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Source: JAMA

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Total 276 results found since Jan 2013.

Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention —Reply
In Reply In their Letter about our recent study of patients with asymptomatic severe carotid stenosis, Dr Sterpetti and colleagues highlight the short life expectancy of the cohort and state that only 43 patients were alive at the end of the study. We would like to clarify that this number applies only to the small subgroup of patients who experienced an ipsilateral stroke and survived through the observation period. Overall mortality of the cohort was 51.4% during the study period. We agree with Sterpetti and colleagues that surgically and medically treated patients were likely not comparable; indeed, we specifically avoi...
Source: JAMA - September 27, 2022 Category: General Medicine Source Type: research

HIV, Subclinical Cardiovascular Disease, and Clinical Progression
People living with HIV have higher risks of cardiovascular disease (CVD) including myocardial infarction, heart failure, stroke, pulmonary hypertension, and sudden cardiac death than those without HIV. These excess CVD risks persist in the modern HIV treatment era and are not readily explained by demographic, environmental, or clinical confounding factors. Nor are these HIV-associated CVD risks explained by antiretroviral therapy (ART); the net cardiovascular and overall benefits of effective HIV treatment clearly outweigh the risks. Thus, refining HIV-specific contributors to CVD pathogenesis is critically important for i...
Source: JAMA - September 13, 2022 Category: General Medicine 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

Early vs Standard Approach to Tracheostomy and Functional Outcome After Severe Stroke —Reply
In Reply In response to the Letters about SETPOINT2, we agree with Mr Li and Dr Zhou that the location and extent of the brain lesion(s) may be more related to tracheostomy need and timing than the exact vascular pathophysiology. This was in part our rationale for combining the 3 major stroke subtypes in the study population, assuming that by randomization differences in lesion location would be similarly distributed, as was the case between treatment groups. The suggestion to perform a post hoc subgroup analysis according to brain lesion location is appropriate, and that analysis is underway.
Source: JAMA - September 13, 2022 Category: General Medicine 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

Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke
This randomized clinical trial compares the efficacy of remote ischemic conditioning as an adjunct to guideline-based treatment vs usual care for patients with acute moderate ischemic stroke.
Source: JAMA - August 16, 2022 Category: General Medicine Source Type: research

Therapeutic Strategies for Intracranial Atherosclerosis
Intracranial atherosclerosis (ICAS) is a major cause of stroke worldwide. Although approximately 12% of White patients with a history of acute ischemic stroke or transient ischemic attack (TIA) have some form of ICAS detected on routine screening in predominantly older adults, ICAS accounts for an estimated up to one-third of ischemic strokes in Black, Asian, and Hispanic populations at comparatively younger ages. The reasons for these differences are not clear, because risk factor profiles are broadly similar across racial and ethnic groups. ICAS presents diagnostic challenges, not just in differentiating this condition f...
Source: JAMA - August 9, 2022 Category: General Medicine Source Type: research

Effect of Stenting Plus Medical Therapy vs Medical Therapy Alone on Risk of Stroke and Death in Intracranial Stenosis
This randomized clinical trial compares the efficacy of percutaneous transluminal angioplasty and stenting plus medical therapy vs medical therapy alone in reducing the risk of stroke or death among patients with symptomatic severe intracranial atherosclerotic stenosis.
Source: JAMA - August 9, 2022 Category: General Medicine Source Type: research

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy for Acute Ischemic Stroke
This clinical trial examines whether intravenous tirofiban could improve disability severity without increasing symptomatic intracranial hemorrhage or mortality in patients with acute ischemic stroke and proximal large vessel occlusions undergoing endovascular treatment.
Source: JAMA - August 9, 2022 Category: General Medicine Source Type: research

Changes in Incidence of Stroke and Other Vascular Events at Younger vs Older Ages, 2002-2018
This study assesses time trends in incidence of stroke, transient ischemic attack, and other major vascular events at younger vs older ages in a population living in Oxfordshire, England, in 2002-2018.
Source: JAMA - August 9, 2022 Category: General Medicine Source Type: research

Echocardiographic Measures of Left Atrial Function and Size and Incident Dementia
To the Editor A recent study described a significant association between left atrial function and an increased risk of subsequent dementia, independent of the presence of atrial fibrillation. These findings are similar to our 2009 study, which examined subclinical left atrial dysfunction and risk of stroke in patients with patent foramen ovale (PFO). We found that impairment of reservoir, conduit, and contractile strain and impairment of emptying, passive emptying, and active emptying fraction was present in patients with multiple ischemic events, PFO, and atrial septal aneurysm compared with healthy individuals. After PFO...
Source: JAMA - July 19, 2022 Category: General Medicine Source Type: research

Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke
To the Editor We have some concerns about the recent CHOICE study that compared intra-arterial alteplase with placebo among patients with large vessel occlusion acute ischemic stroke after successful thrombectomy.
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research

The Concept of Transient Ischemic Attack
To the Editor A recent Viewpoint suggested that the concept of transient ischemic attack (TIA) should be retired. The authors proposed the term acute ischemic cerebrovascular syndrome in its place, stating that all focal ischemia in the brain can cause tissue damage. Although I appreciate the contributions of both authors for raising awareness of TIA being a medical emergency that warrants emergency evaluation due to the high risk of stroke in the early period after a TIA, I do not agree that the concept of TIA should be retired.
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research