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Source: Lancet Neurology
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Total 215 results found since Jan 2013.
Review Treatment of acute ischaemic stroke with thrombolysis or thrombectomy in patients receiving anti-thrombotic treatment
Systemic thrombolysis with alteplase is the only approved medical treatment for patients with acute ischaemic stroke. Thrombectomy is also increasingly used to treat proximal occlusions of the cerebral arteries, but has not shown superiority over systemic thrombolysis with alteplase. Many patients with acute ischaemic stroke are pretreated with antiplatelet or anticoagulant drugs, which can increase the bleeding risk of thrombolysis or thrombectomy. Pretreatment with aspirin monotherapy increases the bleeding risk of alteplase in both observational and randomised trials with no effect on clinical outcome, and the risk of i...
Source: Lancet Neurology - June 16, 2013 Category: Neurology Authors: Hans-Christoph Diener, Christian Foerch, Hanno Riess, Joachim Röther, Gerhard Schroth, Ralph Weber Tags: Review Source Type: research
Review Factors influencing haemorrhagic transformation in ischaemic stroke
Haemorrhagic transformation (HT) of ischaemic infarction occurs when an area of brain infarction is stained with blood products, mainly red blood cells. An abnormally permeable blood–brain barrier resulting from ischaemia of the capillary endothelium allows this extravasation of blood products. HT is part of the natural history of some forms of ischaemic infarction, especially cerebral embolism, but it can be precipitated or enhanced by therapeutic interventions used in the acute phase of ischaemic stroke.
Source: Lancet Neurology - June 16, 2013 Category: Neurology Authors: José Álvarez-Sabín, Olga Maisterra, Estevo Santamarina, Carlos S Kase Tags: Review Source Type: research
Editorial Disparities in stroke: not just black and white
At the start of American Stroke Month, on May 1, 2013, the National Institute for Neurological Disorders and Stroke (NINDS) announced grant awards aimed at reducing the risk and consequences of stroke among racial and ethnic minorities in the USA. The greater risks and poorer outcomes in these groups compared with white people have long been a concern for health-care providers and patients, and without action this gap is expected to widen. Targeting this problem is an important opportunity to reduce not only this disparity but also the overall burden of stroke in the USA.
Source: Lancet Neurology - June 16, 2013 Category: Neurology Authors: The Lancet Neurology Tags: Editorial Source Type: research
In Context News in brief
New research supports an optimum target blood pressure level for prevention of recurrent stroke in patients with a recent lacunar infarct. In an open-label controlled trial, more than 3000 patients with lacunar infarctions on MRI were randomly assigned to a target systolic blood pressure of either 130–149 mm Hg or less than 130 mm Hg (Lancet 2013; published online May 29. http://dx.doi.org/10.1016/S0140-6736(13)60852-1). After a mean follow-up of 3·7 years in the lower target group there was a non-significant reduction in all stroke (ischaemic and haemorrhagic; hazard ratio 0·81, 95% CI 0·64–1·03; p=0·08) and in d...
Source: Lancet Neurology - June 16, 2013 Category: Neurology Authors: The Lancet Neurology Tags: In Context Source Type: research
Articles Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trials
There was no evidence that patients with ischaemic stroke who were at higher risk of thrombotic events or lower risk of haemorrhagic events benefited from heparins. We were therefore unable to define a targeted approach to select the patients who would benefit from treatment with early anticoagulant therapy. We recommend that guidelines for routine or selective use of heparin in stroke should be revised.
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: William N Whiteley, Harold P Adams, Philip MW Bath, Eivind Berge, Per Morten Sandset, Martin Dennis, Gordon D Murray, Ka-Sing Lawrence Wong, Peter AG Sandercock Tags: Articles Source Type: research
Review Non-pharmacological strategies for the treatment of acute ischaemic stroke
Early recanalisation and an increase in collateral blood supply are predictors of favourable outcome in acute ischaemic stroke. Since individual responses to intravenous treatment with alteplase are heterogeneous, additional intra-arterial thrombolytic and mechanical endovascular treatment is increasingly given. Despite encouraging findings from single-centre studies, data from randomised clinical trials have not proven the hypothesis that interventional recanalisation leads to a better outcome. Advanced thrombectomy devices, the effect of ultrasound-enhanced thrombolysis, and imaging-guided selection of patients outside t...
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Michael G Hennerici, Rolf Kern, Kristina Szabo Tags: Review Source Type: research
Review Streamlining of prehospital stroke management: the golden hour
Thrombolysis with alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment. We recommend that all links in the prehospital stroke rescue chain must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of s...
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Klaus Fassbender, Clotilde Balucani, Silke Walter, Steven R Levine, Anton Haass, James Grotta Tags: Review Source Type: research
Review Movement disorders in cerebrovascular disease
Movement disorders can occur as primary (idiopathic) or genetic disease, as a manifestation of an underlying neurodegenerative disorder, or secondary to a wide range of neurological or systemic diseases. Cerebrovascular diseases represent up to 22% of secondary movement disorders, and involuntary movements develop after 1–4% of strokes. Post-stroke movement disorders can manifest in parkinsonism or a wide range of hyperkinetic movement disorders including chorea, ballism, athetosis, dystonia, tremor, myoclonus, stereotypies, and akathisia.
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Raja Mehanna, Joseph Jankovic Tags: Review Source Type: research
Comment Anticoagulant therapy in acute brain ischaemia
Thrombosis plays an important part in acute ischaemic stroke, and antithrombotic therapies are a logical approach to treatment. Heparin has been advocated for acute stroke since the 1950s, and by the 1980s, patients with acute ischaemic stroke and transient ischaemic attack were routinely treated with intravenous heparin with the aim of reducing progression of ischaemia and preventing early stroke recurrence. Since then, multiple randomised trials have tested heparins (unfractionated heparin, low-molecular-weight heparin, and heparinoids) and other anticoagulants in acute stroke.
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: John W Eikelboom, Robert G Hart Tags: Comment Source Type: research
Review Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging
The term cerebral small vessel disease (SVD) describes a range of neuroimaging, pathological, and associated clinical features. Clinical features range from none, to discrete focal neurological symptoms (eg, stroke), to insidious global neurological dysfunction and dementia. The burden on public health is substantial. The pathogenesis of SVD is largely unknown. Although the pathological processes leading to the arteriolar disease are associated with vascular risk factors and are believed to result from an intrinsic cerebral arteriolar occlusive disease, little is known about how these processes result in brain disease, how...
Source: Lancet Neurology - April 18, 2013 Category: Neurology Authors: Joanna M Wardlaw, Colin Smith, Martin Dichgans Tags: Review Source Type: research
In Context News in brief
Findings from two randomised trials assessing closure of the patent foramen ovale (PFO) versus medical treatment for prevention of recurrent cryptogenic stroke have been inconclusive. In the RESPECT trial in 980 patients (mean age 45·9 years), nine patients in the closure group and 16 in the medical treatment group had recurrent stroke (hazard ratio [HR] 0·49, 95% CI 0·22–1·11). Between groups, rates of serious adverse events did not differ significantly (N Engl J Med 2013; 368: 1092–100). In the multicentre PC trial in 414 patients, the primary endpoint—a composite of death, non-fatal stroke, transient ischaemic...
Source: Lancet Neurology - April 18, 2013 Category: Neurology Authors: The Lancet Neurology Tags: In Context Source Type: research
In Context Bo Norrving: putting stroke on the world map
Source: Lancet Neurology - April 1, 2013 Category: Neurology Authors: David Holmes Tags: In Context Source Type: research
In Context News in brief
Three long-awaited trials that directly compare endovascular and thrombolytic treatments for stroke have shed light on the efficacy of these interventions. The multicentre, open-label SYNTHESIS trial looked at whether disability-free survival at 90 days (modified Rankin score of 0 or 1) was better with endovascular treatment than with thrombolysis (N Engl J Med 2013; published online February 6. DOI:10.1056/NEJMoa1213701). 362 patients were randomly assigned 1:1 to each intervention. 55 (30%) patients in the endovascular group and 63 (35%) in the thrombolysis group were disability free at 3 months (adjusted odds ratio 0·7...
Source: Lancet Neurology - April 1, 2013 Category: Neurology Authors: The Lancet Neurology Tags: In Context Source Type: research
Review Hypothermia for acute ischaemic stroke
Ischaemic stroke is one of the leading causes of death and disability worldwide, and intravenous alteplase is the only proven effective treatment in the acute setting. Hypothermia has been shown to improve neurological outcomes after global ischaemia–hypoxia in comatose patients who have had cardiac arrest, and is one of the most extensively studied and powerful therapeutic strategies in acute ischaemic stroke. The protective mechanisms of therapeutic hypothermia affect the ischaemic cascade across several parallel pathways and, when coupled with reperfusion strategies, might yield synergistic benefits for patients who have had a stroke.
Source: Lancet Neurology - February 15, 2013 Category: Neurology Authors: Tzu-Ching Wu, James C Grotta Tags: Review Source Type: research
Correspondence Selection of patients for intra-arterial therapy
Although devices have improved over time, uncertainty remains about how to best select patients for intra-arterial therapy. Time is an important determinant of the risk–benefit profile of treatment. However, time alone does not provide a complete picture of stroke pathophysiology. Collateral circulation—which sustains the ischaemic bed after vessel occlusion—is highly variable between patients and determines how much time a patient has before the infarct has completed its course. Studies have shown that patients with stronger collateral circulation as seen with angiography respond better to intra-arterial therapy.
Source: Lancet Neurology - February 15, 2013 Category: Neurology Authors: Claus Z Simonsen, Grethe Andersen, R Gilberto González, Albert J Yoo Tags: Correspondence Source Type: research
