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Prediction of Early Recurrence After Acute Ischemic Stroke
This study tests the validity of a prognostic score that was exclusively developed to predict early risk of recurrence in a multicenter setting.
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Recombinant Tissue Plasminogen Activator Stroke Therapy
The results of recently completed clinical trials of acute ischemic stroke that report a clear and unequivocal benefit of stent-retriever devices used with intravenous recombinant tissue plasminogen activator (rtPA) vs rtPA alone are the second revolutionary therapeutic breakthrough in acute stroke care in the last 50 years. This breakthrough makes the case for a new standard of care for the treatment of acute ischemic stroke. When we look back at the controversy surrounding interventional acute stroke therapies after multiple trials of interventional treatment, most notably International Management of Stroke III (IMS III)...
Source: JAMA Neurology - January 25, 2016 Category: Neurology Source Type: research

The High Risk of Low Distal Flow
Symptomatic atherosclerosis of the vertebral artery remains a challenging condition with no proven interventional therapy. Completed randomized trials of angioplasty with or without stenting involving patients with symptomatic vertebral artery stenosis include Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS), and Vertebral Artery Stenting Trial (VAST). As the largest (N = 115) completed trial, VAST illustrates many of the challenges of developing interventional therapy for this patient pop...
Source: JAMA Neurology - December 21, 2015 Category: Neurology Source Type: research

Effect of Hemodynamics on Stroke Risk
This longitudinal cohort study evaluates the risk for posterior circulation stroke in patients with symptomatic occlusive disease of the vertebrobasilar system.
Source: JAMA Neurology - December 21, 2015 Category: Neurology Source Type: research

Definition and Implications of the Preventable Stroke
This study tests whether most patients with acute stroke exhibited some degree of stroke preventability.
Source: JAMA Neurology - December 7, 2015 Category: Neurology Source Type: research

Telemedicine in Prehospital Stroke Evaluation and Thrombolysis
This observational study tested whether telemedicine is reliable and remote physician presence adequate for acute stroke treatment using a mobile stroke treatment unit.
Source: JAMA Neurology - December 7, 2015 Category: Neurology Source Type: research

Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke
This observational study using data from the Get With the Guidelines–Stroke registry investigates the risks and benefits associated with long-term antiplatelet therapy among adult patients with ischemic stroke who receive intravenous tissue plasminogen activator.
Source: JAMA Neurology - November 9, 2015 Category: Neurology Source Type: research

Selection Criteria for Stroke Patients Likely to Benefit From Thrombectomy
This cohort study of patients with anterior circulation ischemic stroke compared outcomes after thrombectomy of patients classified as likely vs unlikely to benefit from the procedure based on clinical criteria and MRI findings.
Source: JAMA Neurology - November 2, 2015 Category: Neurology Source Type: research

Thrombolysis-Related Hemorrhage
Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%. Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent...
Source: JAMA Neurology - October 26, 2015 Category: Neurology Source Type: research

Current Risks of Asymptomatic Carotid Stenosis
In the past 2 decades, 2 large multicenter trials have demonstrated the efficacy of carotid endarterectomy (CEA) for patients with asymptomatic carotid stenosis: the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). These trials found that CEA, compared with best medical therapy, was associated with a significant relative risk reduction of 50% during 5 years but only an absolute reduction in ipsilateral stroke of 0.5% to 1% per year. With the number needed to treat to prevent 1 stroke in 1 year approaching 100 to 200, whether this degree of stroke reduction is clinically s...
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

Risk of Stroke at the Time of Carotid Occlusion
This study of patients undergoing carotid ultrasonography reports that the risk of carotid occlusion is well below the risk of carotid stenting or endarterectomy and decreases markedly with more intensive medical therapy.
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

Genetic Variants Associated With Risk of Ischemic Stroke
This genome-wide association study identifies 2 novel genes, PDE4DIP and ACOT4, that are associated with an increased risk for ischemic stroke.
Source: JAMA Neurology - May 11, 2015 Category: Neurology Source Type: research

Care and Outcomes of Patients With In-Hospital Stroke
This prospective cohort study examines stroke care delivery and outcomes for patients with in-hospital vs community-onset stroke.
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Microbleeds, Mortality, and Stroke in Alzheimer Disease The MISTRAL Study
Conclusions and RelevanceIn patients with AD, the presence of nonlobar microbleeds was associated with an increased risk for cardiovascular events and cardiovascular mortality. Patients with lobar microbleeds had an increased risk for stroke and stroke-related mortality, indicating that these patients should be treated with the utmost care.
Source: JAMA Neurology - March 23, 2015 Category: Neurology Source Type: research

Novel Methods and Technologies for 21st-Century Clinical Trials A Review
Conclusions and RelevanceIncreased use of new tools and approaches in future clinical trials can enhance the design, improve the assessment, and engage participants in the evaluation of novel therapies for neurologic disorders.
Source: JAMA Neurology - March 2, 2015 Category: Neurology Source Type: research

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