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Intravenous Thrombolysis in Posterior Circulation Stroke
Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset. Introduction History of Intravenous Thrombolysis—The Most Relevant Studies Intravenous...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Postreperfusion Blood Pressure Variability After Endovascular Thrombectomy Affects Outcomes in Acute Ischemic Stroke Patients With Poor Collateral Circulation
Conclusion: Postreperfusion BP management by decreasing BPV may have influence on improving clinical outcome in cases of poor collateral circulation among patients achieving successful recanalization after ERT. Introduction Endovascular recanalization therapy (ERT) has been adopted as standard stroke care in patients with acute ischemic stroke (1–6). Time to recanalization and degree of recanalization are the most important predictors of clinical outcomes after ERT (7). Before recanalization, an effort to reduce the time from symptom onset to reperfusion is critical for penumbral salvage. After recanalization...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Frequency of Hemorrhage on Follow Up Imaging in Stroke Patients Treated With rt-PA Depending on Clinical Course
Conclusions: Frequency of hemorrhagic transformation in Routine follow-up brain imaging and consecutive changes in therapeutic management were different depending on clinical course measured by NHISS score. Introduction Brain imaging 24–36 h after systemic thrombolysis for acute ischemic stroke is recommended in American Stroke Association and European Stroke Organization guidelines (1, 2). Brain imaging is performed to detect secondary bleeding or hemorrhagic transformation in order to adapt medical stroke prevention if necessary. Guideline recommendations are based on the results of the first study on rt-PA...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis
Conclusion Our data suggest that women who suffer from IS present with a poorer functional outcome than men at 3-months, regardless of other preclinical and clinical factors during the acute phase. These relationships seem to be mediated by atrial dysfunction and inflammation. The inflammatory response is slightly higher in women; however, there are no sex differences in their functional behavior. There is a probable relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, and the connection seems to be more important in cardioembolic stroke patients. In patients wi...
Source: Frontiers in Neurology - April 16, 2019 Category: Neurology Source Type: research

A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes
This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone.Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals.Results: Three hundred eighty-five strokes were registered, an...
Source: Frontiers in Neurology - September 7, 2021 Category: Neurology Source Type: research

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19
Conclusions: Profound reductions in stroke hospital admissions and significant delays in emergency care for acute ischemic stroke occurred during the pandemic of COVID-19. Engagement and effective communication with all stakeholders including patients, health care providers, governmental policymakers, and other implementation partners are required for future success in similar crises.
Source: Frontiers in Neurology - November 5, 2020 Category: Neurology Source Type: research

Distribution of Diagnoses and Clinical and Imaging Characteristics in 1,322 Consecutive Suspected Stroke Patients
Conclusion: Our results help to plan resources in thrombectomy-capable centers in times of expanding indications for EVT where resources will have to be adjusted to patients with low-NIHSS, low-ASPECTS, and distal occlusions, and patients presenting in the extended time window, which may altogether account for an additional 20% of all ischemic stroke patients.
Source: Frontiers in Neurology - October 20, 2021 Category: Neurology Source Type: research

Protocol for LASER: A Randomized Evaluation and an Associated Registry of Early Anticoagulation With Edoxaban After Ischemic Stroke in Patients With Atrial Fibrillation
This study will provide data required for a definitive safety/efficacy study sample size power calculation.
Source: Frontiers in Neurology - March 31, 2021 Category: Neurology Source Type: research

Application of Machine Learning Techniques to Identify Data Reliability and Factors Affecting Outcome After Stroke Using Electronic Administrative Records
Conclusion: Electronic administrative records from this cohort produced reliable outcome prediction and identified clinically appropriate factors negatively impacting most outcome variables following hospital admission with stroke. This presents a means of future identification of modifiable factors associated with patient discharge destination. This may potentially aid in patient selection for certain interventions and aid in better patient and clinician education regarding expected discharge outcomes.
Source: Frontiers in Neurology - September 27, 2021 Category: Neurology Source Type: research

Emerging Role of Carotid MRI for Personalized Ischemic Stroke Risk Prediction in Patients With Carotid Artery Stenosis
Rupture of a vulnerable carotid plaque is an important cause of ischemic stroke. Prediction models can support medical decision-making by estimating individual probabilities of future events, while magnetic resonance imaging (MRI) can provide detailed information on plaque vulnerability. In this review, prediction models for medium to long-term (>90 days) prediction of recurrent ischemic stroke among patients on best medical treatment for carotid stenosis are evaluated, and the emerging role of MRI of the carotid plaque for personalized ischemic stroke prediction is discussed. A systematic search identified two models; ...
Source: Frontiers in Neurology - August 3, 2021 Category: Neurology Source Type: research

High Neutrophil-to-Platelet Ratio Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke
Conclusions: High NPR was associated with the increased risk of HT especially PH in patients with acute ischemic stroke.
Source: Frontiers in Neurology - December 9, 2019 Category: Neurology Source Type: research

A Canine Model of Hemorrhagic Transformation Using Recombinant Tissue Plasminogen Activator Administration After Acute Ischemic Stroke
Early reperfusion of occluded arteries via recombinant tissue plasminogen activator (rtPA) administration is considered to be an effective strategy for the treatment of acute ischemic stroke. However, delayed administration of rtPA may cause severe hemorrhagic transformation (HT) and undesirable neurological outcomes. The current study aims to establish a canine HT model using rtPA administration and to investigate the potential mechanisms underlying HT. Following anesthesia, two autologous clots were injected into the middle cerebral artery (MCA) to induce ischemic stroke. To induce reperfusion, rtPA (2 mg/kg) was adminis...
Source: Frontiers in Neurology - June 24, 2019 Category: Neurology Source Type: research

Interdisciplinary Decision Making in Hemorrhagic Stroke Based on CT Imaging —Differences Between Neurologists and Neurosurgeons Regarding Estimation of Patients' Symptoms, Glasgow Coma Scale, and National Institutes of Health Stroke Scale
Conclusion: Our results stress the need for joint decision making based on detailed neurological examination and neuroimaging findings also in telemedicine.
Source: Frontiers in Neurology - September 25, 2019 Category: Neurology Source Type: research

Net water uptake, a neuroimaging marker of early brain edema, as a predictor of symptomatic intracranial hemorrhage after acute ischemic stroke
ConclusionsNWU-penumbra may have better predictive performance than NWU-core on sICH after MT. A pure imaging model showed potential value to automatically screen patients with sICH risk by image recognition, which may optimize treatment strategy.
Source: Frontiers in Neurology - July 27, 2022 Category: Neurology Source Type: research

Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis
ConclusionIn this single-center analysis, EPT use during EVT was associated with a significantly higher rate of PH1/PH2 grade hemorrhages, but not with differences in sICH, 24-h NIHSS, or 90-day mortality. Randomized prospective trials are needed to determine the safety and efficacy of EPT in this population.
Source: Frontiers in Neurology - September 27, 2022 Category: Neurology Source Type: research

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