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Restarting Anticoagulant Therapy After Intracranial Hemorrhage Clinical Sciences
Background and Purpose—The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism.Methods—We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of anticoagulation. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study het...
Source: Stroke - May 22, 2017 Category: Neurology Authors: Santosh B. Murthy, Ajay Gupta, Alexander E. Merkler, Babak B. Navi, Pitchaiah Mandava, Costantino Iadecola, Kevin N. Sheth, Daniel F. Hanley, Wendy C. Ziai, Hooman Kamel Tags: Catheter Ablation and Implantable Cardioverter-Defibrillator, Myocardial Infarction, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research
Quantitative Imaging of Cerebral Thromboemboli In Vivo Basic Sciences
Background and Purpose—Quantitative imaging for the noninvasive assessment of thrombolysis is needed to advance basic and clinical thrombosis-related research and tailor tissue-type plasminogen activator (tPA) treatment for stroke patients. We quantified the evolution of cerebral thromboemboli using fibrin-targeted glycol chitosan–coated gold nanoparticles and microcomputed tomography, with/without tPA therapy.Methods—We injected thrombi into the distal internal carotid artery in mice (n=50). Fifty-five minutes later, we injected fibrin-targeted glycol chitosan–coated gold nanoparticles, and 5 minutes after that, w...
Source: Stroke - April 24, 2017 Category: Neurology Authors: Dong-Eog Kim, Jeong-Yeon Kim, Dawid Schellingerhout, Ju Hee Ryu, Su-Kyoung Lee, Sangmin Jeon, Ji Sung Lee, Jiwon Kim, Hee Jeong Jang, Jung E. Park, Eo Jin Kim, Ick Chan Kwon, Cheol-Hee Ahn, Matthias Nahrendorf, Kwangmeyung Kim Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke, Embolism, Thrombosis Original Contributions 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
Intravenous thrombolytic treatment of acute ischemic stroke in patients older and younger than 80 years: experience from one hospital (p4.275)
Conclusions:We found that IV thrombolysis still has benefit in people older than 80 years old but treatment decision should be taken with caution in well selected cases.Study Supported by: Not applicableDisclosure: Dr. Bayona has nothing to disclose. Dr. Diaz-Cruz has received research support from EMD Serono and Verily. Dr. Valencia-Mendoza has nothing to disclose. Dr. Díaz has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Bayona, H., Diaz-Cruz, C., Valencia-Mendoza, C., Diaz, A. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research
Rapidly improving neurological deficit of stroke; case series in Academic institute, KAUH, Jeddah (P4.283)
Conclusions:Rapidly improving patient represent a challenge to whether tPA should be given. However, the good outcome with thrombolytic therapy observed in our study, will hopfuly support the decision to treat.Study Supported by: nonDisclosure: Dr. khoja has nothing to disclose. Dr. Alshaer has nothing to disclose. Dr. al-Turkistani has nothing to disclose. Dr. Al-Mekhalfi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: khoja, a., Al-Shaer, D., al-Turkistani, a., Al-Mekhalfi, M. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research
Pulmonary embolism in acute ischaemic stroke (p4.293)
Conclusions:PE was observed in 0.32% of AIS and associated with high rates of death and disability. CTA stroke protocol images from aortic arch to vertex allows visualization of upper pulmonary arteries and detection PE in AIS.Disclosure: Dr. Eswaradass has nothing to disclose. Dr. Dey has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Hill has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Eswaradass, P. V., Dey, S., Singh, D., Hill, M. Tags: In-Hospital Stroke Care Source Type: research
Acute Stroke Therapy in Infective Endocarditis - Case Series and Systematic Review (P6.295)
Conclusions:Endovascular thrombectomy alone appears to be safer than IV-tPA alone in the management of AIS in patients with IE.Disclosure: Dr. Marquardt has nothing to disclose. Dr. Cho has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. Uchino has nothing to disclose. Dr. Wisco has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Marquardt, R., Cho, S.-M., Zhang, L., Uchino, K., Wisco, D. Tags: Cardiovascular Issues in Ischemic Stroke Source Type: research
Recurrent Stroke Due to Metastatic Pulmonary Tumor Emboli as an Important Clinical Entity
We present an autopsy case of repetitive stroke due to tumor emboli, indistinguishable from thromboembolism with a hypercoagulable state in its clinical course. A 72-year-old man diagnosed with stage IVA oropharyngeal squamous cell carcinoma received chemoradiotherapy. Follow-up imaging revealed mediastinal lymph nodes and pulmonary metastasis. One year later, the patient experienced right arm weakness, and brain magnetic resonance imaging showed acute ischemic lesions in multiple vascular territories.
Source: Journal of Stroke and Cerebrovascular Diseases - March 30, 2017 Category: Neurology Authors: Junji Takasugi, Manabu Sakaguchi, Naoki Oyama, Yasufumi Gon, Yasukazu Terasaki, Tsutomu Sasaki, Susumu Nakahara, Kenji Ohshima, Yumiko Hori, Eiichi Morii, Hideki Mochizuki Tags: Case Studies Source Type: research
Voxel-Based Lesion Mapping of Cryptogenic Stroke in Patients with Advanced Cancer: A Detailed Magnetic Resonance Imaging Analysis of Distribution Pattern
Ischemic stroke is one form of cancer-associated thrombosis that can greatly worsen a patient's performance status. The present investigation aimed to elucidate the characteristic distribution pattern(s) of cryptogenic stroke lesions using a voxel-based lesion-mapping technique and examine the differences in clinical manifestations between cryptogenic and conventional strokes in patients with advanced cancer.
Source: Journal of Stroke and Cerebrovascular Diseases - March 28, 2017 Category: Neurology Authors: Takamune Achiha, Masatoshi Takagaki, Hiroshi Oe, Mio Sakai, Hitoshi Matsui, Katsuhiko Nakanishi, Tomohiko Ozaki, Yasunori Fujimoto, Toshiki Yoshimine, Katsuyuki Nakanishi, Manabu Kinoshita 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
Left ventricular diastolic dysfunction and arterial occlusion in ischemic stroke related to atrial fibrillation
【Background】Left ventricular diastolic dysfunction lead to left atrial stasis and thus increases a risk of left atrial appendage thrombus in patients with atrial fibrillation. We investigated whether left ventricular diastolic dysfunction is associated with embolic burden in patients with ischem ic stroke related to atrial fibrillation.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Wi-Sun Ryu, Eun-Kee Bae Source Type: research
The effect of statin use in acute ischemic stroke patients treated with thrombolytic therapy
This study investigated the effects of statins for the acute ischemic stroke patients after thrombolysis on the stroke outcome considering statin intensity and time window.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Jong-Moo Park, Tae Kyoung Kim, Eui Sung Jung, Kyusik Kang, Woung-Woo Lee, Jungju Lee, Ohyun Kwon, Byung-Kun Kim Source Type: research
Clinical outome of weekend and nighttime admitted patients due to acute ischemic stroke
【Background and Purpose】Acute ischemic stroke (AIS) requires urgent diagnosis and subsequent treatment including thrombolytic or neuroendovascular revascularization (tNER). AIS is time-sensitive and weekend and nighttime admission (ENtime) may be associated with poor clinical outcome because of therapeutic delay. The aim of our study was to investigate diferrences in any in-hospital mortality and clinical outcome between ENtime and weekday daytime (DDtime) admitted patients due to AIS.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Noriyoshi Nakai, Takahisa Mori, Yuichi Tanno, Shigen Kasakura, Kazuhiro Yoshioka Source Type: research
Study of a novel small molecule, LT3001, in a thromboembolic stroke model in non-human primates
LT3001 is a novel small molecule designed to have thrombolytic and free radical scavenging activities. Its potential safety and efficacy in treating acute ischemic stroke was evaluated using a thromboembolic stroke model in adult Cynomolgus macaque.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Sheng-Wen Yeh, Tzulin Yeh, Wendy Huang Source Type: research
Proteomic analysis to determine stroke thrombus origin
In this study, we used mass spectrometry to evaluate the protein composition of retrieved emboli from three patients with differing stroke etiologies.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Neal Matsumori Rao, Joseph Capri, Whitaker Cohn, William H. Yong, Lucas Restrepo-Jimenez, David S. Liebeskind, Julian P. Whitelegge Source Type: research
Utility of items of baseline NIH stroke scale as predictors of functional outcomes 3 months after mild ischemic stroke
We examined the utility of individual NIH Stroke Scale (NIHSS) score items or clusters of items as predictors of f unctional outcomes 3 months after mild stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Jay Chol Choi, Jun Lee, Jae-Kwan Cha, Joon-Tae Kim, Hee-Joon Bae Source Type: research
Re-evaluate the Efficacy and Safety of Human Urinary Kallidinogenase (RESK): Protocol for an Open-Label, Single-Arm, Multicenter Phase IV Trial for the Treatment of Acute Ischemic Stroke in Chinese Patients
AbstractAcute ischemic stroke (AIS) is a major medical challenge in China. Thrombolytic drugs recommended for the treatment of AIS usually have a narrow time window. Human urinary kallidinogenase (HUK) was approved by the China Food and Drug Administration (CFDA) in 2005 for the treatment of mild to moderate AIS, and it is thus widely used in China. However, large-scale clinical study data for a more complete understanding of various aspects of its safety and efficacy characteristics are still unavailable. The ongoing Reevaluate the Efficacy and Safety of Human Urinary Kallidinogenase (RESK) trial is designed to reevaluate...
Source: Translational Stroke Research - March 6, 2017 Category: Neurology Source Type: research
Acute Cerebral Venous Thrombosis Clinical Sciences
Background and Purpose—Cerebral venous thrombosis (CVT) affects venous hemodynamics and can provoke severe stroke and chronic intracranial hypertension. We sought to comprehensively analyze 3-dimensional blood flow and hemodynamic alterations during acute CVT including collateral recruitment and at follow-up.Methods—Twenty-two consecutive patients with acute CVT were prospectively included and underwent routine brain magnetic resonance imaging (MRI) and 4-dimensional flow MRI at 3 T for the in vivo assessment of cerebral blood flow. Neurological and MRI follow-up at 6 months was performed in 18 patients.Results—Three...
Source: Stroke - February 27, 2017 Category: Neurology Authors: Florian Schuchardt, Anja Hennemuth, Laure Schroeder, Stephan Meckel, Michael Markl, Thomas Wehrum, Andreas Harloff Tags: Magnetic Resonance Imaging (MRI), Complications, Cerebrovascular Disease/Stroke, Intracranial Hemorrhage, Thrombosis Original Contributions Source Type: research
Thrombus Migration in the Middle Cerebral Artery: Incidence, Imaging Signs, and Impact on Success of Endovascular Thrombectomy Stroke
ConclusionsPreinterventional TM does not seem to be facilitated by intravenous recombinant tissue plasminogen activator and often occurs spontaneously. However, TM is associated with the risk of incomplete reperfusion in subsequent thrombectomy, suggesting increased clot fragility. Occurrence of TM may thereby have a substantial impact on the outcome of endovascularly treated stroke patients.
Source: JAHA:Journal of the American Heart Association - February 15, 2017 Category: Cardiology Authors: Kaesmacher, J., Maegerlein, C., Kaesmacher, M., Zimmer, C., Poppert, H., Friedrich, B., Boeckh-Behrens, T., Kleine, J. F. Tags: Revascularization, Cerebrovascular Disease/Stroke, Cerebrovascular Procedures, Ischemic Stroke Original Research Source Type: research
Racial-Ethnic Disparities in Acute Stroke Care in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study Epidemiology
We examined race‐ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines‐Stroke hospitals.Methods and ResultsSeventy‐five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010–2014). Logistic regression models examined racial‐ethnic differences in acute stroke performance measures and defect‐free care (intravenous tissue plasminogen activator treatment, in‐hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, a...
Source: JAHA:Journal of the American Heart Association - February 14, 2017 Category: Cardiology Authors: Sacco, R. L., Gardener, H., Wang, K., Dong, C., Ciliberti-Vargas, M. A., Gutierrez, C. M., Asdaghi, N., Burgin, W. S., Carrasquillo, O., Garcia-Rivera, E. J., Nobo, U., Oluwole, S., Rose, D. Z., Waters, M. F., Zevallos, J. C., Robichaux, M., Waddy, S. P., Tags: Epidemiology, Race and Ethnicity, Treatment, Cerebrovascular Disease/Stroke Original Research Source Type: research
Remote aspiration thrombectomy in large vessel acute ischemic stroke
We report a three case series of patients with acute ischemic stroke from supraclinoidal internal carotid artery occlusions treated with remote aspiration thrombectomy through a BGC placed at the cervical internal carotid artery, leading to complete reperfusion without the need for intracranial catheterization. Remote thrombectomy in the setting of intracranial internal carotid artery occlusion may constitute a relatively fast and inexpensive initial thrombectomy maneuver. Further investigation is warranted.
Source: Journal of NeuroInterventional Surgery - February 14, 2017 Category: Neurosurgery Authors: Haussen, D. C., Bouslama, M., Grossberg, J. A., Nogueira, R. G. Tags: Ischemic stroke Source Type: research
Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers
Conclusions The APD technique improves apposition of the tested devices to the vessel wall. The widening effect comes at the cost of minimal shortening of the devices. Our clinical experience shows that using the APD technique to deploy the Trevo device is effective and safe.
Source: Journal of NeuroInterventional Surgery - February 14, 2017 Category: Neurosurgery Authors: Wiesmann, M., Brockmann, M.-A., Heringer, S., Müller, M., Reich, A., Nikoubashman, O. Tags: Ischemic stroke Source Type: research
Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation
We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cereb...
Source: Neurology Clinical Practice - February 13, 2017 Category: Neurology Authors: Zacharia, G., Shani, D., Ortiz, R. A. Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research
Thrombolysis for acute ischemic stroke in patients with leukoaraiosis: Caution needed
The term leukoaraiosis (LA), introduced about 30 years ago,1 describes cerebral white matter signal abnormalities (or white matter hyperintensities) commonly observed on structural brain magnetic resonance or CT imaging in elderly individuals. LA severity can be graded using categorical classification, based on different rating scales,2 or continuously, using automatic quantification algorithms. LA has multiple histopathologic correlates, including ependymal loss, cerebral ischemia, demyelination, venous collagenosis, and microcystic infarcts.3 A substantial body of evidence now supports associations between LA and increas...
Source: Neurology - February 13, 2017 Category: Neurology Authors: Streifler, J., Maillard, P. Tags: All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis, Infarction, Intracerebral hemorrhage EDITORIALS Source Type: research
Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension? Clinical Sciences
Conclusions—In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.
Source: Stroke - January 23, 2017 Category: Neurology Authors: Pierre Seners, Robert Hurford, Marie Tisserand, Guillaume Turc, Laurence Legrand, Olivier Naggara, Jean-Louis Mas, Catherine Oppenheim, Jean-Claude Baron Tags: Magnetic Resonance Imaging (MRI), Ischemic Stroke Original Contributions Source Type: research
Sequential Multiple Assignment Randomized Trials: An Opportunity for Improved Design of Stroke Reperfusion Trials
Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and “rescue” endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice.
Source: Journal of Stroke and Cerebrovascular Diseases - January 14, 2017 Category: Neurology Authors: William J. Meurer, Nicholas J. Seewald, Kelley Kidwell Source Type: research
Prosthetic Valve Thrombosis in the Acute Phase of the Stroke: Relevance of Detection and Follow-Up
Stroke may be the first symptom of prosthetic valve thrombosis (PVT); therefore, rapid diagnosis and therapy are crucial. We aimed to evaluate the prevalence, main predictors, and long-term clinical evolution of patients with PVT in the acute phase of stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - January 14, 2017 Category: Neurology Authors: Jacint Sala-Padro, Jorge Pagola, Maria Teresa Gonzalez-Alujas, Laia Sero, Jesus Juega, Noelia Rodriguez-Villatoro, Sandra Boned, David Rodriguez-Luna, Marian Muchada, Ruben Fernandez-Galera, Marta Rubiera, Marc Ribo, Arturo Evangelista, Carlos Molina Source Type: research
Infarct Pattern and Collateral Status in Adult Moyamoya Disease Clinical Sciences
Conclusions—In the studied population of adult MMD patients, embolic phenomenon played an important role in ischemic stroke. Therapeutic strategies against thromboembolism, as well as collateral enhancing strategies targeting improvement of hemodynamic status or increased washout of emboli, are warranted.
Source: Stroke - December 23, 2016 Category: Neurology Authors: Dong Yeop Kim, Jeong Pyo Son, Je Young Yeon, Gyeong-Moon Kim, Jong-Soo Kim, Seung-Chyul Hong, Oh Young Bang Tags: Mechanisms, Magnetic Resonance Imaging (MRI), Ischemic Stroke, Moyamoya Original Contributions Source Type: research
Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis Clinical Sciences
Conclusions—Approximately one third of patients deemed too good for intravenous tissue-type plasminogen activator are unable to be discharged directly to home. Given the current safety profile of intravenous tissue-type plasminogen activator, our results suggest that the concept of being too good to treat should be re-examined with an emphasis on the features associated with poor outcome identified in our study. If replicated, these findings could be incorporated into tissue-type plasminogen activator decision-making algorithms.
Source: Stroke - November 28, 2016 Category: Neurology Authors: Syed F. Ali, Khawja Siddiqui, Hakan Ay, Scott Silverman, Aneesh Singhal, Anand Viswanathan, Natalia Rost, Michael Lev, Lee H. Schwamm Tags: Ischemic Stroke, Transient Ischemic Attack (TIA), Embolism, Thrombosis Original Contributions Source Type: research
Effect of aphasia on acute stroke outcomes
Conclusion: Aphasia is independently associated with increased LOS and complications during the acute stroke admission, adding $2.16 billion annually to US acute stroke care. The presence of aphasia was more likely to produce a poor functional outcome than hemiparesis. These data suggest that further research is necessary to determine whether establishing adaptive communication skills can mitigate its consequences in the acute stroke setting.
Source: Neurology - November 28, 2016 Category: Neurology Authors: Boehme, A. K., Martin-Schild, S., Marshall, R. S., Lazar, R. M. Tags: All Clinical Neurology, All Cerebrovascular disease/Stroke ARTICLE Source Type: research
Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke?
Conclusions In this cohort, specific NIHSS criteria were highly sensitive for emergent large vessel occlusion and, if validated, may allow for clinical screening prior to advanced imaging with CT angiography.
Source: Journal of NeuroInterventional Surgery - November 15, 2016 Category: Neurosurgery Authors: Moore, R. D., Jackson, J. C., Venkatesh, S. L., Quarfordt, S. D., Baxter, B. W. Tags: Ischemic stroke Source Type: research
Ischemic Stroke and Risk of Venous Thromboembolism in the General Population: The Tromso Study Epidemiology
ConclusionsThe risk of VTE increased during the first 3 months after an ischemic stroke. The particularly high risk of provoked VTE suggests that additional predisposing factors, such as immobilization, potentiate the VTE risk in patients with ischemic stroke.
Source: JAHA:Journal of the American Heart Association - November 7, 2016 Category: Cardiology Authors: Rinde, L. B., Smabrekke, B., Mathiesen, E. B., Lochen, M.–L., Nȷolstad, I., Hald, E. M., Wilsgaard, T., Brakkan, S. K., Hansen, J.–B. Tags: Epidemiology, Risk Factors, Ischemic Stroke, Thrombosis Original Research Source Type: research
Emerging Subspecialties in Neurology: Pediatric stroke and cerebrovascular disorders
In 1895, a neuropathologist at the University of Vienna observed that "a large number of cases of infantile cerebral palsy is caused by the same factors that bring about the majority of cases of cerebral paralysis of adults: by tearing, embolism, and thrombosis of cerebral vessels."1 While Sigmund Freud would go on to become better known for other endeavors, his observation that children can have strokes paved the way for the development of the emerging subspecialty of pediatric stroke and cerebrovascular disorders.
Source: Neurology - October 31, 2016 Category: Neurology Authors: Bernson-Leung, M. E., deVeber, G. A. Tags: Childhood stroke, All Cerebrovascular disease/Stroke, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research
Renal Function and the Risk of Stroke and Bleeding in Patients With Atrial Fibrillation Clinical Sciences
Background and Purpose—We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups.Methods—We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR.Results—A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thrombo...
Source: Stroke - October 24, 2016 Category: Neurology Authors: Bonde, A. N., Lip, G. Y. H., Kamper, A.–L., Fosbol, E. L., Staerk, L., Carlson, N., Torp–Pedersen, C., Gislason, G., Olesen, J. B. Tags: Atrial Fibrillation Original Contributions Source Type: research
Resolving Thrombus in the Left Atrial Appendage by Edoxaban Treatment after Acute Ischemic Stroke: Report of 2 Cases
Here we report first 2 cases of patients with nonvalvular atrial fibrillation with acute cardioembolic stroke in whom thrombi in the left atrial appendage (LAA) were resolved by edoxaban administration. Case 1 reports an 86-year-old woman who suddenly showed right hemiparesis and aphasia due to occlusion of the left middle cerebral artery. She received mechanical thrombectomy and recovered neurologically. Transesophageal echocardiography (TEE) performed on day 1 demonstrated thrombus in the LAA.
Source: Journal of Stroke and Cerebrovascular Diseases - August 30, 2016 Category: Neurology Authors: Shin Saito, Seigo Shindo, Shun Tsudaka, Kazutaka Uchida, Manabu Shirakawa, Shinichi Yoshimura Tags: Case Studies Source Type: research
Cognitive Outcomes following Thrombolysis in Acute Ischemic Stroke: A Systematic Review
Patients treated with thrombolytic therapy within 4.5 hours after stroke onset appear to have improved survival and functional outcomes. Poststroke cognitive impairment is associated with reduced quality of life and survival and needs to be reviewed in consideration of the administration of thrombolysis. This review aims to systematically evaluate literature exploring the effect of thrombolysis for ischemic stroke on cognition.
Source: Journal of Stroke and Cerebrovascular Diseases - August 26, 2016 Category: Neurology Authors: Laura Jayne Broome, Ceri Elisabeth Battle, Matthew Lawrence, Phillip Adrian Evans, Michael Stuart Dennis Source Type: research
Aspiration Thrombectomy After Intravenous Alteplase Versus Intravenous Alteplase Alone Clinical Sciences
Conclusions— THERAPY did not achieve its primary end point in this underpowered sample. Directions of effect for all prespecified outcomes were both internally and externally consistent toward benefit. It is possible that an alternate method of thrombectomy, primary aspiration, will benefit selected patients harboring large vessel occlusions. Further study on this topic is indicated. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01429350.
Source: Stroke - August 22, 2016 Category: Neurology Authors: Mocco, J., Zaidat, O. O., von Kummer, R., Yoo, A. J., Gupta, R., Lopes, D., Frei, D., Shownkeen, H., Budzik, R., Ajani, Z. A., Grossman, A., Altschul, D., McDougall, C., Blake, L., Fitzsimmons, B.-F., Yavagal, D., Terry, J., Farkas, J., Lee, S. K., Baxter Tags: Ischemic Stroke Clinical Sciences Source Type: research
Incidence and Predictors of Early Recanalization After Intravenous Thrombolysis: A Systematic Review and Meta-Analysis Brief Reports
Conclusion— The overall incidence of ER after intravenous thrombolysis is substantial, highlighting the importance of reliably predicting ER to limit futile, interhospital transfers. Incidence of no-ER is particularly high for proximal occlusion and severe strokes. Given the scarcity of published data, further studies are needed to improve no-ER prediction accuracy.
Source: Stroke - August 22, 2016 Category: Neurology Authors: Seners, P., Turc, G., Maier, B., Mas, J.-L., Oppenheim, C., Baron, J.-C. Tags: Imaging, Meta Analysis, Ischemic Stroke Brief Reports Source Type: research
Rare Variants in the ADAMTS13 Von Willebrand Factor-Binding Domain Contribute to Pediatric Stroke Original Articles
Conclusions— Our data provide a link between the genetic architecture of ADAMTS13, ADAMTS13 levels, and stroke susceptibility. Altogether, these studies render ADAMTS13 an attractive candidate for functional studies and may contribute to personalized diagnosis and treatment options in future.
Source: Circulation: Cardiovascular Genetics - August 16, 2016 Category: Cardiology Authors: Stoll, M., Ruhle, F., Witten, A., Barysenka, A., Arning, A., Strauss, C., Nowak-Gottl, U. Tags: Cardiovascular Disease, Genetic, Association Studies, Ischemic Stroke, Thrombosis Original Articles Source Type: research
Effective ADAPT Thrombectomy in a Patient with Acute Stroke due to Cardiac Papillary Elastofibroma: Histological Thrombus Confirmation
A 75-year-old man with hypertension and atrial fibrillation was admitted to our emergency room with right-sided hemiplegia and complete aphasia (National Institutes of Health Stroke Scale [NIHSS] score = 18). A noncontrast computed tomography scan showed a slight hypodensity in the left insular region and a bright hyperdense sign in the M1 tract of the left middle cerebral artery (MCA). Angio-CT confirmed an occlusion of the M1 tract of the MCA. Magnetic resonance diffusion-weighted imaging/p erfusion-weighted imaging was obtained and revealed a mismatch in the left parietal cortical region.
Source: Journal of Stroke and Cerebrovascular Diseases - August 15, 2016 Category: Neurology Authors: Francesco Biraschi, Francesco Diana, Francesco Alesini, Giulio Guidetti, Simone Peschillo Tags: Case Studies Source Type: research
Mechanical thrombectomy versus systemic thrombolysis in MCA stroke: a distance to thrombus-based outcome analysis
Conclusions In patients with an acute MCA occlusion and a DT <16 mm, IVT–MT leads to a significantly better outcome than in patients treated with IVT alone.
Source: Journal of NeuroInterventional Surgery - August 12, 2016 Category: Neurosurgery Authors: Lobsien, D., Gawlitza, M., Schaudinn, A., Schob, S., Hobohm, C., Fritzsch, D., Quäschling, U., Hoffmann, K.-T., Friedrich, B. Tags: Ischemic stroke Source Type: research
Thrombolysis for Ischemic Stroke during Pregnancy: A Case Report and Review of the Literature
We report the successful use of intravenous alteplase (tissue plasminogen activator; tPA) thrombolysis in a pregnant woman with acute cardioembolic stroke presumed to be paradoxical embolism through a patent foramen ovale.
Source: Journal of Stroke and Cerebrovascular Diseases - August 11, 2016 Category: Neurology Authors: Steven Tversky, Richard B. Libman, Marina L. Reppucci, Andrea M. Tufano, Jeffrey M. Katz Tags: Case Studies Source Type: research
Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events: Findings From ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) Clinical Sciences
Conclusions— Patients with atrial fibrillation with previous IS/TIA are at high risk of recurrent thromboembolism and bleeding. HDER is at least as effective and is safer than warfarin, regardless of the presence or the absence of previous IS or TIA. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391.
Source: Stroke - July 25, 2016 Category: Neurology Authors: Rost, N. S., Giugliano, R. P., Ruff, C. T., Murphy, S. A., Crompton, A. E., Norden, A. D., Silverman, S., Singhal, A. B., Nicolau, J. C., SomaRaju, B., Mercuri, M. F., Antman, E. M., Braunwald, E., on behalf of the ENGAGE AF-TIMI 48 Investigators Tags: Atrial Fibrillation, Anticoagulants, Ischemic Stroke Clinical Sciences Source Type: research
Diabetes Mellitus Impairs Cognitive Function in Middle-Aged Rats and Neurological Recovery in Middle-Aged Rats After Stroke Basic Sciences
Conclusions— Our data suggest that DM exacerbates neurovascular damage and hinders brain repair processes, which likely contribute to the impairment of stroke recovery.
Source: Stroke - July 25, 2016 Category: Neurology Authors: Zhang, L., Chopp, M., Zhang, Y., Xiong, Y., Li, C., Sadry, N., Rhaleb, I., Lu, M., Zhang, Z. G. Tags: Basic Science Research, Cognitive Impairment, Neurogenesis Basic Sciences Source Type: research
Recurrent Stroke due to Patent Foramen Ovale Closure Device Thrombus Eight Years after Implantation
We present a case of cardioembolic stroke secondary to a mobile thrombus on a PFO closure device 8 years after implantation.
Source: Journal of Stroke and Cerebrovascular Diseases - July 18, 2016 Category: Neurology Authors: Thomas V. Kodankandath, Sanskriti Mishra, Richard B. Libman, Paul Wright Tags: Case Studies Source Type: research
Ambulatory Status Protects against Venous Thromboembolism in Acute Mild Ischemic Stroke Patients
Ischemic stroke patients are at high risk (up to 18%) for venous thromboembolism. We conducted a retrospective cross-sectional study to understand the predictors of acute postmild ischemic stroke patient's ambulatory status and its relationship with venous thromboembolism, hospital length of stay, and in-hospital mortality.
Source: Journal of Stroke and Cerebrovascular Diseases - July 13, 2016 Category: Neurology Authors: Jason-Flor V. Sisante, Michael G. Abraham, Milind A. Phadnis, Sandra A. Billinger, Manoj K. Mittal Source Type: research
Stroke: Highlights of Selected Articles Stroke: Highlights of Selected Articles
Source: Stroke - June 27, 2016 Category: Neurology Tags: Stem Cells, Magnetic Resonance Imaging (MRI), Quality and Outcomes, Ischemic Stroke, Thrombosis Stroke: Highlights of Selected Articles Source Type: research
Prothrombotic State in Patients With a Left Atrial Appendage Thrombus of Unknown Origin and Cerebrovascular Events Clinical Sciences
Conclusions— Prothrombotic blood alterations could be involved in the LAA thrombus formation in patients without documented atrial fibrillation and are associated with increased risk of stroke or transient ischemic attack during follow-up.
Source: Stroke - June 27, 2016 Category: Neurology Authors: Meus, R., Son, M., Sobczyk, D., Undas, A. Tags: Ischemic Stroke Clinical Sciences Source Type: research