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Surgical embolectomy for internal carotid artery terminus occlusion
Abstract The aim of this study was to assess the efficacy and safety of surgical embolectomy for internal carotid artery terminus (ICA-T) occlusion. Twenty-five consecutive patients with acute ischemic stroke attributed to embolic ICA-T occlusion who underwent surgical embolectomy were retrospectively reviewed. Twenty-four patients were examined based on magnetic resonance imaging, with one patient included based on a computed tomography scan. Recanalization rate, recanalization time, complications, National Institutes of Health Stroke Scale (NIHSS) score improvement at 1 month, and modified Rankin Scale (mRS) at...
Source: Neurosurgical Review - May 12, 2015 Category: Neurosurgery Source Type: research

Safety and efficacy of desmoteplase given 3–9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries (DIAS-3): a double-blind, randomised, placebo-controlled phase 3 trial
Publication date: Available online 30 April 2015 Source:The Lancet Neurology Author(s): Gregory W Albers , Rüdiger von Kummer , Thomas Truelsen , Jens-Kristian S Jensen , Gabriela M Ravn , Bjørn A Grønning , Hugues Chabriat , Ku-Chou Chang , Antonio E Davalos , Gary A Ford , James Grotta , Markku Kaste , Lee H Schwamm , Ashfaq Shuaib Background Current treatment of ischaemic stroke with thrombolytic therapy is restricted to 3–4·5 h after symptom onset. We aimed to assess the safety and efficacy of desmoteplase, a fibrin-dependent plasminogen activator, given between 3 h and 9 h after symptom onset in patients with ...
Source: The Lancet Neurology - May 1, 2015 Category: Neurology Source Type: research

Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial
Publication date: Available online 16 April 2015 Source:The Lancet Background Early mobilisation after stroke is thought to contribute to the effects of stroke-unit care; however, the intervention is poorly defined and not underpinned by strong evidence. We aimed to compare the effectiveness of frequent, higher dose, very early mobilisation with usual care after stroke. Methods We did this parallel-group, single-blind, randomised controlled trial at 56 acute stroke units in five countries. Patients (aged ≥18 years) with ischaemic or haemorrhagic stroke, first or recurrent, who met physiological criteria were randomly as...
Source: The Lancet - April 18, 2015 Category: Journals (General) Source Type: research

Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial
Publication date: Available online 27 March 2015 Source:The Lancet Neurology Background Brain scans are essential to exclude haemorrhage in patients with suspected acute ischaemic stroke before treatment with alteplase. However, patients with early ischaemic signs could be at increased risk of haemorrhage after alteplase treatment, and little information is available about whether pre-existing structural signs, which are common in older patients, affect response to alteplase. We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase. Methods IST-3 was a multicentre, randomised ...
Source: The Lancet Neurology - March 27, 2015 Category: Neurology Source Type: research

Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study
This study is registered with ClinicalTrials.gov, number NCT01472926. Findings Between Jan 1, 2012, and Sept 7, 2013, 355 patients were screened, of whom 157 were eligible for intravenous thrombolysis, and 104 patients were enrolled. 52 were assigned to the alteplase group and 52 to tenecteplase. Of 71 patients (35 assigned tenecteplase and 36 assigned alteplase) contributing to the primary endpoint, no significant differences were noted for percentage of penumbral salvaged (68% [SD 28] for the tenecteplase group vs 68% [23] for the alteplase group; mean difference 1·3% [95% CI −9·6 to 12·1]; p=0·81). Neither incide...
Source: The Lancet Neurology - February 26, 2015 Category: Neurology Source Type: research

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture.
Abstract Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were eval...
Source: Journal of Neurosurgery - January 9, 2015 Category: Neurosurgery Authors: Hasegawa H, Inoue T, Tamura A, Saito I Tags: J Neurosurg Source Type: research

Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications
Early neurological deterioration (END) following ischaemic stroke is a serious event with manageable causes in only a fraction of patients. The incidence, causes and predictors of END occurring within 24 h of acute ischaemic stroke (END24) have not been systematically reviewed. We systematically reviewed Medline and Embase from January 1990 to April 2013 for all studies on END24 following acute ischaemic stroke (<8 h from onset). We recorded the incidence and presumed causes of and factors associated with END24. Thirty-six studies were included. Depending on the definition used, the incidence of END24 markedly...
Source: Journal of Neurology, Neurosurgery and Psychiatry - December 17, 2014 Category: Neurosurgery Authors: Seners, P., Turc, G., Oppenheim, C., Baron, J.-C. Tags: Stroke Cerebrovascular disease Source Type: research

Prevalence of Triggering Factors in Acute Stroke: Hospital-Based Observational Cross-sectional Study
Although chronic risk factors for stroke are reasonably well understood, the acute precipitants, or triggers, of stroke relatively remain understudied. Identification of particular time periods during which stroke risk is elevated could prove a valuable strategy to reduce stroke incidence through the introduction of appropriate prevention strategies during a period of vulnerability. The aim of this study was to determine the prevalence of trigger factors in acute stroke patients and to investigate the association of the presence of trigger factors with initial stroke severity at presentation (National Institutes of Health ...
Source: Journal of Stroke and Cerebrovascular Diseases - November 22, 2014 Category: Neurology Authors: Ashish Sharma, Kameshwar Prasad, M.V. Padma, Manjari Tripathi, Rohit Bhatia, Mamta Bhusan Singh, Anupriya Sharma Source Type: research

Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke.
Abstract The authors report a case of an intracranial extravasation during the withdrawal of a Trevo ProVue stent retriever device in a patient being treated for acute ischemic stroke. An 82-year-old woman developed sudden left hemiparesis and aphasia during an urgent cardiac catheterization procedure for a non-ST elevation myocardial infarction. She had a baseline National Institutes of Health Stroke Scale (NIHSS) score of at least 10 and no improvement with intravenous administration of tissue plasminogen activator (tPA). Cerebral angiography was performed with conscious sedation, confirming an occlusion of the ...
Source: Journal of Neurosurgery - June 13, 2014 Category: Neurosurgery Authors: Leishangthem L, Satti SR Tags: J Neurosurg Source Type: research

Can minimally invasive puncture and drainage for hypertensive spontaneous Basal Ganglia intracerebral hemorrhage improve patient outcome: a prospective non-randomized comparative study
Background: The treatment of hypertensive spontaneous intracranial hemorrhage (ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage (MIPD) could improve patient outcome compared with decompressive craniectomy (DC). Methods: Consecutive patients with ICH (>=30 mL in basal ganglia within 24 hours of ictus) were non-randomly assigned to receive MIPD (group A) or DC (group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale. Results: A total of 198...
Source: Epidemiologic Perspectives and Innovations - June 1, 2014 Category: Epidemiology Authors: Guo-Qiang WangShi-Qiang LiYong-Hua HuangWei-Wei ZhangWen-Wei RuanJia-Zhen QinYing LiWei-Min YinYun-Jun LiZheng-Jun RenJi-Qiang ZhuYun-Yan DingJun-Qi PengPei-Jian Li Source Type: research

Safety of Intravenous Tissue Plasminogen Activator Administration with Computed Tomography Evidence of Prior Infarction
Background: Prior stroke within 3 months excludes patients from thrombolysis; however, patients may have computed tomography (CT) evidence of prior infarct, often of unknown time of origin. We aimed to determine if the presence of a previous infarct on pretreatment CT is a predictor of hemorrhagic complications and functional outcomes after the administration of intravenous (IV) tissue plasminogen activator (tPA).Methods: We retrospectively analyzed consecutive patients treated with IV tPA at our institution from 2009-2011. Pretreatment CTs were reviewed for evidence of any prior infarct. Further review determined if any ...
Source: Journal of Stroke and Cerebrovascular Diseases - March 31, 2014 Category: Neurology Authors: Michael J. Lyerly, J. Thomas Houston, Amelia K. Boehme, Karen C. Albright, Reza Bavarsad Shahripour, Paola Palazzo, Muhammed Alvi, Pawan V. Rawal, Niren Kapoor, April Sisson, Anne W. Alexandrov, Andrei V. Alexandrov Tags: Original Articles Source Type: research

Anemia on Admission Increases the Risk of Mortality at 6 Months and 1 Year in Hemorrhagic Stroke Patients in China
Background: The relationship between anemia and intracerebral hemorrhage is not clear. We investigated the associations between anemia at the onset and mortality or dependency in patients with intracerebral hemorrhage (ICH) registered at the China National Stroke Registry (CNSR).Methods: The CNSR recruited consecutive patients with diagnoses of ICH in 2007-2008. Their vascular risk factors, clinical presentations, and outcomes were recorded. The mortality and dependency at 1, 3, and 6 months and at 1 year were compared between ICH patients with and without anemia. A favorable outcome was defined as a modified Rankin Scal...
Source: Journal of Stroke and Cerebrovascular Diseases - March 17, 2014 Category: Neurology Authors: Yi-Jun Zeng, Gai-Fen Liu, Li-Ping Liu, Chun-Xue Wang, Xing-Quan Zhao, Yong-Jun Wang Tags: Original Articles Source Type: research

Effects of Batroxobin with Continuous Transcranial Doppler Monitoring in Patients with Acute Cerebral Stroke: A Randomized Controlled Trial
Our objective was to determine whether continuous transcranial Doppler (TCD) monitoring could safely enhance the efficacy of batroxobin, a thrombin‐like enzyme extracted from Bothrops atrox moojeni venom, in the treatment for acute cerebral stroke beyond the thrombolytic time window. Ninety patients suffering an acute cerebral stroke were recruited into the study within 12 hours after the onset of symptoms. Patients were randomized to receive batroxobin with (target group) or without 1 hour of continuous TCD monitoring (control group). Clinical evaluation of stroke was based on the National Institutes of Health Stroke ...
Source: Echocardiography - March 1, 2014 Category: Cardiology Authors: He Yitao, Ma Kefu, Tang Bingshan, Fu Xuejun, Zhan Ying, Cai Zhili, Jiang Xin, Yi Guo Tags: Original Investigation Source Type: research

Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery
There are clinical, pathologic, and outcome differences in spontaneous dissections of the internal carotid artery vs those of the vertebral artery. Spontaneous cervical artery dissection is a major cause of stroke in younger patients. Spontaneous cervical artery dissection causes up to 25% of all ischemic strokes in patients 15 to 49 years of age (Putaala J et al, Stroke 2009;40:1195-203). Although constitutional and environmental factors are both thought to play a role in spontaneous cervical artery dissection, precise causes are poorly understood. Significant differences between spontaneous internal carotid artery disse...
Source: Journal of Vascular Surgery - December 27, 2013 Category: Surgery Authors: M. von Babo, G.M. De Marchis, H. Sarikaya Tags: Abstracts Source Type: research

A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra‐Arterial therapy (EXTEND‐IA)
Background and HypothesisThrombolysis with tissue plasminogen activator is proven to reduce disability when given within 4·5 h of ischemic stroke onset. However, tissue plasminogen activator only succeeds in recanalizing large vessel arterial occlusion in a minority of patients. We hypothesized that anterior circulation ischemic stroke patients, selected with ‘dual target’ vessel occlusion and evidence of salvageable brain using computed tomography or magnetic resonance imaging ‘mismatch’ within 4·5 h of onset, would have improved reperfusion and early neurological improvement when treated with intra‐arteri...
Source: International Journal of Stroke - November 10, 2013 Category: Neurology Authors: Bruce C. V. Campbell, Peter J. Mitchell, Bernard Yan, Mark W. Parsons, Søren Christensen, Leonid Churilov, Richard J. Dowling, Helen Dewey, Mark Brooks, Ferdinand Miteff, Christopher Levi, Martin Krause, Timothy J. Harrington, Kenneth C. Faulder, Brendan Tags: Protocols Source Type: research

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