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Biomedical subjects

L Wechsler

Publications and source records attributed to L Wechsler.

22 records · Page 2Linked to original sources
PubMedDate not supplied

Acute stroke intervention with intraarterial urokinase infusion.

PURPOSE: A preliminary evaluation of the efficacy and safety of treating patients with acute stroke with intraarterial urokinase infusions was performed. PATIENTS AND METHODS: Twelve patients with acute stroke were treated within 8 hours of symptom onset (average, 5 hours). Thrombolysis was performed within the middle cerebral (n = 10), internal carotid (n = 1), and basilar (n = 1) arteries. Urokinase (160,000-500,000 IU) was infused through microcatheters placed into or adjacent to the thrombi. RESULTS: Thrombolysis was angiographically successful in nine patients (75%), all of whom had long-term neurologic improvement. No or minimal neurologic deficits were present in six patients (50%). Thrombolysis failed in three patients (25%); one patient died and two developed severe permanent neurologic deficits. No hemorrhagic complications occurred. CONCLUSION: Preliminary results suggest that intraarterial urokinase infusion may be effective and safe for treating patients with acute stroke. Potentially devastating neurologic damage was averted or lessened in nine patients (75%). No additional neurologic damage was caused by intervention in the remaining three patients (25%).

Cerebral Angiography↗
PubMedDate not supplied

Remote effects of acute ischemic stroke: A xenon CT cerebral blood flow study.

OBJECTIVE: The purpose of this study was to verify transhemispheric diaschisis in the early hours after an ischemic event. METHODS: XeCT cerebral blood flow (CBF) studies within 8 h of stroke were studied in 23 patients. Mean CBF was evaluated in the ischemic area, contralateral hemisphere and ipsilateral cerebellum. RESULTS: A severe CBF reduction was found in the ischemic area (mean 9 +/- 3 ml/100 g/min). The mean CBF in the unaffected hemisphere (33 +/- 10 ml/100 g/min) was 35% less compared to the normal mean value. CBF was decreased in the cerebellum ipsilateral to the stroke (mean 31 +/- 12 ml/100 g/min) suggesting a blood flow depression of the whole brain. CONCLUSIONS: During the initial hours of cerebral ischemia, the asymptomatic hemisphere demonstrated CBF depression that was part of the global flow reduction.

Adult↗
PubMedDate not supplied

Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group.

PURPOSE: 1) To describe the effectiveness and safety of thrombolytic therapy in patients with acute atherothrombotic and embolic stroke and 2) to study the variables of the occlusion site as seen on the angiograms, the CT signs of early ischemia, the hyperdense middle cerebral artery sign (HMCAS), and the size of the infarcts as seen on the 24-hour CT scan. METHODS: Ninety-three of 139 patients with acute stroke were treated with intravenous tissue plasminogen activator (rt-PA). The initial disease and the effects of treatment were assessed with both CT and cerebral angiography. RESULTS: Recanalization of occluded arteries occurred in 32 patients and was more frequent in distal occlusions. In general, patients displaying recanalization tended to develop small infarcts and patients with a HMCAS tended to develop large infarcts. Patients with signs of early ischemia developed large infarcts. The presence of a HMCAS was 100% fic for an occluded artery, but only 27% sensitive. Hemorrhagic transformations occurred in the distribution of the occluded arteries in 32 patients. CONCLUSIONS: Emergency cerebral angiography, which can be carried out relatively safely, adds important information about the nature and extent of the arterial occlusions, and the recanalization efficacy of fibrinolytic therapy for patients with acute stroke. Fibrinolytic therapy can be carried out with a relatively low complication rate that still needs to be correlated with the clinical benefits of the treatment. Fibrinolytic therapy in the doses utilized in this study, is more effective with distal than with proximal carotid territory occlusions.

Acute Disease↗