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Source: JAMA
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Total 276 results found since Jan 2013.
Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients With Symptomatic Intracranial Stenosis The VISSIT Randomized Clinical Trial
Conclusions and RelevanceAmong patients with symptomatic intracranial arterial stenosis, the use of a balloon-expandable stent compared with medical therapy resulted in an increased 12-month risk of added stroke or TIA in the same territory, and increased 30-day risk of any stroke or TIA. These findings do not support the use of a balloon-expandable stent for patients with symptomatic intracranial arterial stenosis.Trial Registrationclinicaltrials.gov Identifier: NCT00816166.
Source: JAMA - March 24, 2015 Category: Journals (General) Source Type: research
Stroke and Cognitive Decline
Stroke and cognitive impairment are common among older persons. It is estimated that the lifetime risk for stroke is approximately 1 in 5 for women and 1 in 6 for men, and almost one-third of persons with stroke, which typically may involve motor, sensory, or other deficits, may have a significant degree of cognitive impairment within several months of the event. Furthermore, silent strokes are more common than clinically manifest stroke events but pose significant danger because they are harbingers of both future stroke and cognitive dysfunction. It is estimated that as many as 1 in 10 adults experience a silent stroke by...
Source: JAMA - July 7, 2015 Category: Journals (General) Source Type: research
Early vs Standard Approach to Tracheostomy and Functional Outcome After Severe Stroke
To the Editor In the subgroup analysis of the recently published Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial 2 (SETPOINT2), the enrolled patients were divided into 3 subgroups according to their pathology diagnosis: acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. However, the type of stroke is not necessarily related to the need for tracheostomy. We believe it would be helpful to classify these patients based on the location of brain infarction, including distinct categories for brainstem or cerebellar stroke. The purpose of tracheostomy in...
Source: JAMA - September 13, 2022 Category: General Medicine Source Type: research
Time Since Stroke and Risk of Adverse Outcomes After Surgery
To the Editor Dr Jørgensen and colleagues reported an increased risk of recurrent stroke within 30 days after surgery in patients with previous stroke compared with those without previous stroke and that the risk was higher the closer to the incident stroke that the surgery was performed. However, this study cannot be interpreted as showing that the risks of surgery are greater if performed closer to the incident stroke because it lacks a crucial control group with recent stroke who did not undergo surgery.
Source: JAMA - November 8, 2014 Category: Journals (General) Source Type: research
Remote Ischemic Conditioning —Feasible and Potentially Beneficial for Ischemic Stroke
Stroke is the second leading cause of death and disability in the world. In 1996, tissue plasminogen activator (tPA) was approved by the US Food and Drug Administration and remains the only approved pharmacologic agent for treatment of ischemic stroke in the US. In 2015, mechanical thrombectomy was shown to be beneficial for large vessel occlusion ischemic stroke, although 50% of patients treated with mechanical thrombectomy remain disabled at 3 months. Due to short time windows for thrombolytic therapy administration and the stroke system infrastructure needed for mechanical thrombectomy, these reperfusion therapies are a...
Source: JAMA - August 16, 2022 Category: General Medicine Source Type: research
Endovascular Thrombectomy for Ischemic Stroke
In 2015, the publication of 5 clinical trials established the efficacy of endovascular thrombectomy for reducing disability from large artery ischemic stroke, with each trial demonstrating the same superiority of thrombectomy compared with standard care. Endovascular stroke therapy —most recently with the use of stent retrievers to rapidly recanalize the artery during stent deployment and complete the thrombectomy by withdrawing the stent that had engaged the clot during stent deployment—had been practiced prior to that time, despite uncertainty about its uses and benefits . After nearly 2 decades since intravenous tis...
Source: JAMA - September 27, 2016 Category: Journals (General) Source Type: research
Intravenous Alteplase for Mild Nondisabling Acute Ischemic Stroke
Treatment of patients with stroke has changed substantially during the past 25 years. In 1995, the NINDS rt-PA trial showed among selected patients with acute ischemic stroke who were treated with intravenous alteplase within 3 hours of known stroke onset or last known well time had reduced disability at 3 months. In 2008, the ECASS III trial demonstrated benefit of intravenous alteplase among selected patients treated up to 4.5 hours after known stroke onset or last known well time. Benefit from alteplase treatment occurred despite higher rates of symptomatic intracranial hemorrhage compared with placebo (6.4% vs 0.6% in ...
Source: JAMA - July 10, 2018 Category: General Medicine Source Type: research
Matched-Sibling Stem Cell Transplantation and Stroke in Children With SCA
Stroke is one of the most devastating complications of sickle cell anemia (SCA), and risk of stroke starts very early in life. Before screening techniques were available, 11% of children with homozygous SCA had ischemic stroke by their 20th birthday. Although most children with SCA will have neurologic recovery after stroke, approximately one-third will have long-term neurologic sequelae, including motor impairment. Moreover, children with SCA who have had a stroke often have neurocognitive impairment and difficulties with academic performance.
Source: JAMA - January 22, 2019 Category: General Medicine Source Type: research
Door-to-Needle Time and Long-term Outcomes in Patients With Stroke —Reply
In Reply Although factors other than faster door-to-needle times may have contributed to the associations between door-to-needle times and 1-year mortality and readmission in our study, there are multiple lines of evidence to suggest that door-to-needle times contributed to improved clinical outcomes and were not just an index for generic stroke care quality. The hospitals providing data for our study were participating in Get With The Guidelines (GWTG) –Stroke, a national quality improvement initiative. Prior studies have analyzed conformity of GWTG-Stroke hospitals with standard stroke care measures, including 7 perfor...
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research
Time Since Stroke and Risk of Adverse Outcomes After Surgery—Reply
In Reply Dr Powers asks whether surgery actually increased the risk of recurrent stroke or whether recurrent stroke would have occurred at comparable rates among patients not undergoing surgery. As highlighted by Powers, the natural course of stroke includes a time-dependent decline in risk of recurrent stroke also among patients not undergoing surgery.
Source: JAMA - November 8, 2014 Category: Journals (General) Source Type: research
Neuroprotective Agent Given Soon After Stroke Shows No Benefit
Although more than 70 neuroprotective agents have failed to show unequivocal benefit in patients with acute ischemic stroke, none of those tested to date were delivered in the hyperacute phase of stroke. However, according to results from the recent Field Administration of Stroke Therapy–Magnesium (FAST-MAG) phase 3 clinical trial, administration of magnesium sulfate to patients with suspected stroke within 2 hours of symptom onset similarly failed to improve functional outcomes (Saver JL et al. N Engl J Med. 2015;372[6]:528-536).
Source: JAMA - March 24, 2015 Category: Journals (General) Source Type: research
Is Patent Foramen Ovale a Risk Factor for Perioperative Stroke?
Perioperative stroke is one of the most feared complications of any surgery or invasive medical procedure. Perioperative stroke occurs in less than 1% of patients undergoing general surgery, but the risk is several fold higher with cardiac surgery, carotid revascularization, other cerebrovascular procedures, and thoracic aortic repair. Given the volume of these interventions, perioperative and periprocedural stroke likely account for at least 5% of the approximately 800 000 strokes that occur each year in the United States, yet stroke in this setting remains understudied.
Source: JAMA - February 6, 2018 Category: General Medicine Source Type: research
Transportation to Thrombectomy-Capable Center vs Local Stroke Center and Neurological Outcomes of Stroke
This randomized trial assesses the effect of transportation to a local stroke center vs directly to a thrombectomy-capable referral center on 90-day disability among patients with acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy.
Source: JAMA - May 10, 2022 Category: General Medicine Source Type: research
Intervention for Acute Stroke
In Reply In our recent article, we reviewed major thrombolytic stroke trials and a pooled meta-analysis that confirmed favorable clinical outcome at 3 months if intravenous recombinant tissue plasminogen activator (rtPA) was provided between 3 and 4.5 hours of symptom onset. However, because the majority of patients were contributed by a single European trial, the European Cooperative Acute Stroke Study (ECASS-3), we were careful to state that “… in the 3- to 4.5-hour window, rtPA is recommended for patients with moderately severe symptoms younger than 80 years and without contraindications in some guidelines for stroke management.”
Source: JAMA - August 11, 2015 Category: Journals (General) Source Type: research
Task-Oriented Rehabilitation Program for Stroke
In Reply Ms Peters and Dr Page raise several important and timely issues confronting the clinical rehabilitation community. Approximately 30% of stroke survivors receive outpatient rehabilitation, far fewer than those who report residual disability 6 months after stroke and less than expected if clinical practice guideline recommendations were followed. Although considerable resources are devoted to stroke rehabilitation and aftercare, few rigorous phase 3 randomized clinical trials have been reported; therefore, it is relatively uncharted territory. A recent Cochrane overview of interventions for improving upper limb func...
Source: JAMA - July 5, 2016 Category: Journals (General) Source Type: research
