Query: stroke

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Source: JAMA Neurology
Condition: Ischemic Stroke

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Total 129 results found since Jan 2013.

Blood Pressure Thresholds in Endovascular Therapy for Acute Ischemic Stroke
This cohort study investigates whether procedural blood pressure parameters, including specific blood pressure thresholds, are associated with neurological outcomes after endovascular therapy.
Source: JAMA Neurology - January 27, 2020 Category: Neurology Source Type: research

Horizontal and Vertical Boundaries of Hemineglect
This case report describes a 65-year-old woman with a right-hemispheric ischemic stroke in the territory of the middle cerebral artery along with left-sided hemiparesis with dysarthria and left-sided visual hemineglect.
Source: JAMA Neurology - January 27, 2020 Category: Neurology Source Type: research

Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy
Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS). With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiab...
Source: JAMA Neurology - December 9, 2019 Category: Neurology Source Type: research

Association of Endovascular Treatment With Ischemic Stroke and Clinical Outcome in Pediatric Patients
This cohort study examines the use of endovascular recanalization in pediatric patients with arterial ischemic stroke and clinical outcomes.
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Endovascular Therapy for Childhood Stroke —Working Together to Reach Prime Time
The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset. The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disabili...
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Association Between Low-Dose Rivaroxaban With or Without Aspirin and Ischemic Stroke Subtypes
This secondary analysis of a multinational randomized clinical trial of 27  395 participants with systemic atherosclerotic disease examines the association low-dose rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone and the risk of different ischemic stroke subtypes.
Source: JAMA Neurology - September 16, 2019 Category: Neurology Source Type: research

Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack
This pooled analysis combines data from 2 randomized clinical trials to estimate the efficacy and risk of dual antiplatelet therapy after minor ischemic stroke or transient ischemic attack.
Source: JAMA Neurology - August 19, 2019 Category: Neurology Source Type: research

Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
This cohort assesses the clinical effectiveness of direct oral anticoagulants vs warfarin for stroke prevention in patients with atrial fibrillation.
Source: JAMA Neurology - July 22, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Quality Improvement Intervention for Hospital Adherence to Therapies for Patients With Stroke
This cluster randomized clinical trial assesses the effect of a multifaceted quality improvement intervention compared with routine care on adherence to evidence-based therapy among patients with acute ischemic stroke and transient ischemic attack.
Source: JAMA Neurology - May 6, 2019 Category: Neurology Source Type: research

Endovascular Thrombectomy as a Means to Improve Survival in Acute Ischemic Stroke
This meta-analysis examines 90-day mortality and 90-day intracranial hemorrhage reported in trials of endovascular thrombectomy vs medical therapy cited in the 2018 American Stroke Association/American Heart Association guidelines for acute ischemic stroke.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke
This validation study describes the development of a prognostic model to predict swallowing recovery and guide the decision for enteral tube feeding in people with dysphagia after ischemic stroke.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

ABCB1 Polymorphisms and Outcomes of Clopidogrel Treatment for Minor Stroke or Transient Ischemic Attack
This secondary analysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) randomized clinical trial investigates the association ofABCB1 polymorphisms with efficacy of clopidogrel plus aspirin vs aspirin alone in patients with minor stroke or transient ischemic attack.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy
This meta-analysis of individual patient data from 7 randomized clinical trials analyzes the rate of reperfusion after endovascular thrombectomy started at different intervals after symptom onset in patients with acute ischemic stroke.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

Clinical Care and In-Hospital Outcomes of Asian American Patients With Acute Ischemic Stroke
This analysis compares the characteristics, care, and outcomes of Asian American and white patients with acute ischemic stroke at hospitals participating in the Get With The Guidelines –Stroke program.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

Follow-up Infarct Volume and Functional Outcome After Endovascular Therapy in Acute Ischemic Stroke
This pooled data analysis of 7 randomized clinical trials of thrombectomy for acute ischemic stroke examines whether follow-up infarct volume mediates the relationship between endovascular therapy and functional outcome in patients with acute ischemic stroke.
Source: JAMA Neurology - January 7, 2019 Category: Neurology Source Type: research

Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
This cohort study of 25  789 black and white individuals in the United States examines the incidence and risk factors for ischemic stroke by sex and race.
Source: JAMA Neurology - December 10, 2018 Category: Neurology Source Type: research

A Promising Skills-Based Intervention to Reduce Blood Pressure in Individuals With Stroke and Transient Ischemic Attack
Globally, stroke is the second leading cause of death and third leading cause of disability. More than 74% of the burden of stroke has been attributed to smoking, poor diet, and low physical activity, while more than 72% has been attributed to metabolic risk factors (high plasma glucose, high cholesterol, high blood pressure, overweight and obesity, and kidney disease). These are all risk factors that are modifiable with appropriate treatment or change in lifestyle behaviors.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Discharge Educational Strategies for Reduction of Vascular Risk in Stroke and Transient Ischemic Attack
This randomized clinical trial determines the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

A Promising Skills-Based Intervention to Reduce Blood Pressure in Individuals With Stroke and Transient Ischemic Attack
Globally, stroke is the second leading cause of death and third leading cause of disability. More than 74% of the burden of stroke has been attributed to smoking, poor diet, and low physical activity, while more than 72% has been attributed to metabolic risk factors (high plasma glucose, high cholesterol, high blood pressure, overweight and obesity, and kidney disease). These are all risk factors that are modifiable with appropriate treatment or change in lifestyle behaviors.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Discharge Educational Strategies for Reduction of Vascular Risk in Stroke and Transient Ischemic Attack
This randomized clinical trial determines the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke
This exploratory analysis of 1690 patients enrolled in the Field Administration of Stroke Therapy-Magnesium Trial assesses the frequency, predictors, and outcomes of the neurological deterioration that occurs among patients during the ultra-early period after ischemic stroke or intracranial hemorrhage.
Source: JAMA Neurology - July 23, 2018 Category: Neurology Source Type: research

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke
To the Editor Simonsen et al concluded that general anesthesia (GA) did not influence infarct growth compared with conscious sedation in endovascular-treated patients with acute stroke. This is an interesting study that addresses topical questions. However, we would like to point out some limitations.
Source: JAMA Neurology - July 16, 2018 Category: Neurology Source Type: research

Presentation After TIA and Minor Stroke in Relation to the UK FAST Public Education Campaign
This population-based study investigates the association of public education with improving delays and failure in seeking medical attention among consecutive patients with first transient ischemic attack or stroke.
Source: JAMA Neurology - July 2, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke
To the Editor In his Viewpoint, Kamel addresses some issues with the randomized clinical trials (RCTs) of patent foramen ovale (PFO) closure for preventing recurrent stroke and urges a judicious and evidence-based approach for patient selection. I would like to point out additional factors that further demonstrate need for extreme caution in selecting patients to undergo this procedure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke —Reply
In Reply Powers raises several important issues that I did not address in detail in my Viewpoint about managing patent foramen ovale in patients with ischemic stroke. These additional points further highlight that many patients who are fully informed about the available data will reasonably choose medical therapy rather than patent foramen ovale closure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Association of Sickle Cell Trait With Ischemic Stroke Among African Americans
This meta-analysis examines whether sickle cell trait is associated with a higher risk of incident ischemic stroke among African Americans.
Source: JAMA Neurology - April 23, 2018 Category: Neurology Source Type: research

Dual Antiplatelet Therapy in Transient Ischemic Attack and Minor Stroke
This imaging substudy of a randomized clinical trial investigates whether infarction patterns can be used to stratify the risk of recurrent stroke within 3 months of a transient ischemic attack or minor ischemic stroke.
Source: JAMA Neurology - March 26, 2018 Category: Neurology Source Type: research

Keeping Faith With Patients After Stroke or Transient Ischemic Attack
I recently recommended statin therapy to a 68-year-old patient, explaining that it would reduce his risk of a major coronary event or stroke in the next 10 years from 18% to 15%. He asked, “But how will we know if it works?” I confessed we never would because success would be an uneventful walk through good health. He was not sold.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Care Quality for Veterans With Transient Ischemic Attack and Stroke
This cohort study assesses the quality of guideline-recommended transient ischemic attack and minor stroke care across the Veterans Health Administration system nationwide.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Medical Specialties and Thrombectomy for Patients With Acute Ischemic Stroke
This cross-sectional analysis of Medicare data determined the specialty of physicians providing mechanical thrombectomy to patients with ischemic stroke.
Source: JAMA Neurology - January 25, 2018 Category: Neurology Source Type: research

Reperfusion and Brain Edema in Patients With Acute Ischemic Stroke
This study examines the association between reperfusion and brain edema in patients with acute ischemic stroke.
Source: JAMA Neurology - January 24, 2018 Category: Neurology Source Type: research

Effect of General Anesthesia and Conscious Sedation on Infarct Growth and Outcomes in Stroke
This randomized clinical trial analyzes the effect of general anesthesia and conscious sedation on infarct growth and clinical outcome of patients who underwent endovascular therapy for acute ischemic stroke.
Source: JAMA Neurology - January 16, 2018 Category: Neurology Source Type: research

Enoxaparin vs Aspirin in Patients With Cancer and Ischemic Stroke
This randomized clinical trial compares anticoagulation vs antiplatelet therapy in patients with cancer and acute ischemic stroke.
Source: JAMA Neurology - January 8, 2018 Category: Neurology Source Type: research

Thrombectomy for Acute Ischemic Stroke
In this issue ofJAMA Neurology, Nogueira et al report the results of a trial comparing aspiration-assisted stent retrieval with aspiration alone in patients with acute ischemic stroke. In a few years ’ time, mechanical thrombectomy has become a standard for treatment of acute ischemic stroke caused by proximal intracranial thromboembolic occlusions. This progress is amazing when one considers where we stood in 2013, with 3 neutral trials of intra-arterial treatment for stroke. The next 5 trial s that were published in quick succession in early 2015 and 2 later ones all indicated that early thrombectomy has a strong benef...
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Low-Dose vs Standard-Dose Alteplase for Patients With Acute Ischemic Stroke
This secondary analysis reports on the association of low-dose and standard-dose intravenous alteplase treatment with age, ethnicity (Asian vs non-Asian), and severity of acute ischemic stroke among patients in the ENCHANTED randomized clinical trial.
Source: JAMA Neurology - October 2, 2017 Category: Neurology Source Type: research

Stroke Imaging
In this issue ofJAMA Neurology, Boulouis et al report on the crucial influence of pretreatment collateral blood vessel status in determining the benefit of transfer for endovascular thrombectomy for large vessel acute ischemic stroke. All patients had relatively little evidence of irreversible injury on noncontrast computed tomography (CT) at their referring hospitals. However, when imaging was repeated at the comprehensive stroke center, a substantial proportion of patients had evolved large infarcts that caused them not to proceed to endovascular therapy or foreshadowed a poor outcome. These data contribute to the weight...
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

Which Patients With Ischemic Stroke and Insulin Resistance May Benefit From Pioglitazone?
The Insulin Resistance Intervention After Stroke (IRIS) trial has reported that treating insulin resistance with the peroxisome proliferator –activated receptor γ agonist pioglitazone hydrochloride reduced recurrent stroke or myocardial infarction (MI) by about one-fourth compared with placebo (pioglitazone, 9.0% vs placebo, 11.8%; hazard ratio [HR], 0.76; 95% CI, 0.62-0.93) in 3876 patients with recent (<6 months) ischemic stroke or transient ischemic attack and insulin resistance but without diabetes, heart failure, or bladder cancer. Pioglitazone was also associated with less incident diabetes vs placebo (3.8% vs ...
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research

Targeting Pioglitazone Therapy After Stroke or Transient Ischemic Attack
This secondary analysis of the Insulin Resistance Intervention After Stroke trial estimates the relative and absolute effectiveness of pioglitazone after ischemic stroke or transient ischemic attack in subgroups of patients defined by pretreatment risk for stroke or myocardial infarction.
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research

Anticoagulation Timing for Atrial Fibrillation in Acute Ischemic Stroke
Most stroke physicians will have been asked the best time to start anticoagulation for a patient with atrial fibrillation (AF) and acute ischemic stroke. There is no question that long-term anticoagulation with a direct oral anticoagulant or warfarin sodium reduces the risk of strokes in patients with AF, but the right time to start anticoagulation is uncertain.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Rivaroxaban vs Warfarin Sodium Early After AF-Related Mild Ischemic Stroke
This randomized clinical trial examines whether rivaroxaban or warfarin sodium is safer and more effective for preventing early recurrent stroke in patients with atrial fibrillation –related acute ischemic stroke.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Childhood Body Mass Index and First Adult Ischemic Stroke
This population-based cohort study of schoolchildren born from the 1930s through the 1980s in Denmark investigates whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and assesses whether the associations are age dependent or influenced by birth weight.
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research

Mechanical Thrombectomy in Acute Stroke —Reply
In Reply We read with interest the letter by Seners and colleagues regarding our recent publication. The possibility of early recanalization among patients with acute ischemic stroke and a proximal intracranial occlusion was underestimated in the recent trials on mechanical thrombectomy (MT) because vascular imaging was in part done after starting intravenous thrombolysis (IVT), particularly in the MR CLEAN trial. However, Seners et al observed higher recanalization rates for M1 and M2 occlusions at an early stage, but this was not the case for carotid occlusions. Additionally, they defined early recanalization as happenin...
Source: JAMA Neurology - July 10, 2017 Category: Neurology Source Type: research

Endovascular Thrombectomy for Acute Ischemic Stroke
This study compares the functional independence at 3 months between patients treated for acute ischemic stroke under the drip-and-ship paradigm and those treated on site (mothership paradigm).
Source: JAMA Neurology - March 20, 2017 Category: Neurology Source Type: research

Stroke Etiologic Classification —Moving From Prediction to Precision
It is a truism of vascular neurology that secondary prevention depends on the cause of an ischemic stroke. We revascularize those with extracranial carotid stenosis, we anticoagulate those with cardioembolic infarcts due to atrial fibrillation, and we treat with antibiotics those with infective endocarditis. Determining the etiologic subtype, or cause, of stroke is therefore rightly considered the main objective of the evaluation of the patient with stroke. Despite the central role of this evaluation, it is surprising that our ability to determine the cause of stroke in many cases is quite limited, and that the process of ...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Response to Endovascular Therapy for Acute Ischemic Stroke
To the Editor Recent data from randomized clinical trials provide clear evidence that endovascular treatment for acute ischemic stroke because of large vessel anterior circulation occlusion improves clinical outcomes for patients. These studies reported that most patients had an occlusion of the first segment (M1) of the middle cerebral artery and less than 10% in the M2 segment. The retrospective multicenter study conducted by Sarraj et al reports that endovascular treatment is safe and effective for an occlusion of the M2 segment. However, the literature reports different definitions for the M1 and M2 segments, which may...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research