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Selection of Patients for Thrombectomy in the Extended Time Window
Based on the protocols used in the DAWN (Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trials (RCTs) of thrombectomy in the extended window, current guidelines recommend thrombectomy either in the 6- to 16-hour window in patients with a target perfusion imaging mismatch profile or in the 6- to 24-hour window in patients with a clinical imaging mismatch profile. However, these criteria ...
Source: JAMA Neurology - July 26, 2021 Category: Neurology Source Type: research

Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion —Reply
In Reply We thank Ospel and colleagues for their thoughtful comments on our article showing that more proximal occlusion and greater thrombus length predict early neurological deterioration of ischemic origin (ENDi) in patients with acute minor ischemic stroke with large-vessel occlusion treated with intravenous thrombolysis, with implications regarding how to best manage these patients. Although the precise pathophysiological links between more proximal occlusion, a longer thrombus, and ENDi are uncertain, we fully agree that a leading hypothesis is in situ thrombus extension leading to secondary hemodynamic compromise vi...
Source: JAMA Neurology - July 6, 2021 Category: Neurology Source Type: research

Streamlining the Path to Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the associations of repeated imaging on arrival at an endovascular thrombectomy (EVT) –capable hospital with clinical outcomes after EVT. They studied an observational cohort of 2533 patients who had ischemic stroke with large vessel occlusion within 24 hours of stroke onset. It is well understood that a favorable outcome depends on the time from stroke onset to reperfusion, and th ere is no doubt that proceeding directly to the angiography suite (DTA) saves time compared with repeating imaging (median time, 26 minutes shorter in Sarraj et al). Direct transfer to th...
Source: JAMA Neurology - June 14, 2021 Category: Neurology Source Type: research

Assessment of Recurrent Stroke Risk in Patients With a Carotid Web
This cohort study assesses the recurrent stroke risk in a population of patients with a large vessel occlusion stroke of the anterior circulation and ipsilateral carotid web.
Source: JAMA Neurology - May 10, 2021 Category: Neurology Source Type: research

Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events
This analysis of pooled cohort data from 4 popluation-based cohort studies evaluates whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction.
Source: JAMA Neurology - May 3, 2021 Category: Neurology Source Type: research

Electronic Cigarette Use and Cigarette-Smoking Cessation Attempts Among Stroke Survivors in the US
This cross-sectional study estimates the prevalence of electronic cigarette use among actively smoking stroke survivors in the US and evaluates its association with at least 1 cigarette-smoking cessation attempt in the past year.
Source: JAMA Neurology - April 12, 2021 Category: Neurology Source Type: research

Risk of Hemorrhagic Stroke in Patients With Coronavirus Disease 2019 —Reply
In Reply We thank Dr Silverman and colleagues for their interest in our study and providing us the opportunity to expand on our results. Among the 1916 patients who visited the emergency department or were hospitalized with coronavirus disease 2019 (COVID-19) in our study, 8 patients (0.4% [95% CI, 0.2%-0.8%]) had hemorrhagic stroke, including 7 with intracerebral hemorrhage and 1 with subarachnoid hemorrhage. Among these 8 patients, 4 strokes were attributed to anticoagulant use.
Source: JAMA Neurology - March 8, 2021 Category: Neurology Source Type: research

Local Cerebral Recombinant Tissue Plasminogen Activator Concentrations During Acute Stroke
This study evaluates concentrations of local cerebral recombinant tissue plasminogen activator during mechanical thrombectomy treatment in acute stroke.
Source: JAMA Neurology - March 8, 2021 Category: Neurology Source Type: research

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity
This study describes differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.
Source: JAMA Neurology - March 1, 2021 Category: Neurology Source Type: research

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke
This case-control study analyzes the clinical, functional, and safety outcomes associated with endovascular therapy for patients with posterior circulation distal, medium vessel occlusion.
Source: JAMA Neurology - February 22, 2021 Category: Neurology Source Type: research

Prediction of Early Neurological Deterioration in Minor Stroke and LVO Intended for Intravenous Thrombolysis
This cohort study aims to develop and validate an easily applicable predictive score of early neurological deterioration of presumed ischemic origin following intravenous thrombolysis in patients with minor stroke and large vessel occlusion (LVO).
Source: JAMA Neurology - January 11, 2021 Category: Neurology Source Type: research

Prehospital Prediction of Large Anterior Vessel Occlusion
This cohort study performs external validations, head-to-head comparisons, and feasibility ratings of 7 scales used by emergency medical services in the field to predict symptomatic large anterior vessel occlusion among patients suspected of acute stroke.
Source: JAMA Neurology - November 30, 2020 Category: Neurology Source Type: research

Cerebral Microbleeds and Antithrombotic Treatments —Stop Worrying About Bleeding
Cerebral microbleeds (CMBs) are found in up to one-third of patients with ischemic stroke. Because of their hemorrhagic histopathological substrate, they have been historically associated with a risk of intracerebral hemorrhage (ICH). This has led to concerns about the safety of anticoagulation use in patients with CMBs even in the context of high risk of recurrent ischemic stroke, such as in atrial fibrillation. However, growing evidence suggests that CMBs are not only markers of bleeding propensity but also markers of future ischemic events. To further evaluate both types of risks, an assessment of the number and anatomi...
Source: JAMA Neurology - October 19, 2020 Category: Neurology Source Type: research

Remote Ischemic Perconditioning for the Treatment of Acute Ischemic Stroke
To the Editor We read with interest the article by Pico et al, who reported the results of a randomized clinical trial to determine whether remote ischemic perconditioning can reduce brain infarction volume growth in patients with acute ischemic stroke. In the study, treatment with remote ischemic perconditioning had no significant effect on brain infarction volume growth at 24 hours after symptom onset. Two main hypotheses were proposed for the neutral results: remote ischemic perconditioning may not have any beneficial effect, or this trial mainly recruited patients who had received reperfusion therapies. However, we con...
Source: JAMA Neurology - September 28, 2020 Category: Neurology Source Type: research

Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era
This cohort study uses a large US national registry to assess temporal trends from 2008 to 2018 in the use of intravenous and endovascular reperfusion therapies, process measures of quality, and association between functional outcomes and key patient characteristics, comorbidities, and treatments of in-hospital vs out-of-hospital stroke onset.
Source: JAMA Neurology - September 21, 2020 Category: Neurology Source Type: research

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