Treatment before cardioversion

Treatment after cardioversion

Patients with atrial fibrillation of more than 48 hours duration

Non-vitamin K antagonist oral anticoagulants (NOACs)

Dabigatran etexilate

Apixaban

Rivaroxaban

Role of TEE

Atrial fibrillation of less than 48 hours duration

Immediate/emergency cardioversion

Summary and recommendations

References

Chapter 22 Medication-induced stroke

Background

Classification of medication-induced stroke

Medication-induced thromboembolism

Oral contraceptive pills

Hormone replacement therapy

Testosterone/anabolic steroids

Heparin-induced thrombocytopenia

Chemotherapeutic agents

Erythropoiesis stimulating agents

Antifibrinolytic agents

Intravenous immunoglobulin

Non-steroidal anti-inflammatory drugs

Antiretroviral medications

Medication-induced vasospasm

Medication-induced vasculitis

Medication-induced coagulation dysfunction

Oral anticoagulant therapy

Heparin and its derivatives

Medication-induced platelet dysfunction

Antiplatelet agents

Parenteral glycoprotein IIb/IIIa inhibitors

Medication-induced thrombolysis

MIS secondary to other/unknown mechanisms

Management and prevention

Conclusion

References

Section VIII Cerebral venous thrombosis

Chapter 23 Cerebral venous thrombosis

Introduction

Cerebral venous thrombosis and pharmacological treatment

Hormone therapy

Combined oral contraceptives

Glucocorticoids

Anabolic steroids

Drugs in cancer therapeutic regimens

L-asparaginase

Tamoxifen and chemotherapy of breast cancer

Angiogenesis inhibitors

Other agents

Hemostatic treatments

Heparin-induced thrombocytopenia

IV immunoglobulin therapy

Miscellaneous

Interventions

Lumbar puncture and related procedures

Procedures on the sinus and veins

Neurosurgery

Neck surgery

Ear, nose, and throat surgical procedures

Transplantation

Other surgeries

Iatrogenic CVT in the International Study in Cerebral Vein and Dural Sinus Thrombosis

Conclusion

References

Section IX Medication reversal and restarting in patients with iatrogenic strokes

Chapter 24 Treatment of oral anticoagulant related intracranial hemorrhages

Introduction

Epidemiology

Mechanism of ICH related to OACs

Laboratory measurement of intensity of anticoagulation by OACs

Prothrombin time (PT)

International normalized ratio (INR)

Dilute prothrombin time (dPT)

Thrombin time (TT)

Ecarin clotting time

Activated partial thromboplastin time (aPTT)

Heptest

Prothrombinase-induced clotting time (PiCT)

Chromogenic assays

Treatment

Vitamin K

Fresh frozen plasma

Prothrombin complex concentrate

Recombinant factor VIIa

Current guidelines

Calculating the dose of PCC or the volume of FFP

Reversal of INR as part of quality metrics for intensity of care in patients with ICH

Reversal of new oral anticoagulants

When do we restart the patient on anticoagulants?

Conclusion

References

Index

 

An aparitie	2016
Autor	Alexander Tsiskaridze, Arne Lindgren
Dimensiuni	18.9 x 1.8 x 24.6 cm
Editura	Cambridge
Format	Hardback
ISBN	9781107037434
Limba	Engleza
Nr pag	288