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Deferoxamine Treatment Prevents Post-Stroke Vasoregression and Neurovascular Unit Remodeling Leading to Improved Functional Outcomes in Type 2 Male Diabetic Rats: Role of Endothelial Ferroptosis
This study aimed to determine the impact of iron chelation with deferoxamine (DFX) on (1) cerebral vascularization patterns and (2) functional outcomes after stroke in control and diabetic rats. After 8 weeks of type 2 diabetes induced by a combination of high-fat diet and low-dose streptozotocin, male control and diabetic animals were subjected to thromboembolic middle cerebral artery occlusion (MCAO) and randomized to vehicle, DFX, or tPA/DFX and followed for 14 days with behavioral tests. Vas cular indices (vascular volume and surface area), neurovascular remodeling (AQP4 polarity), and microglia activation were meas...
Source: Translational Stroke Research - August 31, 2020 Category: Neurology Source Type: research
Hemorrhagic Stroke in Setting of Severe COVID-19 Infection Requiring Extracorporeal Membrane Oxygenation (ECMO)
To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications.
Source: Journal of Stroke and Cerebrovascular Diseases - June 5, 2020 Category: Neurology Authors: Muhammad J. Zahid, Anam Baig, Nestor Galvez-Jimenez, Nydia Martinez Tags: Case Report Source Type: research
Hemorrhagic stroke and anticoagulation in COVID-19
We present a retrospective study of 33 patients positive for COVID-19 with neuroimaging-documented ICH and examine anticoagulation use in this population.
Source: Journal of Stroke and Cerebrovascular Diseases - May 22, 2020 Category: Neurology Authors: Siddhant Dogra, Rajan Jain, Meng Cao, Seda Bilaloglu, David Zagzag, Sarah Hochman, Ariane Lewis, Kara Melmed, Katherine Hochman, Leora Horwitz, Steven Galetta, Jeffrey Berger Tags: Hemorrhagic stroke in COVID-19 Source Type: research
Risk analysis of post-procedural intracranial hemorrhage based on STAY ALIVE Acute Stroke Registry
Intracranial hemorrhages (ICH) are classified as symptomatic or asymptomatic according to the presence of clinical deterioration. Here, we aimed to find predictive factors of symptomatic intracranial bleeding in a registry-based stroke research.
Source: Journal of Stroke and Cerebrovascular Diseases - May 9, 2020 Category: Neurology Authors: Peter Csecsei, Gabor Tarkanyi, Edit Bosnyak, Laszlo Szapary, Gabor Lenzser, Alex Szolics, Andras Buki, Peter Hegyi, Alan Abada, Tihamer Molnar Source Type: research
Associations of Antithrombotic Timing and Regimen with Ischemic Stroke and Bleeding Complications in Blunt Cerebrovascular Injury
Blunt carotid injuries and vertebral arterial injuries, collectively referred to as blunt cerebrovascular injuries (BCVIs), are generally rare events but are associated with high mortality rates and long-term health effects.1 The long-term effects of BCVI include loss of both cognition and function, including the ability to perform daily cognitive and mobility activities without assistance, recurrent stroke, and need for extensive rehabilitation.2-6 Blunt cerebrovascular injuries have been reported to occur in 0.1-0.7% of all trauma patients in the United States,7-10 although higher rates ( ∼1-2%) have been reported afte...
Source: Journal of Stroke and Cerebrovascular Diseases - April 14, 2020 Category: Neurology Authors: Daniel Barrera, Erica Sercy, Alessandro Orlando, Charles W. Mains, Robert Madayag, Matthew M. Carrick, Allen Tanner, Mark Lieser, David Acuna, James Yon, David Bar-Or Source Type: research
Racial Disparity in the Prescription of Anticoagulants and Risk of Stroke and Bleeding in Atrial Fibrillation Patients
Background: Oral anticoagulant (OAC) therapy is proven to be effective at reducing risk of stroke in patients with atrial fibrillation (AF). However, racial minorities with AF are less likely to be prescribed vitamin K anticoagulants (VKA). There is little information on the racial disparity in the prescription of the non-vitamin K oral anticoagulants (NOACs) and the associated risks of stroke and bleeding. Methods: We used data from the Northwestern Medicine Enterprise Data Warehouse – a joint initiative across 11 Northwestern Medicine affiliated healthcare centers within metropolitan Chicago, Illinois.
Source: Journal of Stroke and Cerebrovascular Diseases - February 27, 2020 Category: Neurology Authors: Yacob G. Tedla, Sarah M. Schwartz, Philip Silberman, Philip Greenland, Rod S. Passman Source Type: research
Risk of Ischemic Stroke and Major Bleeding in Patients With Atrial Fibrillation and Cancer
Background: Atrial fibrillation (AF) is an important risk factor for ischemic stroke. Cancer may increase the risk both of ischemic stroke and of bleeding. Less is known about risk of ischemic stroke and bleeding among cancer patients with AF, complicating the prevention of ischemic stroke in these patients. Methods: Register based cohort study comprising all Swedish patients hospitalized with a primary diagnosis of AF from July 1, 2005 until December 31, 2014. Patients with cancer diagnosis were compared to the rest of the cohort.
Source: Journal of Stroke and Cerebrovascular Diseases - December 26, 2019 Category: Neurology Authors: Sara Aspberg, Liyang Yu, Bruna Gigante, Karin E Smedby, Daniel E Singer Source Type: research
Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke
Conclusions Our findings suggest that rt-PA patients have the highest risk of post rt-PA sICH within the first 24 hours after treatment. This supports monitoring of rt-PA-treated patients in specialized settings such as neuro-intensive care units or stroke units. Our findings suggest that the probability of sICH is low 36 hours post rt-PA. Future larger studies are warranted to identify the patterns of bleeding after rt-PA administration.
Source: Neurology Clinical Practice - August 11, 2019 Category: Neurology Authors: Chen, P. M., Lehmann, B., Meyer, B. C., Rapp, K., Hemmen, T., Modir, R., Agrawal, K., Hailey, L., Mortin, M., Meyer, D. M. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Research Source Type: research
A Narrative Review of Nonvitamin K Antagonist Oral Anticoagulant Use in Secondary Stroke Prevention
The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2019 Category: Neurology Authors: Valeria Caso, Florian Masuhr Tags: Review Article Source Type: research
Thrombolysis in Ischemic Stroke Patients with Isolate Pulmonary Arteriovenous Malformations
Pulmonary arteriovenous malformations are rare cause for ischemic stroke. British Thoracic Society Clinical Statement considered insufficient evidence of safety or clinical benefit to recommend thrombolysis for stroke with pulmonary arteriovenous malformations. For pulmonary arteriovenous malformations with hereditary hemorrhagic telangiectasia, bleeding risk after thrombolysis is high, while for isolate pulmonary arteriovenous malformations, bleeding risk is much lower. We here present 2 cases of ischemic stroke with isolate pulmonary arteriovenous malformations treated with thrombolysis.
Source: Journal of Stroke and Cerebrovascular Diseases - March 28, 2019 Category: Neurology Authors: Gaoping Lin, Peng Jiang, Min Lou Tags: Case Report Source Type: research
MMP10 Promotes Efficient Thrombolysis After Ischemic Stroke in Mice with Induced Diabetes
AbstractDiabetes is an important risk factor for ischemic stroke (IS). Tissue-type plasminogen activator (tPA) has been associated with less successful revascularization and poor functional outcome in diabetes. We assessed whether a new thrombolytic strategy based on MMP10 was more effective than tPA in a murine IS model of streptozotocin (STZ)-induced diabetes. Wild-type mice were administered a single dose of streptozotocin (STZ) (180 mg/kg) to develop STZ-induced diabetes mellitus. Two weeks later, IS was induced by thrombin injection into the middle cerebral artery and the effect of recombinant MMP10 (6.5 μg/kg), t...
Source: Translational Stroke Research - July 27, 2018 Category: Neurology Source Type: research
Efficacy and Safety of Ticagrelor in Relation to Aspirin Use Within the Week Before Randomization in the SOCRATES Trial Clinical Sciences
Conclusions—In this secondary analysis from SOCRATES, fewer primary end points occurred on ticagrelor treatment than on aspirin in patients receiving aspirin before randomization, but there was no significant treatment-by-prior-aspirin interaction. A new study will investigate the benefit-risk of combining ticagrelor and aspirin in patients with acute cerebral ischemia (URL: https://www.clinicaltrials.gov. Unique identifier: NCT03354429).Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT01994720.
Source: Stroke - June 25, 2018 Category: Neurology Authors: K.S. Lawrence Wong, Pierre Amarenco, Gregory W. Albers, Hans Denison, J. Donald Easton, Scott R. Evans, Peter Held, Anders Himmelmann, Scott E. Kasner, Mikael Knutsson, Per Ladenvall, Kazuo Minematsu, Carlos A. Molina, Yongjun Wang, S. Claiborne Johnston Tags: Ischemic Stroke Original Contributions Source Type: research
Continuation or Discontinuation of Anticoagulation in the Early Phase After Acute Ischemic Stroke Brief Report
Background and Purpose—There is no consensus on whether anticoagulation should be continued or temporarily stopped in patients suffering acute ischemic stroke while using anticoagulation. We assessed treatment variations and outcomes in these patients.Methods—Post hoc analysis of PASS (Preventive Antibiotics in Stroke Study). We included patients with acute ischemic stroke who used anticoagulation at admission. We compared clinical outcomes, thrombotic, and major bleeding events at 3 months.Results—Nine percent (192/2101) of the patients with acute ischemic stroke used anticoagulation at admission (186 vitamin K anta...
Source: Stroke - June 25, 2018 Category: Neurology Authors: Adrien E. Groot, Jan-Dirk M. Vermeij, Willeke F. Westendorp, Paul J. Nederkoorn, Diederik van de Beek, Jonathan M. Coutinho Tags: Secondary Prevention, Anticoagulants, Cerebrovascular Disease/Stroke, Ischemic Stroke Brief Reports Source Type: research
Low Levels of Caveolin-1 Predict Symptomatic Bleeding After Thrombolytic Therapy in Patients With Acute Ischemic Stroke Brief Report
Background and Purpose—Experimental models of cerebral ischemia demonstrate that the decrease in the caveolin-1 membrane protein results in an increase in endothelial permeability. Because this phenomenon is responsible for hemorrhagic transformation (HT) after cerebral ischemia, we aimed to determine whether caveolin-1 levels may predict bleeding after recombinant tissue-type plasminogen activator (r-tPA) administration in patients with acute stroke.Methods—We studied 133 patients with a first hemispheric stroke treated with r-tPA within 4.5 hours of symptom onset. HT was evaluated and classified on cranial computed t...
Source: Stroke - May 25, 2018 Category: Neurology Authors: Mar Castellanos, Cecile van Eendenburg, Carme Gubern, Elisabet Kadar, Gemma Huguet, Josep Puig, Tomas Sobrino, Gerard Blasco, Joaquin Serena, Juan Manuel Sanchez Tags: Biomarkers, Endothelium/Vascular Type/Nitric Oxide, Blood-Brain Barrier, Ischemic Stroke Brief Reports Source Type: research
External Validation of Risk Scores for Major Bleeding in a Population-Based Cohort of Transient Ischemic Attack and Ischemic Stroke Patients Clinical Sciences
Conclusions—The S2TOP-BLEED score shows modest performance in a population-based cohort of patients with a transient ischemic attack or ischemic stroke. Although bleeding risks were associated with risks of ischemic events, risk stratification may still be useful to identify a subgroup of patients at particularly high risk of bleeding, in whom preventive measures are indicated.
Source: Stroke - February 26, 2018 Category: Neurology Authors: Nina A. Hilkens, Linxin Li, Peter M. Rothwell, Ale Algra, Jacoba P. Greving Tags: Risk Factors, Secondary Prevention, Ischemic Stroke Original Contributions Source Type: research
Cerebrovascular Outcomes With Proton Pump Inhibitors and Thienopyridines Clinical Sciences
Background and Purpose—Pharmacokinetic and prior studies on thienopyridine and proton pump inhibitors (PPI) coadministration provide conflicting data for cardiovascular outcomes, whereas there is no established evidence on the association of concomitant use of PPI and thienopyridines with adverse cerebrovascular outcomes.Methods—We conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies from inception to July 2017, reporting following outcomes among patients treated with thienopyridine and PPI versus thienopyridine alone (1) ischemic stroke, (2) combined ischemic or hemorrhagi...
Source: Stroke - January 22, 2018 Category: Neurology Authors: Konark Malhotra, Aristeidis H. Katsanos, Mohammad Bilal, Muhammad Fawad Ishfaq, Nitin Goyal, Georgios Tsivgoulis Tags: Meta Analysis, Ischemic Stroke Original Contributions Source Type: research
Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation Clinical Sciences
Background and Purpose—The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibril...
Source: Stroke - December 22, 2017 Category: Neurology Authors: Marco Proietti, Imma Romanazzi, Giulio Francesco Romiti, Alessio Farcomeni, Gregory Y.H. Lip Tags: Atrial Fibrillation, Anticoagulants, Quality and Outcomes Original Contributions Source Type: research
Recurrent Stroke and Bleeding Events after Acute Cardioembolic Stroke —Analysis Using Japanese Healthcare Database from Acute-Care Institutions
To understand the reality of patients who experienced a cardioembolic stroke (CES) is important because of the high incidence of recurrent stroke and the need to account for bleeding risk in relation to the need for anticoagulation treatment. We elucidated the current real-world medical care in patients who had a CES and identified the risk factors for recurrent stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - December 12, 2017 Category: Neurology Authors: Masahiro Yasaka, Yukihiro Koretsune, Takeshi Yamashita, Eisei Oda, Daisuke Matsubayashi, Kaori Ota, Masafumi Kobayashi, Yasuyuki Matsushita, Jumpei Kaburagi, Kei Ibusuki, Atsushi Takita, Mikio Iwashita, Takuhiro Yamaguchi Source Type: research
Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin Clinical Sciences
Conclusions—In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
Source: Stroke - November 27, 2017 Category: Neurology Authors: Dragos Vinereanu, Renato D. Lopes, Hillary Mulder, Bernard J. Gersh, Michael Hanna, Pedro G.M. de Barros e Silva, Dan Atar, Lars Wallentin, Christopher B. Granger, John H. Alexander Tags: Arrhythmias, Echocardiography, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research
Thrombolysis in Postoperative Stroke Clinical Sciences
Conclusions—IVT may be administered safely in postoperative patients as off-label use after appropriate risk–benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset.
Source: Stroke - October 23, 2017 Category: Neurology Authors: Nicolas Voelkel, Nikolai Dominik Hubert, Roland Backhaus, Roman Ludwig Haberl, Gordian Jan Hubert Tags: Complications, Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research
Predicting Major Bleeding in Ischemic Stroke Patients With Atrial Fibrillation Brief Report
Conclusions—Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot guide treatment decisions for oral anticoagulants but may still be useful to identify modifiable risk factors for bleeding. Clinical usefulness may be best for ORBIT, which is based on a limited number of easily obtainable variables and showed reasonable performance.
Source: Stroke - October 23, 2017 Category: Neurology Authors: Nina A. Hilkens, Ale Algra, Jacoba P. Greving Tags: Atrial Fibrillation, Secondary Prevention, Ischemic Stroke Brief Reports Source Type: research
Fibrin Clot Permeability as a Predictor of Stroke and Bleeding in Anticoagulated Patients With Atrial Fibrillation Clinical Sciences
Background and Purpose—Formation of denser fiber networks has been reported in atrial fibrillation and ischemic stroke. In this longitudinal cohort study, we evaluated whether fibrin clot density may predict thromboembolic and bleeding risk in patients with atrial fibrillation on vitamin K antagonists.Methods—In 236 patients with atrial fibrillation receiving vitamin K antagonists treatment, we measured ex vivo plasma clot permeability (Ks), a measure of the pore size in fibrin networks.Results—During a median follow-up of 4.3 (interquartile range, 3.7–4.8) years, annual rates of ischemic stroke or transient ischem...
Source: Stroke - September 25, 2017 Category: Neurology Authors: Leszek Drabik, Paweł Wołkow, Anetta Undas Tags: Atrial Fibrillation, Ischemic Stroke, Thrombosis Original Contributions Source Type: research
Individualized risk prediction of major bleeding in secondary stroke prevention: Are we there yet?
In most patients diagnosed with a TIA or ischemic stroke, secondary stroke prevention relies on antiplatelet therapy unless anticoagulation is indicated. Aspirin has the largest evidence base and reduces the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications.1 Because antiplatelet therapy typically continues for many years, clinicians and patients need an estimation of the annual bleeding risk to accurately assess future risk. In a meta-analysis of 25 randomized trials of antiplatelet therapy in primary or secondary prevention of cardiovascular disease, aspirin increased the abs...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lemmens, R., Al-Shahi Salman, R. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction EDITORIALS Source Type: research
Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED
Conclusions: The S2TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding.
Source: Neurology - August 28, 2017 Category: Neurology Authors: Hilkens, N. A., Algra, A., Diener, H.-C., Reitsma, J. B., Bath, P. M., Csiba, L., Hacke, W., Kappelle, L. J., Koudstaal, P. J., Leys, D., Mas, J.-L., Sacco, R. L., Amarenco, P., Sissani, L., Greving, J. P., For the Cerebrovascular Antiplatelet Trialists' Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction ARTICLE Source Type: research
Saving Vanessa, part 1: A mystery rash, a stroke and an epic rescue
Vanessa’s rash first appeared on her arms and legs when she 3 or 4 months old. It was red and bumpy and went away when she was sick with a virus, which happened often. Then it would come back. The dermatology team she saw at Boston Children’s Hospital was puzzled. “I was expecting they were going to think it was nothing, but they took it very seriously,” says Katherine Bell, one of Vanessa’s mothers. “They took a biopsy and very quickly realized they had no idea what it was.” Vanessa’s case was even featured at a regional dermatology conference where doctors take up mystery patients. “A hundred to 150 der...
Source: Thrive, Children's Hospital Boston - July 25, 2017 Category: Pediatrics Authors: Nancy Fliesler Tags: Diseases & Conditions Our Patients’ Stories Dr. Carolyn Rogers Dr. Pui Lee Dr. Robert Sundel Dr. Scellig Stone Dr. Todd Lyons stroke Source Type: news
Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack Clinical Sciences
Conclusions—Results from our study of the 3 NOACs versus warfarin in nonvalvular atrial fibrillation patients with a previous history of stroke/transient ischemic attack are relatively consistent with their respective phase III trials and previous stroke/transient ischemic attack subgroup analyses. All NOACs seemed no worse than warfarin in respect to ischemic stroke, ICH, or major bleeding risk.
Source: Stroke - July 24, 2017 Category: Neurology Authors: Craig I. Coleman, W. Frank Peacock, Thomas J. Bunz, Mark J. Alberts Tags: Arrhythmias, Quality and Outcomes, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research
Regional Pediatric Acute Stroke Protocol Brief Report
Conclusions—Hyperacute recanalization treatment in pediatric stroke, relying on common protocols and adult/pediatric ward collaboration, is feasible. Larger systematic case collection is encouraged.
Source: Stroke - July 24, 2017 Category: Neurology Authors: Laurence Tabone, Nicolas Mediamolle, Celine Bellesme, Fabrice Lesage, David Grevent, Augustin Ozanne, Olivier Naggara, Beatrice Husson, Isabelle Desguerre, Catherine Lamy, Christian Denier, Manoelle Kossorotoff Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Brief Reports Source Type: research
Classification of Bleeding Events Brief Report
Conclusions—Classification of ICH by ECASS III and HBC criteria show distinct differences. These differences warrant special attention during interpretation and comparison of scientific publications.
Source: Stroke - June 26, 2017 Category: Neurology Authors: Ulf Neuberger, Markus Alfred Mohlenbruch, Christian Herweh, Christian Ulfert, Martin Bendszus, Johannes Pfaff Tags: Cerebrovascular Procedures, Intracranial Hemorrhage, Ischemic Stroke Brief Reports Source Type: research
Toll-Like Receptor 4 Mediates Hemorrhagic Transformation After Delayed Tissue Plasminogen Activator Administration in In Situ Thromboembolic Stroke Brief Report
Conclusions—Our results demonstrate TLR4 involvement in hemorrhagic transformation induced by delayed tPA administration, very likely by increasing matrix metalloproteinase 9 expression.
Source: Stroke - May 22, 2017 Category: Neurology Authors: Alicia Garcia–Culebras, Sara Palma–Tortosa, Ana Moraga, Isaac Garcia–Yebenes, Violeta Duran–Laforet, Maria I. Cuartero, Juan de la Parra, Ana L. Barrios–Munoz, Jaime Diaz–Guzman, Jesus M. Pradillo, Maria A. Moro, Ignaci Tags: Blood-Brain Barrier, Cerebrovascular Disease/Stroke, Ischemic Stroke Brief Reports Source Type: research
Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
Conclusions: Clopidogrel–aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. Clinicaltrials.gov identifier: NCT00979589. Classification of evidence: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
Source: Neurology - May 15, 2017 Category: Neurology Authors: Pan, Y., Jing, J., Chen, W., Meng, X., Li, H., Zhao, X., Liu, L., Wang, D., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE investigators Tags: All Cerebrovascular disease/Stroke, Clinical trials Randomized controlled (CONSORT agreement) ARTICLE Source Type: research
Benefits of Emergency Departments’ Contribution to Stroke Prophylaxis in Atrial Fibrillation Clinical Sciences
Conclusions—Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.
Source: Stroke - April 24, 2017 Category: Neurology Authors: Blanca Coll–Vinent, Alfonso Martin, Juan Sanchez, Juan Tamargo, Coral Suero, Francisco Malagon, Mercedes Varona, Manuel Cancio, Susana Sanchez, Jose Carbaȷosa, Jose Rios, Georgina Casanovas, Carles Rafols, Carmen del Arco, on behalf of the E Tags: Arrhythmias Original Contributions Source Type: research
Using Artificial Intelligence to Reduce the Risk of Nonadherence in Patients on Anticoagulation Therapy Brief Report
Conclusions—Patients, some with little experience using a smartphone, successfully used the technology and demonstrated a 50% improvement in adherence based on plasma drug concentration levels. For patients receiving direct oral anticoagulants, absolute improvement increased to 67%. Real-time monitoring has the potential to increase adherence and change behavior, particularly in patients on direct oral anticoagulant therapy.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02599259.
Source: Stroke - April 24, 2017 Category: Neurology Authors: Daniel L. Labovitz, Laura Shafner, Morayma Reyes Gil, Deepti Virmani, Adam Hanina Tags: Secondary Prevention, Quality and Outcomes, Ischemic Stroke Brief Reports Source Type: research
Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke Clinical Sciences
Conclusions—Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH.
Source: Stroke - April 24, 2017 Category: Neurology Authors: Yonggang Hao, Dong Yang, Huaiming Wang, Wenjie Zi, Meng Zhang, Yu Geng, Zhiming Zhou, Wei Wang, Haowen Xu, Xiguang Tian, Penghua Lv, Yuxiu Liu, Yunyun Xiong, Xinfeng Liu, Gelin Xu, for the ACTUAL Investigators (Endovascular Treatment for Acute Anterior C Tags: Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research
Effectiveness and Safety of Apixaban and Rivaroxaban Versus Warfarin for the Secondary Prevention of Stroke or Systemic Embolism Among Nonvalvular Atrial Fibrillation Patients (S51.001)
Conclusions:Among NVAF patients with a prior history of SSE, rivaroxaban reduced ischemic stroke and ICH risk versus warfarin and did not significantly impact major bleeding. Apixaban did not significantly alter patients’ risk of SSE or major bleeding compared to warfarin in this high-risk population.Study Supported by: Bayer Pharma AGDisclosure: Dr. Coleman has received personal compensation for activities with Janssen Scientific affairs, LLC, Bayer Pharma AG, and BIPI . Dr. Coleman has received research support from Janssen Scientific Affairs, LLC, and Bayer Pharma AG. Dr. Bunz has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Coleman, C., Bunz, T. Tags: Cerebrovascular Disease and Interventional Neurology: Stroke Prevention and Translation Source Type: research
Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Thrombocytopenia (P4.264)
Conclusions:IV rtPA for AIS might be safe in patients with platelet count <100,000/mm3 and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count .Disclosure: Dr. Mowla has nothing to disclose. Dr. Kamal has nothing to disclose. Dr. Lail has nothing to disclose. Dr. Vaughn has nothing to disclose. Dr. Mehla has nothing to disclose. Dr. Deline has nothing to disclose. Dr. Ching has nothing to disclose. Dr. Crumlish has nothing to disclose. Dr. Sawyer has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Mowla, A., Kamal, H., Lail, N., Vaughn, C., Mehla, S., Deline, C., Ching, M., Crumlish, A., Sawyer, R. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research
Intravenous Thrombolysis in Anticoagulated and Thrombocytopenic Ischemic Stroke Patients Does Not Increase the Risk of Intracerebral Hemorrhage (P4.271)
Conclusions:These data suggest that IV rt-PA can be safely administered in coagulopathic and thrombocytopenic patients. Although rates of sICH and mortality were similar to the NINDS cohort, caution may be needed to identify certain hemorrhagic risk factors. Routine exclusion of anticoagulated or thrombocytopenic patients is not supported and the use of IV rt-PA in these patients may increase the eligibility for acute stroke therapy, particularly at institutions where IA therapy is unavailable.Disclosure: Dr. Barazangi has received personal compensation for activities with Genentech. Dr. Sorensen has nothing to disclose. D...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Barazangi, N., Sorensen, S., Chen, C., Wong, C., Yee, A., Ke, M., Rose, J., Grosvenor, D., Bedenk, A., Fernandes, J., Tong, D. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research
Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation Clinical Sciences
Conclusions—In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Ying Bai, Hai Deng, Alena Shantsila, Gregory Y.H. Lip Tags: Meta Analysis, Quality and Outcomes Original Contributions Source Type: research
Endovascular recanalization therapy in the patients with acute ischemic stroke and active malignancy
【Background】Patients with cancer who have acute ischemic stroke are often precluded from intravenous tPA due to high risk of bleeding. In this case, endovascular recanalization therapy may be an alternative treatment option.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Man-Seok Park, Bang-Hoon Cho, Kang-Ho Choi, Joon-Tae Kim, Seung-Han Lee, Woong Yoon, Ki-Hyun Cho Source Type: research
Investigation of optimum conditions of iodine extraction image in after recanalization therapy of acute ischemic stroke
【Background and Purpose】After acute recanalization of ischemic stroke, we distinguish contrast agent leakand bleeding by dual energy CT (DECT). Discrimination confirmed the contrast agent leakage in Iodine map (IM), and confirmed bleeding in the Virtual non-contrast. However, the analysis in the default setting of IM would extract the lateral ventricle (LV). The purpose of this study is to make IM more clearly with different method which is using ΔCT values.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Kotaro Fukuda, Masataka Hayashi, Shizuka Nishikawa, Rika Fukui, Isao Tanaka Source Type: research
Stroke and Mortality Risk in Patients With Various Patterns of Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) Original Article
Conclusions— In ENGAGE AF-TIMI 48 trial, patients with paroxysmal AF suffered fewer thromboembolic events and deaths compared with those with persistent and permanent AF. The efficacy and safety profile of edoxaban as compared with warfarin was consistent across the 3 patterns of AF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391.
Source: Circulation: Arrhythmia and Electrophysiology - January 10, 2017 Category: Cardiology Authors: Link, M. S., Giugliano, R. P., Ruff, C. T., Scirica, B. M., Huikuri, H., Oto, A., Crompton, A. E., Murphy, S. A., Lanz, H., Mercuri, M. F., Antman, E. M., Braunwald, E., on behalf of the ENGAGE AF-TIMI 48 Investigators Tags: Arrhythmias, Atrial Fibrillation, Ischemic Stroke, Transient Ischemic Attack (TIA) Original Article Source Type: research
Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack Clinical Sciences
Background and Purpose—Patients with chronic kidney disease (CKD) are at a particularly high risk for ischemic and bleeding events. Limited data exist as to the efficacy and safety of clopidogrel in stroke patients with renal dysfunction. Therefore, we sought to assess the impact of decreased kidney function on clinical outcomes for stroke patients on clopidogrel–aspirin treatment.Methods—Patients in the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) were randomized to clopidogrel–aspirin or aspirin-alone treatment. The primary efficacy outcome was new stroke during ...
Source: Stroke - October 23, 2016 Category: Neurology Authors: Zhou, Y., Pan, Y., Wu, Y., Zhao, X., Li, H., Wang, D., Johnston, S. C., Liu, L., Wang, C., Meng, X., Wang, Y., , on behalf of the CHANCE Investigators Tags: Nephrology and Kidney, Ischemic Stroke, Transient Ischemic Attack (TIA) Original Contributions Source Type: research
Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone Clinical Sciences
Conclusions— Clopidogrel plus aspirin might not be superior to aspirin alone for preventing new ischemic lesion and clinical vascular events in patients with acute ischemic stroke caused by large artery atherosclerosis. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00814268.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Hong, K.-S., Lee, S.-H., Kim, E. G., Cho, K.-H., Chang, D. I., Rha, J.-H., Bae, H.-J., Lee, K. B., Kim, D. E., Park, J.-M., Kim, H.-Y., Cha, J.-K., Yu, K.-H., Lee, Y.-S., Lee, S. J., Choi, J. C., Cho, Y.-J., Kwon, S. U., Kim, G.-M., Sohn, S.-I., Park, K.- Tags: Ischemic Stroke Clinical Sciences Source Type: research
Repeated Intravenous Thrombolysis for Early Recurrent Stroke: Challenging the Exclusion Criterion Brief Reports
Conclusions— Patients with small infarct volumes and robust clinical improvement might be considered for repeated IVT within 3 months. Studies following strict protocols and larger registries incorporating these patients might serve to identify selection criteria for the safe use of repeated IVT in ERS.
Source: Stroke - July 24, 2016 Category: Neurology Authors: Kahles, T., Mono, M.-L., Heldner, M. R., Baumgartner, R. W., Sarikaya, H., Luft, A., Bohlhalter, S., Traenka, C., Engelter, S. T., Kurka, N., Kohrmann, M., Curtze, S., Michel, P., Tatlisumak, T., Nedeltchev, K. Tags: Treatment, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage Brief Reports Source Type: research
Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke Clinical Sciences
Conclusions— There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. Clinical Trial Registration— http://www.isrctn.com. Unique identifier: ISRCTN66157730.
Source: Stroke - March 27, 2016 Category: Neurology Authors: Gonzalez-Valcarcel, J., Sissani, L., Labreuche, J., Bousser, M.-G., Chamorro, A., Fisher, M., Ford, I., Fox, K. M., Hennerici, M. G., Mattle, H. P., Rothwell, P. M., Steg, P. G., Vicaut, E., Amarenco, P., for the PERFORM Investigators Tags: Intracranial Hemorrhage, Ischemic Stroke, Transient Ischemic Attack (TIA) Clinical Sciences Source Type: research
Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China Clinical Sciences
Conclusions— The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.
Source: Stroke - January 25, 2016 Category: Neurology Authors: Yang, X., Li, Z., Zhao, X., Wang, C., Liu, L., Wang, C., Pan, Y., Li, H., Wang, D., Hart, R. G., Wang, Y., Wang, Y., on behalf of the China National Stroke Registry II Investigators Tags: Anticoagulants, Treatment, Quality and Outcomes, Ischemic Stroke Clinical Sciences Source Type: research
Efficacy and Safety of Platelet Glycoprotein Receptor Blockade in Aged and Comorbid Mice With Acute Experimental Stroke Basic Sciences
Conclusions— Inhibition of early steps of thrombus formation protects adult and comorbid mice from ischemic stroke. The use of clinically meaningful mouse strains might improve the translation of preclinical stroke research to the clinic.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Kraft, P., Schuhmann, M. K., Fluri, F., Lorenz, K., Zernecke, A., Stoll, G., Nieswandt, B., Kleinschnitz, C. Tags: Animal Models of Human Disease, Hypertension, Treatment, Ischemic Stroke, Atherosclerosis Basic Sciences Source Type: research
Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials Understanding and Applying the Endovascular Trials
The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, 9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute strok...
Source: Stroke - May 22, 2015 Category: Neurology Authors: Toyoda, K., Koga, M., Hayakawa, M., Yamagami, H. Tags: Emergency treatment of Stroke, Anticoagulants, Thrombolysis, Angioplasty and Stenting Understanding and Applying the Endovascular Trials Source Type: research
Antithrombotic Therapy After Acute Ischemic Stroke in Patients With Atrial Fibrillation Clinical Sciences
Conclusions— Contrary to current guidelines, 30% of patients with atrial fibrillation and recent IS are not prescribed any OAC therapy on discharge, whereas a further 30% are prescribed combination OAC and antiplatelet therapy. Combination OAC and antiplatelet therapy in patients at high cardiovascular risk requires evaluation in clinical trials, particularly with the newer OACs, given their more favorable risk–benefit ratio compared with warfarin.
Source: Stroke - November 24, 2014 Category: Neurology Authors: McGrath, E. R., Kapral, M. K., Fang, J., Eikelboom, J. W., Conghaile, A. O., Canavan, M., O'Donnell, M. J., on behalf of the Investigators of the Ontario Stroke Registry Tags: Secondary prevention, Acute Cerebral Infarction, Arrhythmias, clinical electrophysiology, drugs Clinical Sciences Source Type: research
Race/Ethnic Differences in the Risk of Hemorrhagic Complications Among Patients With Ischemic Stroke Receiving Thrombolytic Therapy Clinical Sciences
Conclusions— In patients with stroke receiving tPA, hemorrhagic complications were slightly higher in blacks and Asians, but not in Hispanics compared with whites. Asians also faced significantly higher risk for sICH relative to other race/ethnic groups. Future studies are needed to evaluate whether reduction in tPA dose similar to that used in many Asian countries could improve the safety of tPA therapy in Asians in the United States with acute ischemic strokes while maintaining efficacy.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Mehta, R. H., Cox, M., Smith, E. E., Xian, Y., Bhatt, D. L., Fonarow, G. C., Peterson, E. D., for the Get With The Guidelines-Stroke Program Tags: Thrombolysis Clinical Sciences Source Type: research
Rivaroxaban for Stroke Prevention in East Asian Patients From the ROCKET AF Trial Clinical Sciences
Conclusions— Observed relative efficacy and safety of rivaroxaban versus warfarin were similar among patients within and outside East Asia. Rivaroxaban, 20 mg once daily, is an alternative to warfarin for stroke prevention in East Asians with nonvalvular atrial fibrillation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123456.
Source: Stroke - May 27, 2014 Category: Neurology Authors: Wong, K. S. L., Hu, D. Y., Oomman, A., Tan, R.-S., Patel, M. R., Singer, D. E., Breithardt, G., Mahaffey, K. W., Becker, R. C., Califf, R., Fox, K. A. A., Berkowitz, S. D., Hacke, W., Hankey, G. J., on behalf of The Executive Steering Committee and the RO Tags: Other anticoagulants, Embolic stroke, Anticoagulants Clinical Sciences Source Type: research