![]() ![]() ![]() 13 We aimed to evaluate the use of intravenous heparin during EVT in Dutch stroke intervention centers and to assess its efficacy and safety. The uncertainty regarding this risk-benefit ratio is also reflected in the wide variation in the use of heparin in randomized trials that investigated the effect of EVT. 12 The risk-benefit ratio of periprocedural intravenous heparin in patients with ischemic stroke undergoing EVT is still unclear. In a systematic literature review, we found that heparin use during EVT indeed seems to be associated with an increased risk of sICH, but this increase seems to be outweighed by a higher overall chance of a good functional outcome. 11 By contrast, heparin is not the standard anticoagulant in EVT for ischemic stroke, which might be related to the perceived risk of sICH. That heparin may contribute to the treatment effect of EVT is not a new concept but originates from cardiology practices: periprocedural heparin has been used since the first percutaneous coronary intervention performed in 1977 and is standard practice since then. ![]() 10 However, as the rate of successful recanalization is high in patients treated with EVT, heparin is now more capable of penetrating the downstream microvessels and targeting the no-reflow areas. In the pre-EVT era, no benefit of heparin use on outcome in ischemic stroke patients was seen, with a concomitant 1.2% increase in occurrence of symptomatic intracranial hemorrhage (sICH). 6–9 The effect of unfractionated heparin on neutrophil extracellular traps in humans has not been evaluated. 5 neutrophil extracellular traps are resistant to r-tPA (recombinant tissue-type plasminogen activator), but experimental studies show that unfractionated heparin is able to dissolve neutrophil extracellular traps at the microvascular level. 2–4 One of the causes of microvascular obstruction is the formation of neutrophil extracellular traps, which are known to be present in all thrombi of ischemic stroke patients irrespective of stroke cause. This incomplete microvascular reperfusion, also described as the no-reflow phenomenon, has first been reported in animal studies. 1 Although EVT is successful in reopening large intracranial arteries, it does not always restore microvascular perfusion.
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His status as a changeling can be confirmed by killing him, but Starfleet has instead issued them prototype weapons called "polaron emitters," designed to emit a form of radiation which could destabilize a changeling's humanoid form. Gowron himself is protected constantly by his personal guard. Sisko calls a briefing on the mission: Gowron has relocated the Klingon center of military operations to Ty'Gokor, a heavily fortified and well-defended planet. Sisko orders Odo to be a part of the infiltration team, although Odo has lost confidence in himself since the Founders robbed him of his shapechanging abilities. Starfleet is sending an infiltration team to expose Gowron's status as a shape-shifter, and have elected Sisko as its leader. The conflict between the Federation and the Klingon Empire continues, spearheaded by Chancellor Gowron, whom Odo recognized as a changeling infiltrator. One in this series of science fiction programs about a twenty-fourth-century space station, Deep Space Nine. Continue searching the Collection STAR TREK: DEEP SPACE NINE: APOCALYPSE RISING (TV) Summary ![]() |
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