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Source: The Lancet Neurology

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Total 214 results found since Jan 2013.

Support programme for secondary prevention of stroke: inspiration to continue?
Publication date: Available online 7 November 2019Source: The Lancet NeurologyAuthor(s): Linxin Li
Source: The Lancet Neurology - November 8, 2019 Category: Neurology Source Type: research

A support programme for secondary prevention in patients with transient ischaemic attack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial
Publication date: Available online 7 November 2019Source: The Lancet NeurologyAuthor(s): Michael Ahmadi, Inga Laumeier, Thomas Ihl, Maureen Steinicke, Caroline Ferse, Matthias Endres, Armin Grau, Sidsel Hastrup, Holger Poppert, Frederick Palm, Martin Schoene, Christian L Seifert, Farid I Kandil, Joachim E Weber, Paul von Weitzel-Mudersbach, Martin L J Wimmer, Ale Algra, Pierre Amarenco, Jacoba P Greving, Otto BusseSummaryBackgroundPatients with recent stroke or transient ischaemic attack are at high risk for a further vascular event, possibly leading to permanent disability or death. Although evidence-based treatments for ...
Source: The Lancet Neurology - November 8, 2019 Category: Neurology Source Type: research

Availability of stroke units in Colombia
Publication date: November 2019Source: The Lancet Neurology, Volume 18, Issue 11Author(s): Hernán Bayona-Ortiz, Juan Nicolás Useche, Nicolás Yanez, Sofia Catalina Velasco
Source: The Lancet Neurology - October 11, 2019 Category: Neurology Source Type: research

Global prevention of stroke: focus on the individual?
Publication date: October 2019Source: The Lancet Neurology, Volume 18, Issue 10Author(s): The Lancet Neurology
Source: The Lancet Neurology - September 14, 2019 Category: Neurology Source Type: research

Association between plasma GFAP concentrations and MRI abnormalities in patients with CT-negative traumatic brain injury in the TRACK-TBI cohort: a prospective multicentre study
This study is registered with ClinicalTrials.gov, number NCT02119182.FindingsBetween Feb 26, 2014, and June 15, 2018, we recruited 450 patients with normal head CT scans (of whom 330 had negative MRI scans and 120 had positive MRI scans), 122 orthopaedic trauma controls, and 209 healthy controls. AUC for GFAP in patients with CT-negative and MRI-positive findings versus patients with CT-negative and MRI-negative findings was 0·777 (95% CI 0·726–0·829) over 24 h. Median plasma GFAP concentration was highest in patients with CT-negative and MRI-positive findings (414·4 pg/mL, 25–75th percentile 139·3–813·4), foll...
Source: The Lancet Neurology - August 24, 2019 Category: Neurology Source Type: research

Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial
Publication date: September 2019Source: The Lancet Neurology, Volume 18, Issue 9Author(s): Rebecca Palmer, Munyaradzi Dimairo, Cindy Cooper, Pam Enderby, Marian Brady, Audrey Bowen, Nicholas Latimer, Steven Julious, Elizabeth Cross, Abualbishr Alshreef, Madeleine Harrison, Ellen Bradley, Helen Witts, Tim ChaterSummaryBackgroundPost-stroke aphasia might improve over many years with speech and language therapy; however speech and language therapy is often less readily available beyond a few months after stroke. We assessed self-managed computerised speech and language therapy (CSLT) as a means of providing more therapy than ...
Source: The Lancet Neurology - August 8, 2019 Category: Neurology Source Type: research

Global brain inflammation in stroke
Publication date: Available online 8 July 2019Source: The Lancet NeurologyAuthor(s): Kaibin Shi, De-Cai Tian, Zhi-Guo Li, Andrew F Ducruet, Michael T Lawton, Fu-Dong ShiSummaryStroke, including acute ischaemic stroke and intracerebral haemorrhage, results in neuronal cell death and the release of factors such as damage-associated molecular patterns (DAMPs) that elicit localised inflammation in the injured brain region. Such focal brain inflammation aggravates secondary brain injury by exacerbating blood–brain barrier damage, microvascular failure, brain oedema, oxidative stress, and by directly inducing neuronal cell dea...
Source: The Lancet Neurology - July 10, 2019 Category: Neurology Source Type: research

Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Publication date: Available online 23 May 2019Source: The Lancet NeurologyAuthor(s): Duncan Wilson, Gareth Ambler, Keon-Joo Lee, Jae-Sung Lim, Masayuki Shiozawa, Masatoshi Koga, Linxin Li, Caroline Lovelock, Hugues Chabriat, Michael Hennerici, Yuen Kwun Wong, Henry Ka Fung Mak, Luis Prats-Sánchez, Alejandro Martínez-Domeño, Shigeru Inamura, Kazuhisa Yoshifuji, Ethem Murat Arsava, Solveig Horstmann, Jan Purrucker, Bonnie Yin Ka LamSummaryBackgroundCerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or ...
Source: The Lancet Neurology - May 23, 2019 Category: Neurology Source Type: research

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial
Publication date: Available online 22 May 2019Source: The Lancet NeurologyAuthor(s): Rustam Al-Shahi Salman, David P Minks, Dipayan Mitra, Mark A Rodrigues, Priya Bhatnagar, Johann C du Plessis, Yogish Joshi, Martin S Dennis, Gordon D Murray, David E Newby, Peter A G Sandercock, Nikola Sprigg, Jacqueline Stephen, Cathie L M Sudlow, David J Werring, William N Whiteley, Joanna M Wardlaw, Philip M White, Colin Baigent, Daniel LassersonSummaryBackgroundFindings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antipl...
Source: The Lancet Neurology - May 23, 2019 Category: Neurology Source Type: research

Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial
Publication date: June 2019Source: The Lancet Neurology, Volume 18, Issue 6Author(s): Kazunori Toyoda, Shinichiro Uchiyama, Takenori Yamaguchi, J Donald Easton, Kazumi Kimura, Haruhiko Hoshino, Nobuyuki Sakai, Yasushi Okada, Kortaro Tanaka, Hideki Origasa, Hiroaki Naritomi, Kiyohiro Houkin, Keiji Yamaguchi, Masanori Isobe, Kazuo Minematsu, Shinya Goto, Tatsuya Isomura, Masayasu Matsumoto, Yasuo Terayama, Hidekazu TomimotoSummaryBackgroundAlthough dual antiplatelet therapy with aspirin and clopidogrel reduces early recurrence of ischaemic stroke, with long-term use this type of therapy is no longer effective and the risk of...
Source: The Lancet Neurology - May 22, 2019 Category: Neurology Source Type: research

Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial
Publication date: June 2019Source: The Lancet Neurology, Volume 18, Issue 6Author(s): Gary A Ford, Bipin B Bhakta, Alastair Cozens, Suzanne Hartley, Ivana Holloway, David Meads, John Pearn, Sharon Ruddock, Catherine M Sackley, Eirini-Christina Saloniki, Gillian Santorelli, Marion F Walker, Amanda J FarrinSummaryBackgroundDopamine is a key modulator of striatal function and learning and might improve motor recovery after stroke. Previous small trials of dopamine agonists after stroke provide equivocal evidence of effectiveness on improving motor recovery. We aimed to assess the safety and efficacy of co-careldopa plus routi...
Source: The Lancet Neurology - May 22, 2019 Category: Neurology Source Type: research

Priorities to reduce the burden of stroke in Latin American countries
Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
Source: The Lancet Neurology - April 26, 2019 Category: Neurology Source Type: research

Stroke genetics: discovery, biology, and clinical applications
Publication date: Available online 8 April 2019Source: The Lancet NeurologyAuthor(s): Martin Dichgans, Sara L Pulit, Jonathan RosandSummaryStroke, a leading cause of long-term disability and death worldwide, has a heritable component. Recent gene discovery efforts have expanded the number of known single-gene disorders associated with stroke and have linked common variants at approximately 35 genetic loci to stroke risk. These discoveries have highlighted novel mechanisms and pathways implicated in stroke related to large artery atherosclerosis, cardioembolism, and small vessel disease, and defined shared genetic influence...
Source: The Lancet Neurology - April 9, 2019 Category: Neurology Source Type: research

Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications
Publication date: Available online 4 April 2019Source: The Lancet NeurologyAuthor(s): Luca Saba, Tobias Saam, H Rolf Jäger, Chun Yuan, Thomas S Hatsukami, David Saloner, Bruce A Wasserman, Leo H Bonati, Max WintermarkSummaryStroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for...
Source: The Lancet Neurology - April 4, 2019 Category: Neurology Source Type: research

Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial
Publication date: April 2019Source: The Lancet Neurology, Volume 18, Issue 4Author(s): Andrei V Alexandrov, Martin Köhrmann, Lauri Soinne, Georgios Tsivgoulis, Andrew D Barreto, Andrew M Demchuk, Vijay K Sharma, Robert Mikulik, Keith W Muir, Gordon Brandt, John Alleman, James C Grotta, Christopher R Levi, Carlos A Molina, Maher Saqqur, Dimitris Mavridis, Theodora Psaltopoulou, Milan Vosko, Jochen B Fiebach, Pitchaiah MandavaSummaryBackgroundPulsed-wave ultrasound increases the exposure of an intracranial thrombus to alteplase (recombinant tissue plasminogen activator), potentially facilitating early reperfusion. We aimed ...
Source: The Lancet Neurology - March 16, 2019 Category: Neurology Source Type: research

Stroke in China: advances and challenges in epidemiology, prevention, and management
Publication date: April 2019Source: The Lancet Neurology, Volume 18, Issue 4Author(s): Simiao Wu, Bo Wu, Ming Liu, Zhengming Chen, Wenzhi Wang, Craig S Anderson, Peter Sandercock, Yongjun Wang, Yining Huang, Liying Cui, Chuanqiang Pu, Jianping Jia, Tong Zhang, Xinfeng Liu, Suming Zhang, Peng Xie, Dongsheng Fan, Xunming Ji, Ka-Sing Lawrence Wong, Longde WangSummaryWith over 2 million new cases annually, stroke is associated with the highest disability-adjusted life-years lost of any disease in China. The burden is expected to increase further as a result of population ageing, an ongoing high prevalence of risk factors (eg, ...
Source: The Lancet Neurology - March 16, 2019 Category: Neurology Source Type: research

Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator gene...
Source: The Lancet Neurology - March 13, 2019 Category: Neurology Source Type: research

Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study
Publication date: March 2019Source: The Lancet Neurology, Volume 18, Issue 3Author(s): Sarah T Pendlebury, Peter M Rothwell, Oxford Vascular StudySummaryBackgroundRisk of dementia after stroke is a major concern for patients and carers. Reliable data for risk of dementia, particularly after transient ischaemic attack or minor stroke, are scarce. We studied the risks of, and risk factors for, dementia before and after transient ischaemic attack and stroke.MethodsThe Oxford Vascular Study is a prospective incidence study of all vascular events in a population of 92 728 people residing in Oxfordshire, UK. Patients with tran...
Source: The Lancet Neurology - February 14, 2019 Category: Neurology Source Type: research

Comparison of prasugrel and clopidogrel in patients with non-cardioembolic ischaemic stroke: a phase 3, randomised, non-inferiority trial (PRASTRO-I)
Publication date: March 2019Source: The Lancet Neurology, Volume 18, Issue 3Author(s): Akira Ogawa, Kazunori Toyoda, Kazuo Kitagawa, Takanari Kitazono, Takehiko Nagao, Hiroshi Yamagami, Shinichiro Uchiyama, Norio Tanahashi, Masayasu Matsumoto, Kazuo Minematsu, Izumi Nagata, Masakatsu Nishikawa, Shinsuke Nanto, Kenji Abe, Yasuo Ikeda, PRASTRO-I Study GroupSummaryBackgroundThe effect of prasugrel in terms of the prevention of recurrence of ischaemic stroke is unknown. We investigated the non-inferiority of prasugrel to clopidogrel for prevention of ischaemic stroke, myocardial infarction, and death from other vascular causes...
Source: The Lancet Neurology - February 14, 2019 Category: Neurology Source Type: research

Optimal stroke prevention in patients with PFO
Publication date: March 2019Source: The Lancet Neurology, Volume 18, Issue 3Author(s): Maurizio Melis, Stefano Ricci, Danilo Toni, editorial committee of the Italian National Guidelines on Stroke
Source: The Lancet Neurology - February 14, 2019 Category: Neurology Source Type: research

The role of plasminogen activators in stroke treatment: fibrinolysis and beyond
Publication date: December 2018Source: The Lancet Neurology, Volume 17, Issue 12Author(s): Audrey M Thiebaut, Maxime Gauberti, Carine Ali, Sara Martinez De Lizarrondo, Denis Vivien, Manuel Yepes, Benoit D RousselSummaryAlthough recent technical advances in thrombectomy have revolutionised acute stroke treatment, prevalence of disability and death related to stroke remain high. Therefore, plasminogen activators—eukaryotic, bacterial, or engineered forms that can promote fibrinolysis by converting plasminogen into active plasmin and facilitate clot breakdown—are still commonly used in the acute treatment of ischaemic str...
Source: The Lancet Neurology - November 15, 2018 Category: Neurology Source Type: research

Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation
Publication date: Available online 8 November 2018Source: The Lancet NeurologyAuthor(s): David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo NorrvingSummaryBackgroundAbout 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population,...
Source: The Lancet Neurology - November 9, 2018 Category: Neurology Source Type: research

Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data
Publication date: Available online 6 November 2018Source: The Lancet NeurologyAuthor(s): Bruce C V Campbell, Charles B L M Majoie, Gregory W Albers, Bijoy K Menon, Nawaf Yassi, Gagan Sharma, Wim H van Zwam, Robert J van Oostenbrugge, Andrew M Demchuk, Francis Guillemin, Philip White, Antoni Dávalos, Aad van der Lugt, Kenneth S Butcher, Aboubaker Cherifi, Henk A Marquering, Geoffrey Cloud, Juan M Macho Fernández, Jeremy Madigan, Catherine OppenheimSummaryBackgroundCT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessment...
Source: The Lancet Neurology - November 7, 2018 Category: Neurology Source Type: research

Stroke–heart syndrome: clinical presentation and underlying mechanisms
Publication date: Available online 26 October 2018Source: The Lancet NeurologyAuthor(s): Jan F Scheitz, Christian H Nolte, Wolfram Doehner, Vladimir Hachinski, Matthias EndresSummaryCardiac complications are a frequent medical problem during the first few days after an ischaemic stroke, and patients present with a broad range of symptoms including myocardial injury, cardiac dysfunction, and arrhythmia, with varying overlap between these three conditions. Evidence from clinical and neuroimaging studies and animal research suggests that these cardiac disturbances share the same underlying mechanisms. Although the exact casca...
Source: The Lancet Neurology - October 27, 2018 Category: Neurology Source Type: research

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial
Publication date: Available online 28 September 2018Source: The Lancet NeurologyAuthor(s): Scott E Kasner, Balakumar Swaminathan, Pablo Lavados, Mukul Sharma, Keith Muir, Roland Veltkamp, Sebastian F Ameriso, Matthias Endres, Helmi Lutsep, Steven R Messé, J David Spence, Krassen Nedeltechev, Kanjana Perera, Gustavo Santo, Veronica Olavarria, Arne Lindgren, Shrikant Bangdiwala, Ashkan Shoamanesh, Scott D Berkowitz, Hardi MundlSummaryBackgroundPatent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurren...
Source: The Lancet Neurology - October 5, 2018 Category: Neurology Source Type: research

Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data
Publication date: October 2018Source: The Lancet Neurology, Volume 17, Issue 10Author(s): Luis San Román, Bijoy K Menon, Jordi Blasco, María Hernández-Pérez, Antoni Dávalos, Charles B L M Majoie, Bruce C V Campbell, Francis Guillemin, Hester Lingsma, René Anxionnat, Jonathan Epstein, Jeffrey L Saver, Henk Marquering, John H Wong, Demetrius Lopes, Gernot Reimann, Hubert Desal, Diederik W J Dippel, Shelagh Coutts, Richard du Mesnil de RochemontSummaryBackgroundEvidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the associat...
Source: The Lancet Neurology - September 19, 2018 Category: Neurology Source Type: research

Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial
Publication date: Available online 28 August 2018Source: The Lancet NeurologyAuthor(s): Rainer Dziewas, Rebecca Stellato, Ingeborg van der Tweel, Ernst Walther, Cornelius J Werner, Tobias Braun, Giuseppe Citerio, Mitja Jandl, Michael Friedrichs, Katja Nötzel, Milan R Vosko, Satish Mistry, Shaheen Hamdy, Susan McGowan, Tobias Warnecke, Paul Zwittag, Philip M Bath, Tobias Braun, Rainer Dziewas, Michael FriedrichsSummaryBackgroundDysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this ...
Source: The Lancet Neurology - August 29, 2018 Category: Neurology Source Type: research

Epidemiology, aetiology, and management of ischaemic stroke in young adults
Publication date: September 2018Source: The Lancet Neurology, Volume 17, Issue 9Author(s): Merel S Ekker, Esther M Boot, Aneesh B Singhal, Kay Sin Tan, Stephanie Debette, Anil M Tuladhar, Frank-Erik de LeeuwSummaryEpidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18–50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young ad...
Source: The Lancet Neurology - August 15, 2018 Category: Neurology Source Type: research

Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial
This report presents a secondary analysis, and follow-up is complete.FindingsBetween May, 2001, and October, 2008, 1713 patients were enrolled and randomly allocated treatment (855 were assigned stenting and 858 endarterectomy), of whom 1530 individuals were followed up with ultrasound (737 assigned stenting and 793 endarterectomy) for a median of 4·0 years (IQR 2·3–5·0). At least moderate restenosis (≥50%) occurred in 274 patients after stenting (cumulative 5-year risk 40·7%) and in 217 after endarterectomy (29·6%; unadjusted hazard ratio [HR] 1·43, 95% CI 1·21–1·72; p<0·0001). Patients with at least mo...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

Sex differences in the evaluation and treatment of acute ischaemic stroke
Publication date: July 2018Source: The Lancet Neurology, Volume 17, Issue 7Author(s): Cheryl Bushnell, Virginia J Howard, Lynda Lisabeth, Valeria Caso, Seana Gall, Dawn Kleindorfer, Seemant Chaturvedi, Tracy E Madsen, Stacie L Demel, Seung-Jae Lee, Mathew ReevesSummaryWith the greater availability of treatments for acute ischaemic stroke, including advances in endovascular therapy, personalised assessment of patients before treatment is more important than ever. Women have a higher lifetime risk of stroke; therefore, reducing potential sex differences in the acute stroke setting is crucial for the provision of equitable an...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis
Publication date: July 2018Source: The Lancet Neurology, Volume 17, Issue 7Author(s): Sara Mazzucco, Linxin Li, Lucy Binney, Peter M Rothwell, Oxford Vascular Study Phenotyped CohortSummaryBackgroundPercutaneous closure of patent foramen ovale (PFO) has been shown to be superior to medical treatment alone for prevention of recurrent stroke after cryptogenic transient ischaemic attack or non-disabling stroke in patients aged 60 years or younger. The justification for trials in older patients with transient ischaemic attack or stroke depends on whether PFO is shown to be associated with cryptogenic events at older ages, for ...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study
This study is registered with ClinicalTrials.gov, number NCT02513316.FindingsBetween Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·5...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial
Publication date: June 2018Source: The Lancet Neurology, Volume 17, Issue 6Author(s): Bum Joon Kim, Eun-Jae Lee, Sun U Kwon, Jong-Ho Park, Yong-Jae Kim, Keun-Sik Hong, Lawrence K S Wong, Sungwook Yu, Yang-Ha Hwang, Ji Sung Lee, Juneyoung Lee, Joung-Ho Rha, Sung Hyuk Heo, Sung Hwan Ahn, Woo-Keun Seo, Jong-Moo Park, Ju-Hun Lee, Jee-Hyun Kwon, Sung-Il Sohn, Jin-Man JungSummaryBackgroundThe optimal treatment for patients with ischaemic stroke with a high risk of cerebral haemorrhage is unclear. We assessed the efficacy and safety of cilostazol versus aspirin, with and without probucol, in these patients.MethodsIn this randomis...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

Sex differences in the evaluation and treatment of acute ischaemic stroke
Publication date: July 2018Source: The Lancet Neurology, Volume 17, Issue 7Author(s): Cheryl Bushnell, Virginia J Howard, Lynda Lisabeth, Valeria Caso, Seana Gall, Dawn Kleindorfer, Seemant Chaturvedi, Tracy E Madsen, Stacie L Demel, Seung-Jae Lee, Mathew ReevesSummaryWith the greater availability of treatments for acute ischaemic stroke, including advances in endovascular therapy, personalised assessment of patients before treatment is more important than ever. Women have a higher lifetime risk of stroke; therefore, reducing potential sex differences in the acute stroke setting is crucial for the provision of equitable an...
Source: The Lancet Neurology - July 5, 2018 Category: Neurology Source Type: research

Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis
Publication date: July 2018Source: The Lancet Neurology, Volume 17, Issue 7Author(s): Sara Mazzucco, Linxin Li, Lucy Binney, Peter M Rothwell, Oxford Vascular Study Phenotyped CohortSummaryBackgroundPercutaneous closure of patent foramen ovale (PFO) has been shown to be superior to medical treatment alone for prevention of recurrent stroke after cryptogenic transient ischaemic attack or non-disabling stroke in patients aged 60 years or younger. The justification for trials in older patients with transient ischaemic attack or stroke depends on whether PFO is shown to be associated with cryptogenic events at older ages, for ...
Source: The Lancet Neurology - July 5, 2018 Category: Neurology Source Type: research

Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial
This report presents a secondary analysis, and follow-up is complete.FindingsBetween May, 2001, and October, 2008, 1713 patients were enrolled and randomly allocated treatment (855 were assigned stenting and 858 endarterectomy), of whom 1530 individuals were followed up with ultrasound (737 assigned stenting and 793 endarterectomy) for a median of 4·0 years (IQR 2·3–5·0). At least moderate restenosis (≥50%) occurred in 274 patients after stenting (cumulative 5-year risk 40·7%) and in 217 after endarterectomy (29·6%; unadjusted hazard ratio [HR] 1·43, 95% CI 1·21–1·72; p<0·0001). Patients with at least mo...
Source: The Lancet Neurology - July 5, 2018 Category: Neurology Source Type: research

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study
This study is registered with ClinicalTrials.gov, number NCT02513316.FindingsBetween Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·5...
Source: The Lancet Neurology - July 5, 2018 Category: Neurology Source Type: research

Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial
Publication date: June 2018Source: The Lancet Neurology, Volume 17, Issue 6Author(s): Bum Joon Kim, Eun-Jae Lee, Sun U Kwon, Jong-Ho Park, Yong-Jae Kim, Keun-Sik Hong, Lawrence K S Wong, Sungwook Yu, Yang-Ha Hwang, Ji Sung Lee, Juneyoung Lee, Joung-Ho Rha, Sung Hyuk Heo, Sung Hwan Ahn, Woo-Keun Seo, Jong-Moo Park, Ju-Hun Lee, Jee-Hyun Kwon, Sung-Il Sohn, Jin-Man JungSummaryBackgroundThe optimal treatment for patients with ischaemic stroke with a high risk of cerebral haemorrhage is unclear. We assessed the efficacy and safety of cilostazol versus aspirin, with and without probucol, in these patients.MethodsIn this randomis...
Source: The Lancet Neurology - July 5, 2018 Category: Neurology Source Type: research

Sex differences in the evaluation and treatment of acute ischaemic stroke
Publication date: July 2018 Source:The Lancet Neurology, Volume 17, Issue 7 Author(s): Cheryl Bushnell, Virginia J Howard, Lynda Lisabeth, Valeria Caso, Seana Gall, Dawn Kleindorfer, Seemant Chaturvedi, Tracy E Madsen, Stacie L Demel, Seung-Jae Lee, Mathew Reeves With the greater availability of treatments for acute ischaemic stroke, including advances in endovascular therapy, personalised assessment of patients before treatment is more important than ever. Women have a higher lifetime risk of stroke; therefore, reducing potential sex differences in the acute stroke setting is crucial for the provision of equitable and fa...
Source: The Lancet Neurology - June 16, 2018 Category: Neurology Source Type: research

Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis
Publication date: Available online 7 June 2018 Source:The Lancet Neurology Author(s): Sara Mazzucco, Linxin Li, Lucy Binney, Peter M Rothwell Background Percutaneous closure of patent foramen ovale (PFO) has been shown to be superior to medical treatment alone for prevention of recurrent stroke after cryptogenic transient ischaemic attack or non-disabling stroke in patients aged 60 years or younger. The justification for trials in older patients with transient ischaemic attack or stroke depends on whether PFO is shown to be associated with cryptogenic events at older ages, for which existing evidence is conflicting, and o...
Source: The Lancet Neurology - June 8, 2018 Category: Neurology Source Type: research

Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial
This report presents a secondary analysis, and follow-up is complete. Findings Between May, 2001, and October, 2008, 1713 patients were enrolled and randomly allocated treatment (855 were assigned stenting and 858 endarterectomy), of whom 1530 individuals were followed up with ultrasound (737 assigned stenting and 793 endarterectomy) for a median of 4·0 years (IQR 2·3–5·0). At least moderate restenosis (≥50%) occurred in 274 patients after stenting (cumulative 5-year risk 40·7%) and in 217 after endarterectomy (29·6%; unadjusted hazard ratio [HR] 1·43, 95% CI 1·21–1·72; p&lt;0·0001). Patients with at lea...
Source: The Lancet Neurology - June 1, 2018 Category: Neurology Source Type: research

Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial
Publication date: June 2018 Source:The Lancet Neurology, Volume 17, Issue 6 Author(s): Bum Joon Kim, Eun-Jae Lee, Sun U Kwon, Jong-Ho Park, Yong-Jae Kim, Keun-Sik Hong, Lawrence K S Wong, Sungwook Yu, Yang-Ha Hwang, Ji Sung Lee, Juneyoung Lee, Joung-Ho Rha, Sung Hyuk Heo, Sung Hwan Ahn, Woo-Keun Seo, Jong-Moo Park, Ju-Hun Lee, Jee-Hyun Kwon, Sung-Il Sohn, Jin-Man Jung, Jose C Navarro, Dong-Wha Kang Background The optimal treatment for patients with ischaemic stroke with a high risk of cerebral haemorrhage is unclear. We assessed the efficacy and safety of cilostazol versus aspirin, with and without probucol, in these pati...
Source: The Lancet Neurology - May 17, 2018 Category: Neurology Source Type: research

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study
This study is registered with ClinicalTrials.gov, number NCT02513316. Findings Between Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0...
Source: The Lancet Neurology - May 16, 2018 Category: Neurology Source Type: research

Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study
Publication date: February 2018 Source:The Lancet Neurology, Volume 17, Issue 2 Author(s): Marian Galovic, Nico Döhler, Barbara Erdélyi-Canavese, Ansgar Felbecker, Philip Siebel, Julian Conrad, Stefan Evers, Michael Winklehner, Tim J von Oertzen, Hans-Peter Haring, Anna Serafini, Giorgia Gregoraci, Mariarosaria Valente, Francesco Janes, Gian Luigi Gigli, Mark R Keezer, John S Duncan, Josemir W Sander, Matthias J Koepp, Barbara Tettenborn Background Stroke is one of the leading causes of acquired epilepsy in adults. An instrument to predict whether people are at high risk of developing post-stroke seizures is not availab...
Source: The Lancet Neurology - January 18, 2018 Category: Neurology Source Type: research

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data
Publication date: January 2018 Source:The Lancet Neurology, Volume 17, Issue 1 Author(s): Bruce C V Campbell, Wim H van Zwam, Mayank Goyal, Bijoy K Menon, Diederik W J Dippel, Andrew M Demchuk, Serge Bracard, Philip White, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Gary A Ford, Natalia Pérez de la Ossa, Michael Kelly, Romain Bourcier, Geoffrey A Donnan, Yvo B W E M Roos, Oh Young Bang, Raul G Nogueira, Thomas G Devlin, Lucie A van den Berg, Frédéric Clarençon, Paul Burns, Jeffrey Carpenter, Olvert A Berkhemer, Dileep R Yavagal, Vitor Mendes Pereira, Xavier Ducrocq, Anand Dixit, Helena Quesada, Jonathan E...
Source: The Lancet Neurology - December 16, 2017 Category: Neurology Source Type: research

Prediction of motor recovery after stroke: advances in biomarkers
Publication date: October 2017 Source:The Lancet Neurology, Volume 16, Issue 10 Author(s): Cathy M Stinear Stroke remains a leading cause of adult disability, and the recovery of motor function after stroke is crucial for the patient to regain independence. However, making accurate predictions of a patient's motor recovery and outcome is difficult when based on clinical assessment alone. Clinical assessment of motor impairment within a few days of stroke can help to predict subsequent recovery, while neurophysiological and neuroimaging biomarkers of corticomotor structure and function can help to predict both motor recove...
Source: The Lancet Neurology - September 13, 2017 Category: Neurology Source Type: research

B vitamins in stroke prevention: time to reconsider
Publication date: September 2017 Source:The Lancet Neurology, Volume 16, Issue 9 Author(s): J David Spence, Qilong Yi, Graeme J Hankey B vitamin therapy lowers plasma total homocysteine concentrations, and might be a beneficial intervention for stroke prevention; however, cyanocobalamin (a form of vitamin B12) can accelerate decline in renal function and increase the risk of cardiovascular events in patients with impaired renal function. Although early trials did not show benefit in reduction of stroke, these results might have been due to harm in participants with impaired renal function. In patients with diabetic nephro...
Source: The Lancet Neurology - August 9, 2017 Category: Neurology Source Type: research

Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial
This study is registered with ClinicalTrials.gov, number NCT01949948. Findings Between Sept 1, 2012, and Sept 30, 2016, 1107 patients met the inclusion criteria and seven patients were excluded because informed consent was withdrawn or eligibility for thrombolytic treatment was reconsidered. 1100 patients were randomly assigned to the tenecteplase (n=549) or alteplase (n=551) groups. The median age of participants was 77 years (IQR 64–79) and the median National Institutes of Health Stroke Scale score at baseline was 4 points (IQR 2–8). A final diagnosis other than ischaemic stroke or transient ischaemic attack was fou...
Source: The Lancet Neurology - August 3, 2017 Category: Neurology Source Type: research

Increasing value and reducing waste in stroke research
Publication date: May 2017 Source:The Lancet Neurology, Volume 16, Issue 5 Author(s): Eivind Berge, Rustam Al-Shahi Salman, H Bart van der Worp, Christian Stapf, Peter Sandercock, Nikola Sprigg, Malcolm R Macleod, Peter J Kelly, Paul J Nederkoorn, Gary A Ford Stroke is a major burden to patients and society, and resources spent on stroke research must be used efficiently and produce good value in terms of improvements in human health. However, many instances of poor value from stroke research funding have resulted from the way in which stroke research topics have been chosen and how studies have been designed, conducted, ...
Source: The Lancet Neurology - April 12, 2017 Category: Neurology Source Type: research

Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial
This study is registered with ClinicalTrials.gov, number NCT01436487. Findings The study was done between Oct 24, 2011, and Dec 7, 2015. After safety assessments in eight patients in group 1, 129 patients were randomly assigned (67 to receive multipotent adult progenitor cells and 62 to receive placebo) in groups 2 and 3 (1200 million cells). The ITT populations consisted of 65 patients who received multipotent adult progenitor cells and 61 patients who received placebo. There were no dose-limiting toxicity events in either group. There were no infusional or allergic reactions and no difference in treatment-emergent advers...
Source: The Lancet Neurology - March 18, 2017 Category: Neurology Source Type: research