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Total 186 results found since Jan 2013.
Comment HERMES: messenger for stroke interventional treatment
The treatment approach for acute ischaemic stroke is straightforward: restore blood flow as soon as possible and do it as safely and completely as possible. The overlong path to confirming this simple and intuitive treatment plan leads to the HERMES collaboration, the meta-analysis from Mayank Goyal and colleagues—including principal investigators from the selected trials—published in The Lancet, which combines individual patient data from five trials of endovascular mechanical thrombectomy published in 2015.
Source: LANCET - February 17, 2016 Category: Journals (General) Authors: Keith W Muir, Philip White Tags: Comment Source Type: research
Articles Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
Endovascular thrombectomy is of benefit to most patients with acute ischaemic stroke caused by occlusion of the proximal anterior circulation, irrespective of patient characteristics or geographical location. These findings will have global implications on structuring systems of care to provide timely treatment to patients with acute ischaemic stroke due to large vessel occlusion.
Source: LANCET - February 17, 2016 Category: Journals (General) Authors: Mayank Goyal, Bijoy K Menon, Wim H van Zwam, Diederik W J Dippel, Peter J Mitchell, Andrew M Demchuk, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Maria A de Miquel, Geoffrey A Donnan, Yvo B W E M Roos, Alain Bonafe, Reza Jahan, Hans-Christoph Tags: Articles Source Type: research
Perspectives Consciousness: wonder and fragility
It was a Monday morning when he had a stroke. By that evening he'd had his second and possibly third. Life since has been a blur. We've been waiting for him to regain consciousness, each of us struggling to define what that means. At first it was simple: dead or alive, a drama played out in numbers on a computer screen above his head. As the signs of life get more familiar though, the question of consciousness becomes more complicated. “Wiggle your fingers if you can hear me.” “Can you open your eyes?” Each longed-for benchmark discarded as soon as it arrives, hopes immediately pinned to the next.
Source: LANCET - February 13, 2016 Category: Journals (General) Authors: Dara Mohammadi Tags: Perspectives Source Type: research
Comment Age and carotid intervention outcomes
In The Lancet, the Carotid Stenting Trialists' Collaboration (CSTC) present a meta-analysis of the effect of increasing age on perioperative death or stroke related and late ipsilateral stroke in 4754 symptomatic patients randomised to carotid endarterectomy (CEA) or carotid artery stenting (CAS) in three European randomised controlled trials (RCTs; EVA-3S, SPACE, and ICSS) and one North American RCT (CREST).1 Key findings were that once the perioperative period (between randomisation and 120 days) passed, there was no difference in late ipsilateral stroke between CEA and CAS, irrespective of age, and that increasing age h...
Source: LANCET - February 11, 2016 Category: Journals (General) Authors: A Ross Naylor Tags: Comment Source Type: research
Articles Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials
In these RCTs, CEA was clearly superior to CAS in patients aged 70–74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure.
Source: LANCET - February 11, 2016 Category: Journals (General) Authors: George Howard, Gary S Roubin, Olav Jansen, Jeroen Hendrikse, Alison Halliday, Gustav Fraedrich, Hans-Henning Eckstein, David Calvet, Richard Bulbulia, Leo H Bonati, Jean-Pierre Becquemin, Ale Algra, Martin M Brown, Peter A Ringleb, Thomas G Brott, Jean-Lo Tags: Articles Source Type: research
Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke
The STROKE-INF trial (Nov 7, p1835)1 reported outcomes that were different from those initially included in the ISRCTN registry (number ISRCTN37118456). There were two pre-specified primary outcomes, of which one was reported in the Article, and the other (“total hospital costs”) was not reported anywhere in the paper. In addition, the Article reported a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) that was not pre-specified, without declaring it as such. Of the 14 pre-specified secondary outcomes, six were reported in the paper, and eight were unreported anywhere in the paper.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Ioan Milosevic, Aaron Dale, Henry Drysdale, Kamal Mahtani, COMPare project team Tags: Correspondence Source Type: research
Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke – Author's reply
Ioan Milosevic and colleagues pointed out that the outcomes presented in our Article1 were different from those in the ISRCTN registry (number ISRCTN37118456). They stated that one pre-specified primary outcome (“hospital costs”) was not reported, and a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) added. We have clarified in the Methods section that physician diagnosed pneumonia was not a primary outcome but was presented as an alternative to algorithm-based diagnosis to harmonise with diagnostic criteria used in previous studies.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Lalit Kalra Tags: Correspondence Source Type: research
Articles Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis
Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mm Hg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease.
Source: LANCET - December 23, 2015 Category: Journals (General) Authors: Dena Ettehad, Connor A Emdin, Amit Kiran, Simon G Anderson, Thomas Callender, Jonathan Emberson, John Chalmers, Anthony Rodgers, Kazem Rahimi Tags: Articles Source Type: research
Editorial Postacute stroke care: same standards as acute care?
The Sentinel Stroke National Audit Programme (SSNAP), led by the Royal College of Physicians, has released the first comprehensive audit into 604 of 756 postacute stroke care services throughout the UK. Although vast improvements have been achieved in acute stroke care in recent years, progress in postacute care for long-term rehabilitation has been left behind in comparison.
Source: LANCET - December 11, 2015 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Comment New option for primary stroke prevention in sickle cell anaemia
The results of the TWiTCH trial1 establish a new standard of care for primary stroke prevention in children with sickle cell anaemia and high transcranial doppler (TCD) flow velocities (≥200 cm/s). In this high-risk group, the incidence of strokes per year is about
Source: LANCET - December 6, 2015 Category: Journals (General) Authors: Michael R DeBaun, Fenella J Kirkham Tags: Comment Source Type: research
Articles Hydroxycarbamide versus chronic transfusion for maintenance of transcranial doppler flow velocities in children with sickle cell anaemia—TCD With Transfusions Changing to Hydroxyurea (TWiTCH): a multicentre, open-label, phase 3, non-inferiority trial
For high-risk children with sickle cell anaemia and abnormal TCD velocities who have received at least 1 year of transfusions, and have no MRA-defined severe vasculopathy, hydroxycarbamide treatment can substitute for chronic transfusions to maintain TCD velocities and help to prevent primary stroke.
Source: LANCET - December 6, 2015 Category: Journals (General) Authors: Russell E Ware, Barry R Davis, William H Schultz, R Clark Brown, Banu Aygun, Sharada Sarnaik, Isaac Odame, Beng Fuh, Alex George, William Owen, Lori Luchtman-Jones, Zora R Rogers, Lee Hilliard, Cynthia Gauger, Connie Piccone, Margaret T Lee, Janet L Kwiat Tags: Articles Source Type: research
World Report Profile: NIMHD—NIH's institute for minority health
For many Americans, health disparities are a fact of life—and death. Compared with white people, minorities are more likely to have and die from obesity, hypertension, heart attacks, cancer, stroke, and diabetes. On average, African-American people live 4 years less than do white people. The causes of these health disparities are a complex mixture of social and genetic factors, and they affect everything from the choices people make to how they interact with medical providers to how the system interacts with them.
Source: LANCET - November 6, 2015 Category: Journals (General) Authors: Carrie Arnold Tags: World Report Source Type: research
Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation
The Review by Freek Verheugt and colleagues (July 18, p 303)1 provides an excellent overview of non-vitamin K antagonist oral anticoagulants (NOACs) and stroke prevention in atrial fibrillation. However, we emphasise another factor that was omitted: survivors of intracranial haemorrhage who also have atrial fibrillation. Observational studies show up to 37% of patients with an intracerebral haemorrhage have concurrent atrial fibrillation,2 with absolute numbers of patients who have anticoagulant-related intracranial haemorrhage expected to increase because of the increased use of oral anticoagulation and an ageing population.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Duncan Wilson, Rustam Al-Shahi Salman, Catharina J M Klijn, Gregory Y H Lip, David J Werring Tags: Correspondence Source Type: research
Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation – Authors' reply
We thank Duncan Wilson and colleagues for their comments about our Review.1 These authors discuss an important issue and suggest that non-vitamin K antagonist oral anticoagulants might provide a strong option to reduce ischaemic stroke in patients who have atrial fibrillation and have suffered an intracranial haemorrhage. A fundamental advantage of non-vitamin K antagonist oral anticoagulants over warfarin is the substantially lower risk of intracranial haemorrhage,2 and this feature might be particularly important for patients at high risk of intracranial haemorrhage, including those with previous history of this disorder.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Freek W A Verheugt, Christopher B Granger Tags: Correspondence Source Type: research
