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Biomarker Application for Precision Medicine in Stroke
AbstractStroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this com...
Source: Translational Stroke Research - December 18, 2019 Category: Neurology Source Type: research

Mechanical Thrombectomy in Pediatric Stroke: Report of Three New Cases
Mechanical thrombectomy for treatment of arterial ischemic stroke (AIS) and cerebral venous thrombosis (CVT) is well-studied in adult populations, but not in children.
Source: Journal of Stroke and Cerebrovascular Diseases - December 13, 2019 Category: Neurology Authors: Whitney L. Gervelis, Meredith R. Golomb Source Type: research

Delay to Tissue Plasminogen Activator in Hypertensive Stroke Patients: An Analysis of Delay Duration Across Agents
A subset of ischemic stroke patients present with blood pressures above that considered safe for thrombolytic administration, requiring antihypertensive therapy. Guideline statements are ambivalent regarding which antihypertensive agent should be used to obtain a satisfactory blood pressure
Source: Journal of Stroke and Cerebrovascular Diseases - December 4, 2019 Category: Neurology Authors: Joseph F. Carrera, Brian J. Sorace, Bradford B. Worrall, Andrew M. Southerland, Nicole A. Chiota-McCollum Source Type: research

Safety and Efficacy of Intravenous Thrombolytic Therapy in Patients With Acute Posterior Circulation Stroke: A Single-Center Study
This study was designed to evaluate the prestroke and baseline characteristics, stroke sub-types, complications, and outcomes of PCS patients and compare them with anterior circulation stroke (ACS) after intravenous thrombolysis. Methods: Data of consecutive patients with PCS and ACS treated with alteplase in a standard dose of 0.9 mg/kg in our stroke center were collected and analyzed retrospectively.
Source: Journal of Stroke and Cerebrovascular Diseases - December 2, 2019 Category: Neurology Authors: Xuan Zhu, Nuo Wang, Huangbin Lin, Ping Zhang, Lei Chen, Minmin Zhang, Benqiang Deng, Tao Wu Source Type: research

Is Door-to-Needle Time Reduced for Emergency Medical Services Transported Stroke Patients Routed Directly to the Computed Tomography Scanner on Emergency Department Arrival?
A nationally recommended practice to accelerate thrombolytic therapy for acute ischemic stroke is to route emergency medical services (EMS)-transported stroke patients directly to the computed tomography (CT) scanner on arrival. We evaluated door-to-needle time with direct-to-CT routing versus emergency department (ED)-bed first routing.
Source: Journal of Stroke and Cerebrovascular Diseases - November 4, 2019 Category: Neurology Authors: Bryan Sloane, Nichole Bosson, Nerses Sanossian, Jeffrey L. Saver, Lorrie Perez, Marianne Gausche-Hill Source Type: research

Multicenter prospective analysis of stroke patients taking oral anticoagulants: The PASTA registry - Study design and characteristics
The management of atrial fibrillation and deep venous thrombosis has evolved with the development of direct oral anticoagulants (DOAC), and oral anticoagulant (OAC) might influence the development or clinical course in both ischemic and hemorrhagic stroke. However, detailed data on the differences between the effects of the prior prescription of warfarin and DOAC on the clinical characteristics, neuroradiologic findings, and outcome of stroke are limited.
Source: Journal of Stroke and Cerebrovascular Diseases - October 29, 2019 Category: Neurology Authors: Satoshi Suda, Yasuyuki Iguchi, Shigeru Fujimoto, Yoshiki Yagita, Yu Kono, Masayuki Ueda, Kenichi Todo, Tomoyuki Kono, Takayuki Mizunari, Mineo Yamazaki, Takao Kanzawa, Seiji Okubo, Kimito Kondo, Nobuhito Nakajima, Takeshi Inoue, Takeshi Iwanaga, Makoto Na Source Type: research

Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities) Clinical Sciences
Conclusions— Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.
Source: Stroke - September 26, 2016 Category: Neurology Authors: Asdaghi, N., Romano, J. G., Wang, K., Ciliberti-Vargas, M. A., Koch, S., Gardener, H., Dong, C., Rose, D. Z., Waddy, S. P., Robichaux, M., Garcia, E. J., Gonzalez-Sanchez, J. A., Burgin, W. S., Sacco, R. L., Rundek, T. Tags: Secondary Prevention, Women, Quality and Outcomes, Ischemic Stroke Clinical Sciences Source Type: research

Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes: A Pooled Analysis of 9 Trials Clinical Sciences
Conclusions— Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit.
Source: Stroke - August 22, 2016 Category: Neurology Authors: Lees, K. R., Emberson, J., Blackwell, L., Bluhmki, E., Davis, S. M., Donnan, G. A., Grotta, J. C., Kaste, M., von Kummer, R., Lansberg, M. G., Lindley, R. I., Lyden, P., Murray, G. D., Sandercock, P. A. G., Toni, D., Toyoda, K., Wardlaw, J. M., Whiteley, Tags: Treatment, Cerebrovascular Disease/Stroke, Cerebrovascular Procedures, Ischemic Stroke Clinical Sciences Source Type: research

Identification of Reversible Disruption of the Human Blood-Brain Barrier Following Acute Ischemia Brief Reports
Conclusions— This study demonstrates that diffuse, mild BBB disruption in the acutely ischemic human brain is reversible with reperfusion. This study also confirms prior findings that focal severe BBB disruption confers an increased risk of hemorrhagic transformation in patients treated with intravenous tissue-type plasminogen activator.
Source: Stroke - August 22, 2016 Category: Neurology Authors: Simpkins, A. N., Dias, C., Leigh, R., on behalf of the National Institutes of Health Natural History of Stroke Investigators, Benson, Hsia, Latour, Luby, Lynch, Merino, Nadareishvili, Warach Tags: Magnetic Resonance Imaging (MRI), Blood-Brain Barrier, Intracranial Hemorrhage, Ischemic Stroke Brief Reports Source Type: research

Permeable Thrombi Are Associated With Higher Intravenous Recombinant Tissue-Type Plasminogen Activator Treatment Success in Patients With Acute Ischemic Stroke Clinical Sciences
Conclusions— Thrombus perviousness, as measured on computed tomography in the acute stage of ischemic stroke, is strongly associated with recanalization after intravenous r-tPA treatment and with favorable functional outcome.
Source: Stroke - July 25, 2016 Category: Neurology Authors: Santos, E. M. M., Dankbaar, J. W., Treurniet, K. M., Horsch, A. D., Roos, Y. B., Kappelle, L. J., Niessen, W. J., Majoie, C. B., Velthuis, B., Marquering, H. A., on behalf of the DUST Investigators, Duijm, Keizer, van der Lugt, Dippel, Droogh - de Greeve, Tags: Computerized Tomography (CT), Prognosis, Revascularization, Treatment, Ischemic Stroke Clinical Sciences Source Type: research

Thrombus Histology Suggests Cardioembolic Cause in Cryptogenic Stroke Clinical Sciences
Conclusions— Quantitative evaluation of thrombus composition may help to distinguish between different stroke causes. Our findings support the notion that the majority of cryptogenic strokes are cardioembolic.
Source: Stroke - June 27, 2016 Category: Neurology Authors: Boeckh-Behrens, T., Kleine, J. F., Zimmer, C., Neff, F., Scheipl, F., Pelisek, J., Schirmer, L., Nguyen, K., Karatas, D., Poppert, H. Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Clinical Sciences Source Type: research

Intravenous Thrombolysis With Recombinant Tissue-Type Plasminogen Activator in a Stroke Patient Receiving Dabigatran Anticoagulant After Antagonization With Idarucizumab Brief Reports
Conclusions— This case represents a new therapeutic paradigm. It is further supported by in vitro data showing no nonspecific interactions of idarucizumab with recombinant tissue-type plasminogen activator–induced thrombolysis. Thus, patients effectively anticoagulated with dabigatran who were previously contraindicated for thrombolytic therapy in this situation may now receive treatment because of the ability to rapidly reverse the anticoagulant activity of dabigatran with idarucizumab.
Source: Stroke - June 27, 2016 Category: Neurology Authors: Berrouschot, J., Stoll, A., Hogh, T., Eschenfelder, C. C. Tags: Cerebrovascular Procedures, Ischemic Stroke Brief Reports Source Type: research

Clinical Implications and Determinants of Left Atrial Mechanical Dysfunction in Patients With Stroke Clinical Sciences
Conclusions— LA mechanical dysfunction is closely associated with high risks of cardioembolism. Global LALS assessed by speckle tracking TTE well discriminates the presence of LA or LA appendage thrombus on TEE in patients with acute ischemic stroke.
Source: Stroke - May 23, 2016 Category: Neurology Authors: Kim, D., Shim, C. Y., Hong, G.-R., Kim, M.-H., Seo, J., Cho, I. J., Kim, Y. D., Chang, H.-J., Ha, J.-W., Heo, J. H., Chung, N. Tags: Echocardiography, Cerebrovascular Disease/Stroke, Ischemic Stroke Clinical Sciences Source Type: research

Atrial Fibrillation Is Associated With a Worse 90-Day Outcome Than Other Cardioembolic Stroke Subtypes Clinical Sciences
Conclusions— AF is associated with an unfavorable 90-day outcome among patients with a CES independent of established risk factors and initial stroke severity. This suggests that AF-specific mechanisms affect CES severity and functional status after CES. If confirmed in future studies, further investigation into the underlying pathophysiological mechanisms may provide novel avenues to AF detection and treatment.
Source: Stroke - May 23, 2016 Category: Neurology Authors: Henninger, N., Goddeau, R. P., Karmarkar, A., Helenius, J., McManus, D. D. Tags: Atrial Fibrillation, Etiology, Ischemic Stroke Clinical Sciences Source Type: research

Microbubble-Mediated Sonothrombolysis Improves Outcome After Thrombotic Microembolism-Induced Acute Ischemic Stroke Basic Sciences
Conclusions— Microbubble-mediated sonothrombolysis improved the outcomes of microthrombi-induced acute ischemic stroke. Thus, this method may serve as an attractive adjunct to recanalization therapy for acute ischemic stroke.
Source: Stroke - April 25, 2016 Category: Neurology Authors: Lu, Y., Wang, J., Huang, R., Chen, G., Zhong, L., Shen, S., Zhang, C., Li, X., Cao, S., Liao, W., Liao, Y., Bin, J. Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke, Embolism, Thrombosis Basic Sciences Source Type: research

Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke Clinical Sciences
Conclusions— This study shows that simultaneous measurement of thrombus attenuation in noncontrast computed tomography and computed tomographic angiography allows for quantification of thrombus perviousness. Thrombus perviousness is strongly associated with improved functional outcome, smaller final infarct volume, and higher recanalization rate.
Source: Stroke - February 22, 2016 Category: Neurology Authors: Santos, E. M. M., Marquering, H. A., den Blanken, M. D., Berkhemer, O. A., Boers, A. M. M., Yoo, A. J., Beenen, L. F., Treurniet, K. M., Wismans, C., van Noort, K., Lingsma, H. F., Dippel, D. W. J., van der Lugt, A., van Zwam, W. H., Roos, Y. B. W. E. M., Tags: Angiography, Computerized Tomography (CT), Quality and Outcomes, Ischemic Stroke, Thrombosis Clinical Sciences Source Type: research

Does b1000-b0 Mismatch Challenge Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery Mismatch in Stroke? Brief Reports
Conclusions— b1000–b0 mismatch may identify patients with ischemic stroke of the within 4.5 hours of onset with high positive predictive value, perhaps constituting an alternative imaging tissue clock.
Source: Stroke - February 22, 2016 Category: Neurology Authors: Geraldo, A. F., Berner, L.-P., Haesebaert, J., Chabrol, A., Cho, T.-H., Derex, L., Hermier, M., Louis-Tisserand, G., Chamard, L., Klaerke Mikkelsen, I., Ribe, L., Ostergaard, L., Hjort, N., Pedraza, S., Thomalla, G., Baron, J.-C., Nighoghossian, N., Berth Tags: Cardiopulmonary Resuscitation and Emergency Cardiac Care, Magnetic Resonance Imaging (MRI), Cerebrovascular Disease/Stroke, Ischemic Stroke, Thrombosis Brief Reports Source Type: research

Plasma D-Dimer and Incident Ischemic Stroke and Coronary Heart Disease: The Atherosclerosis Risk in Communities Study Clinical Sciences
Conclusions— A higher basal plasma d-dimer concentration in the general population is a risk marker for ischemic stroke, especially cardioembolic stroke.
Source: Stroke - December 28, 2015 Category: Neurology Authors: Folsom, A. R., Gottesman, R. F., Appiah, D., Shahar, E., Mosley, T. H. Tags: Epidemiology, Risk Factors, Cerebrovascular Disease/Stroke, Acute Coronary Syndromes Clinical Sciences Source Type: research

Long-term survival and serial assessment of stroke damage and recovery - practical and methodological considerations.
Authors: Modo M Abstract Impairments caused by stroke remain the main cause for adult disability. Despite a vigorous research effort, only 1 thrombolytic treatment has been approved in acute stroke (<3h). The limitations of preclinical studies and how these can be overcome have been the subject of various guidelines. However, often these guidelines focus on the acute stroke setting and omit long-term outcome measures, such as behaviour and neuroimaging. The considerations and practicalities of including the serial assessment of these approaches and their significance to establish therapeutic efficacy are discuss...
Source: Journal of Experimental Stroke and Translational Medicine - December 2, 2015 Category: Neurology Tags: J Exp Stroke Transl Med Source Type: research

Effects of Blood Pressure and Blood Pressure-Lowering Treatment During the First 24 Hours Among Patients in the Third International Stroke Trial of Thrombolytic Treatment for Acute Ischemic Stroke Clinical Sciences
Conclusions— Among patients with ischemic stroke who are candidates for thrombolytic treatment, high baseline blood pressure and a large pressure variability during the first 24 hours may be associated with a poor prognosis, whereas a large reduction in blood pressure and the use of blood pressure–lowering treatment during the first 24 hours may be associated with a favorable prognosis. These data support the rationale for further trials of agents that lower blood pressure or reduce blood pressure variability in the acute phase of ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltria...
Source: Stroke - November 23, 2015 Category: Neurology Authors: Berge, E., Cohen, G., Lindley, R. I., Sandercock, P., Wardlaw, J. M., Sandset, E. C., Whiteley, W. Tags: Treatment, Cerebrovascular Disease/Stroke, Ischemic Stroke Clinical Sciences Source Type: research

Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study Clinical Sciences
Conclusions— AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Hayden, D. T., Hannon, N., Callaly, E., Ni Chroinin, D., Horgan, G., Kyne, L., Duggan, J., Dolan, E., O'Rourke, K., Williams, D., Murphy, S., Kelly, P. J. Tags: Cerebrovascular Disease/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

Coagulation and Fibrinolytic Activity of Tenecteplase and Alteplase in Acute Ischemic Stroke Brief Reports
Conclusions— In patients with acute ischemic stroke, alteplase 0.9 mg/kg caused significant disruption of the fibrinolytic system, whereas tenecteplase 0.25 mg/kg did not, consistent with the trend toward lower intracerebral hemorrhage incidence with tenecteplase in the ATTEST study. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472926.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Huang, X., Moreton, F. C., Kalladka, D., Cheripelli, B. K., MacIsaac, R., Tait, R. C., Muir, K. W. Tags: Treatment, Ischemic Stroke, Thrombosis Brief Reports Source Type: research

Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study Clinical Sciences
Conclusions— ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
Source: Stroke - October 26, 2015 Category: Neurology Authors: Kamel, H., Hunter, M., Moon, Y. P., Yaghi, S., Cheung, K., Di Tullio, M. R., Okin, P. M., Sacco, R. L., Soliman, E. Z., Elkind, M. S. V. Tags: Electrocardiology, Echocardiography, Arrhythmias, clinical electrophysiology, drugs, Embolic stroke, Risk Factors for Stroke Clinical Sciences Source Type: research

Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke: Systematic Review Clinical Sciences
Conclusions— This systematic review and meta-analysis suggest that greater systolic BPV, measured early from ischemic stroke or intracerebral hemorrhage onset, is associated with poor longer-term functional outcome. Future prospective studies should investigate how best to measure and define BPV in acute stroke, as well as to determine its prognostic significance.
Source: Stroke - August 24, 2015 Category: Neurology Authors: Manning, L. S., Rothwell, P. M., Potter, J. F., Robinson, T. G. Tags: Cerebrovascular disease/stroke, Acute Cerebral Hemorrhage, Acute Cerebral Infarction, Acute Stroke Syndromes Clinical Sciences Source Type: research

Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment Clinical Sciences
Conclusions— There was a growing risk for poor outcome and symptomatic intracerebral hemorrhage with increasing pretreatment DWI lesion volumes. Nevertheless, favorable outcome was achieved in every third patient with DWI lesions >70 mL after successful endovascular reperfusion, whereas after poor or failed reperfusion, outcome was favorable in only every 12th patient. Therefore, endovascular treatment might be considered in patients with large DWI lesions, especially in younger patients.
Source: Stroke - August 24, 2015 Category: Neurology Authors: Gilgen, M. D., Klimek, D., Liesirova, K. T., Meisterernst, J., Klinger-Gratz, P. P., Schroth, G., Mordasini, P., Hsieh, K., Slotboom, J., Heldner, M. R., Broeg-Morvay, A., Mono, M.-L., Fischer, U., Mattle, H. P., Arnold, M., Gralla, J., El-Koussy, M., Jun Tags: Acute Cerebral Infarction, Thrombolysis, Other Stroke Treatment - Medical Clinical Sciences Source Type: research

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry Clinical Sciences
Conclusions— These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke.
Source: Stroke - June 22, 2015 Category: Neurology Authors: Fukuda, K., Kai, H., Kamouchi, M., Hata, J., Ago, T., Nakane, H., Imaizumi, T., Kitazono, T., on behalf of the FSR Investigators, The steering committee of the Fukuoka Stroke Registry included, Ishitsuka, Fujimoto, Ibayashi, Kusuda, Arakawa, Irie, Fujii, Tags: Acute Cerebral Infarction Clinical Sciences Source Type: research

Role of Imaging in Current Acute Ischemic Stroke Workflow for Endovascular Therapy Understanding and Applying the Endovascular Trials
Ischemic stroke is caused by a thrombus that blocks an intracranial artery. Brain tissue beyond the blocked artery survives for a variable period of time because of blood and nutrients received through tiny vessels called collaterals. Imaging the brain and the vasculature that supplies it is therefore a vital first step in treating patients with acute ischemic stroke. In this review, we focus on current evidence for imaging selection of patients for endovascular therapy in the context of the recently positive clinical trials, such as Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke ...
Source: Stroke - May 22, 2015 Category: Neurology Authors: Menon, B. K., Campbell, B. C. V., Levi, C., Goyal, M. Tags: CT and MRI, Emergency treatment of Stroke Understanding and Applying the Endovascular Trials 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

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke: Use, Temporal Trends, and Outcomes Clinical Sciences
Conclusions— Drip and ship tPA is common, used in 1 in 4 patients treated with tPA in the United States. Modest differences in mortality and symptomatic intracranial hemorrhage may be because of patient selection bias, post-tPA care differences, or unmeasured confounding. The drip and ship paradigm may facilitate widespread tPA use in patients with acute stroke.
Source: Stroke - February 23, 2015 Category: Neurology Authors: Sheth, K. N., Smith, E. E., Grau-Sepulveda, M. V., Kleindorfer, D., Fonarow, G. C., Schwamm, L. H. Tags: Acute Cerebral Infarction, Acute Stroke Syndromes, Embolic stroke, Emergency treatment of Stroke, Thrombolysis Clinical Sciences Source Type: research

Variations in Acute Hospital Stroke Care and Factors Influencing Adherence to Quality Indicators in 6 European Audits Brief Reports
Conclusions— Detected variations in performance of acute stroke services were found. Differences in adherence to quality indicators might indicate population subgroups with specific needs for improving care delivery.
Source: Stroke - January 26, 2015 Category: Neurology Authors: Wiedmann, S., Hillmann, S., Abilleira, S., Dennis, M., Hermanek, P., Niewada, M., Norrving, B., Asplund, K., Rudd, A. G., Wolfe, C. D. A., Heuschmann, P. U., on behalf of the European Implementation Score Collaboration Tags: Health policy and outcome research, Emergency treatment of Stroke, Other Stroke Treatment - Medical Brief Reports Source Type: research

Intraluminal Thrombus, Intraplaque Hemorrhage, Plaque Thickness, and Current Smoking Optimally Predict Carotid Stroke Clinical Sciences
Conclusions— After excluding patients with noncarotid plaque stroke sources, optimal discrimination of carotid-source stroke was obtained with intraluminal thrombus, IPH, plaque thickness, and smoking history but not ulceration and stenosis.
Source: Stroke - December 22, 2014 Category: Neurology Authors: McNally, J. S., McLaughlin, M. S., Hinckley, P. J., Treiman, S. M., Stoddard, G. J., Parker, D. L., Treiman, G. S. Tags: CT and MRI, Carotid Stenosis, Embolic stroke, Risk Factors for Stroke Clinical Sciences Source Type: research

Influence of Arterial Occlusion on Outcome After Intravenous Thrombolysis for Acute Ischemic Stroke Clinical Sciences
Conclusions— In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however.
Source: Stroke - December 22, 2014 Category: Neurology Authors: Medlin, F., Amiguet, M., Vanacker, P., Michel, P. Tags: Arterial thrombosis, CT and MRI, Acute Cerebral Infarction, Thrombolysis, Other Stroke Treatment - Medical Clinical Sciences Source Type: research

Symptomatic Carotid Atherosclerotic Disease: Correlations Between Plaque Composition and Ipsilateral Stroke Risk Clinical Sciences
Conclusions— Features of the vulnerable carotid plaque, including plaque thrombus, low fibrous content, macrophage infiltration, and microvessel density, correlate with predicted stroke risk. This study provides a basis for plaque imaging studies focused on stroke risk stratification.
Source: Stroke - December 22, 2014 Category: Neurology Authors: Howard, D. P. J., van Lammeren, G. W., Rothwell, P. M., Redgrave, J. N., Moll, F. L., de Vries, J.-P. P. M., de Kleijn, D. P. V., den Ruijter, H. M., de Borst, G. J., Pasterkamp, G. Tags: Pathophysiology, Carotid Stenosis, Primary and Secondary Stroke Prevention, Carotid endarterectomy Clinical Sciences Source Type: research

Sex, diastolic blood pressure, and outcome after thrombolysis for ischemic stroke.
Conclusion. The study indicates that females appear to gain a relatively greater benefit from thrombolytic therapy than men due to a better functional recovery. A higher diastolic blood pressure increases the risk for a worse prospective functional status in men. PMID: 25302134 [PubMed]
Source: Stroke Research and Treatment - December 2, 2014 Category: Neurology Tags: Stroke Res Treat Source Type: research

Does a history of migraine affect the rate of thrombolysis in young stroke patients?
Conclusion. Migraine is associated with a low rate of thrombolytic therapy in young patients admitted with acute ischaemic stroke. Migraine patients admitted with acute ischaemic stroke are at risk of maltreatment. PMID: 24349822 [PubMed]
Source: Stroke Research and Treatment - December 2, 2014 Category: Neurology Tags: Stroke Res Treat Source Type: research

Medicolegal considerations with intravenous tissue plasminogen activator in stroke: a systematic review.
Conclusion. Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred. PMID: 24083048 [PubMed]
Source: Stroke Research and Treatment - December 2, 2014 Category: Neurology Tags: Stroke Res Treat Source Type: research

Reducing haemorrhagic transformation after thrombolysis for stroke: a strategy utilising minocycline.
Authors: Blacker DJ, Prentice D, Alvaro A, Bates TR, Bynevelt M, Kelly A, Kho LK, Kohler E, Hankey GJ, Thompson A, Major T Abstract Haemorrhagic transformation (HT) of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs). The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA). The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS) aims to determine the safety and efficacy ...
Source: Stroke Research and Treatment - December 2, 2014 Category: Neurology Tags: Stroke Res Treat Source Type: research

Carotid-Bulb Atypical Fibromuscular Dysplasia in Young Afro-Caribbean Patients With Stroke Brief Reports
Conclusions— CaFMD could be a common condition in young Afro-Caribbeans with carotid-territory ischemic stroke. Recurrences were frequent under antiplatelet treatment, while surgical CaFMD removal seemed more effective.
Source: Stroke - November 24, 2014 Category: Neurology Authors: Joux, J., Chausson, N., Jeannin, S., Saint-Vil, M., Mejdoubi, M., Hennequin, J.-L., Deschamps, L., Smadja, D., Olindo, S. Tags: Carotid Stenosis, Pathology of Stroke, Epidemiology Brief Reports Source Type: research

Population-Based Study of Blood Biomarkers in Prediction of Subacute Recurrent Stroke Clinical Sciences
Conclusions— In the largest study to date, we found limited predictive use for early recurrent stroke for a panel of inflammatory, thrombotic, and cell damage biomarkers.
Source: Stroke - September 22, 2014 Category: Neurology Authors: Segal, H. C., Burgess, A. I., Poole, D. L., Mehta, Z., Silver, L. E., Rothwell, P. M. Tags: Other diagnostic testing, Risk Factors for Stroke, Coagulation and fibronolysis Clinical Sciences Source Type: research

Impact of Living Alone on the Care and Outcomes of Patients With Acute Stroke Brief Reports
Conclusions— Patients living alone had delayed hospital arrival, less thrombolytic therapy, and were less likely to return home. Greater understanding of the inter-relationships among living alone, social isolation, access to stroke care, and outcomes is needed.
Source: Stroke - September 22, 2014 Category: Neurology Authors: Reeves, M. J., Prager, M., Fang, J., Stamplecoski, M., Kapral, M. K. Tags: Acute Stroke Syndromes Brief Reports Source Type: research

Thrombolysis in Ischemic Stroke Without Arterial Occlusion at Presentation Clinical Sciences
Conclusions— This study provides crucial data that patients with ischemic stroke who do not have visible arterial occlusion at presentation may benefit from thrombolysis.
Source: Stroke - August 25, 2014 Category: Neurology Authors: Lahoti, S., Gokhale, S., Caplan, L., Michel, P., Samson, Y., Rosso, C., Limaye, K., Hinduja, A., Singhal, A., Ali, S., Pettigrew, L. C., Kryscio, R., Dedhia, N., Hastak, S., Liebeskind, D. S. Tags: Cerebral Lacunes, Embolic stroke, Computerized tomography and Magnetic Resonance Imaging, Pathology of Stroke, Thrombolysis Clinical Sciences Source Type: research

Defining Clinically Relevant Cerebral Hemorrhage After Thrombolytic Therapy for Stroke: Analysis of the National Institute of Neurological Disorders and Stroke Tissue-Type Plasminogen Activator Trials Clinical Sciences
Conclusions— The ECASS2 and mSITS-MOST symptomatic intracerebral hemorrhage definitions, which combine radiological features and occurrence of substantial early neurological deterioration, best identify tPA hemorrhages that alter final patient outcome.
Source: Stroke - August 25, 2014 Category: Neurology Authors: Rao, N. M., Levine, S. R., Gornbein, J. A., Saver, J. L. Tags: Acute Cerebral Infarction, Emergency treatment of Stroke, Intracerebral Hemorrhage, Thrombolysis 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

Cryptogenic Subtype Predicts Reduced Survival Among Cancer Patients With Ischemic Stroke Clinical Sciences
Conclusions— Cryptogenic stroke is independently associated with reduced survival in patients with active cancer and ischemic stroke.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Navi, B. B., Singer, S., Merkler, A. E., Cheng, N. T., Stone, J. B., Kamel, H., Iadecola, C., Elkind, M. S. V., DeAngelis, L. M. Tags: Arterial thrombosis, Thrombophilia, Acute Cerebral Infarction, Embolic stroke, Pathology of Stroke Clinical Sciences Source Type: research

Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale Clinical Sciences
Conclusions— Among patients with ischemic stroke/transient ischemic attack and patent foramen ovale, the majority of detected DVTs were in LE veins rather than the pelvic veins and did not differ by stroke subtype. The routine inclusion of pelvic magnetic resonance venography in the diagnostic evaluation of CS warrants further prospective investigation.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Liberman, A. L., Daruwalla, V. J., Collins, J. D., Maas, M. B., Botelho, M. P. F., Ayache, J. B., Carr, J., Ruff, I., Bernstein, R. A., Alberts, M. J., Prabhakaran, S. Tags: Deep vein thrombosis, Other diagnostic testing, Acute Cerebral Infarction, Embolic stroke Clinical Sciences Source Type: research

Vessel Wall Magnetic Resonance Imaging in Acute Ischemic Stroke: Effects of Embolism and Mechanical Thrombectomy on the Arterial Wall Clinical Sciences
Conclusions— Mechanical thrombectomy results in intracranial arterial wall thickening and enhancement, potentially mimicking the VW-MRI appearance of primary arteritis. This arterial wall abnormality is less common in patients with arterial occlusion who have been treated with medical therapy alone.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Power, S., Matouk, C., Casaubon, L. K., Silver, F. L., Krings, T., Mikulis, D. J., Mandell, D. M. Tags: Embolic stroke, Computerized tomography and Magnetic Resonance Imaging, Pathology of Stroke, Primary and Secondary Stroke Prevention Clinical Sciences Source Type: research

Different Doses of Recombinant Tissue-Type Plasminogen Activator for Acute Stroke in Chinese Patients Clinical Sciences
Conclusions— These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71–80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Chao, A.-C., Liu, C.-K., Chen, C.-H., Lin, H.-J., Liu, C.-H., Jeng, J.-S., Hu, C.-J., Chung, C.-P., Hsu, H.-Y., Sheng, W.-Y., Hu, H.-H., on behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group Tags: Thrombolysis Clinical Sciences Source Type: research

Community-Based Stroke System of Care for Chinese Rural Areas Clinical Sciences
Conclusions— A stroke system of care would be reliable and practical in Chinese rural areas. Clinical Trial Registration— URL: http://www.chictr.org. Unique identifier: ChiCTR-RCH-13003408.
Source: Stroke - July 28, 2014 Category: Neurology Authors: He, M., Wang, J., Gong, L., Dong, Q., Ji, N., Xing, H., Zhou, Y., Qin, S., Wang, H., Zhang, H., Hui, R., Wang, Y. Tags: Other Stroke Treatment - Medical Clinical Sciences Source Type: research

Establishment of Government-Initiated Comprehensive Stroke Centers for Acute Ischemic Stroke Management in South Korea Clinical Sciences
Conclusions— The Regional CSC program has improved the performance of acute stroke management in South Korea and can be used as a model for rapidly improving stroke management.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Kim, J., Hwang, Y.-H., Kim, J.-T., Choi, N.-C., Kang, S.-Y., Cha, J.-K., Ha, Y. S., Shin, D.-I., Kim, S., Lim, B.-H. Tags: Emergency treatment of Stroke Clinical Sciences Source Type: research