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Expansion of the dimensions in the current management of acute ischemic stroke
AbstractStroke is the fifth leading cause of death in the United States with a huge burden on health care. Acute ischemic stroke (AIS) accounts for 87% of all stroke. The use of thrombolytic agents in AIS treatment is well known since 1950 but no FDA approval until 1996, due to lack of strong evidence showing benefits outweigh the risk of intracranial hemorrhage. The NINDS trial led to the approval of intravenous tissue plasminogen activator treatment (IV recombinant tPA) within 3  h of stroke. Due to this limitation of 3–4.5 h. window, evolution began in the development of effective endovascular therapy (EVT). Multipl...
Source: Journal of Neurology - May 19, 2020 Category: Neurology Source Type: research

Outcome Differences between Carotid artery stenting (CAS) and Carotid endarterectomy (CEA) in Postoperative Ventricular Arrhythmia, Neurological Complications and In-Hospital Mortality.
Conclusions: In short-term outcomes, CEA was associated with lower risk of postoperative ventricular arrhythmia, neurological complications, in-hospital mortality, and lower cost as compared with CAS. PMID: 32396028 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - May 14, 2020 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke.
CONCLUSIONS: The study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions. PMID: 32357335 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - April 30, 2020 Category: Neurosurgery Authors: Mouchtouris N, Al Saiegh F, Valcarcel B, Andrews CE, Fitchett E, Nauheim D, Moskal D, Herial N, Jabbour P, Tjoumakaris SI, Sharan AD, Rosenwasser RH, Gooch MR Tags: J Neurosurg Source Type: research

Indications and Evidence for Dual Antiplatelet Therapy After Acute Ischemic Stroke
The antiplatelet landscape for the secondary prevention of ischemic stroke has changed significantly over the past decade. Poststroke dual antiplatelet regimens are becoming increasingly routine as supported by recent literature and guideline recommendations. Dual antiplatelet therapy after stroke generally consists of aspirin and clopidogrel and is considered in the short term after stroke in select populations including those with mild stroke or transient ischemic attack and in patients with severe intracranial atherosclerosis. When initiating dual antiplatelet therapy, factors that may increase a patient's risk of bleed...
Source: Critical Care Nursing Quarterly - February 22, 2020 Category: Nursing Tags: Original Articles Source Type: research

Transcranial Doppler Ultrasound During Critical Illness in Children: Survey of Practices in Pediatric Neurocritical Care Centers*
Conclusions: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
Source: Pediatric Critical Care Medicine - January 1, 2020 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample
Background: To use a nationwide database of hospital admissions to assess for trends in inpatient mortality from acute spontaneous intracerebral hemorrhage as well as associated potentially contributing factors. Methods: Adults with intracerebral hemorrhage in the US National Inpatient Sample database from 2012 to 2015 were included in this study. We assessed for mortality rate as well as potential impact of various comorbidities and demographic factors such as ethnicity and median house hold income on inpatient mortality rate.
Source: Journal of Stroke and Cerebrovascular Diseases - December 18, 2019 Category: Neurology Authors: Vijayakumar Javalkar, Okkes Kuybu, Debra Davis, Roger E. Kelley Source Type: research

The Effects of Balloon Occlusion of the Aorta on Cerebral Blood Flow, Intracranial Pressure, and Brain Tissue Oxygen Tension in a Rodent Model of Penetrating Ballistic-Like Brain Injury
Trauma is among the leading causes of death in the United States. Technological advancements have led to the development of resuscitative endovascular balloon occlusion of the aorta (REBOA) which offers a pre-hospital option to non-compressible hemorrhage control. Due to the prevalence of concomitant traumatic brain injury (TBI), an understanding of the effects of REBOA on cerebral physiology is critical. To further this understanding, we employed a rat model of penetrating ballistic-like brain injury (PBBI). PBBI produced an injury pattern within the right frontal cortex and striatum that replicates the pathology from a p...
Source: Frontiers in Neurology - December 17, 2019 Category: Neurology Source Type: research

Antithrombotic therapy for chronic coronary syndrome and atrial fibrillation: less might be more
AbstractThe best strategy in atrial fibrillation (AF) after  >  12 months after an acute coronary syndrome or in patients with chronic coronary syndrome without an indication for interventional revascularization remains unclear. European guidelines generally recommend therapy with oral anticoagulation (OAC) alone, whereas North American guidelines advise com bination therapy consisting of OAC plus antiplatelet therapy in some patients. We performed a meta-analysis of available trials comparing these treatment strategies. The primary endpoint was major adverse cardiac events (MACE), secondary endpoints included maj...
Source: Journal of Thrombosis and Thrombolysis - December 2, 2019 Category: Hematology Source Type: research

Influence of a Comorbid Diagnosis of Seizure on 30-Day Readmission Rates Following Hospitalization for an Index Stroke
Objective: To examine the association of a comorbid seizure diagnosis with early hospital readmission rates following an index hospitalization for stroke in the United States. Methods: Retrospective analysis of the 2014 National Readmission Database. The study population included adult patients (age>18 years old) with stroke, identified using the International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1, and 436 for ischemic stroke as well as 430, 431, 432.0, 432.1, and 432.9 for hemorrhagic stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - November 25, 2019 Category: Neurology Authors: Alain Lekoubou, Kinfe G Bishu, Bruce Ovbiagele Source Type: research

Algorithmic anticoagulation: streamlining the decision to hold and restart blood thinners in the periendoscopy period
The number and complexity of procedures performed by gastroenterologists are increasing in the United States.1,2 In addition, the number and complexity of antithrombotic agents are growing.3 These concurrent trends may lead to confusion among providers on the  appropriate management of these drugs during endoscopy. The skilled clinician must balance the risks of thrombosis, including myocardial infarction and stroke, against the risks of procedure-related hemorrhage, which can be potentially fatal.
Source: Gastrointestinal Endoscopy - November 20, 2019 Category: Gastroenterology Authors: Theodore W. James, Todd H. Baron Tags: Original article Source Type: research

Older Age Is Not Associated with Worse Outcomes Following Decompressive Hemicraniectomy for Spontaneous Intracerebral Hemorrhage
Background: Decompressive hemicraniectomy (DHC) is commonly offered after large spontaneous intracerebral hemorrhage (ICH) as a life-saving measure. Based on limited available evidence, surgery is sometimes avoided in the elderly. The association between age and outcomes following DHC in spontaneous ICH remains largely understudied. Objective: The goal of this study is to investigate the influence of older age on outcomes of patients who undergo DHC for spontaneous ICH. Methods: In this retrospective cohort study, inpatient data were obtained from the United States Nationwide Inpatient Sample from 2000 to 2011.
Source: Journal of Stroke and Cerebrovascular Diseases - August 4, 2019 Category: Neurology Authors: Roy A. Poblete, Ling Zheng, Marcela Arenas, Alejandro Vazquez, Derek Yu, Benjamin A. Emanuel, May A. Kim-Tenser, Nerses Sanossian, William Mack Source Type: research

Short-term exposure to air pollution and incidence of stroke in the Women's Health Initiative.
CONCLUSIONS: In this large cohort of post-menopausal US women, daily NO2 and NOx were associated with higher risk of hemorrhagic stroke, but ambient levels of four other air pollutants were not associated with higher risk of total stroke, ischemic stroke, or ischemic stroke subtypes. PMID: 31382185 [PubMed - as supplied by publisher]
Source: Environment International - August 1, 2019 Category: Environmental Health Authors: Sun S, Stewart JD, Eliot MN, Yanosky JD, Liao D, Tinker LF, Eaton CB, Whitsel EA, Wellenius GA Tags: Environ Int Source Type: research

Pre-existing Renal Failure Increases In-Hospital Mortality in Patients With Intracerebral Hemorrhage
We read with interest the study of Khatri et al that concluded pre-existing renal failure increased the risk of in-hospital mortality among patients with intracerebral hemorrhage (ICH).1 These results were derived from a retrospective analysis of over 328,000 adult patients (11.8% with pre-existing renal failure) who were admitted to hospitals in the United States with ICH over a 5-year period.
Source: Journal of Stroke and Cerebrovascular Diseases - May 22, 2019 Category: Neurology Authors: Ruemon Bhattacharyya, Larry E. Miller Tags: Letter to the Editor Source Type: research

Common Data Elements for Subarachnoid Hemorrhage and Unruptured Intracranial Aneurysms: Recommendations from the Working Group on Subject Characteristics
ConclusionsThese CDEs would allow the development of best practice guidelines to standardize the assessment and reporting of observations concerning UIA and SAH.
Source: Neurocritical Care - May 9, 2019 Category: Neurology Source Type: research

Age- and Sex-Associated Impacts of Body Mass Index on Stroke Type Risk: A 27-Year Prospective Cohort Study in a Low-Income Population in China
Conclusions Being overweight increased the risk of both ischemic and hemorrhagic strokes; obesity was only associated with an increased risk of IS. Additionally, the positive association between BMI and stroke risk was only observed in participants aged <65 years and the associations differed between men and women. Being overweight increased the risk of both ischemic and hemorrhagic strokes in men and being underweight increased their risk of hemorrhagic stroke. In women, being overweight increased the hemorrhagic stroke risk, whereas obesity increased their IS risks. The high prevalence of hypertension and elevat...
Source: Frontiers in Neurology - April 30, 2019 Category: Neurology Source Type: research

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