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Multi‐modal CT in acute stroke: wait for a serum creatinine before giving intravenous contrast? No!
ConclusionsThe incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90‐day mRS outcomes. Renal profiling and waiting for a baseline serum‐creatinine are an unnecessary delay to emergency reperfusion treatment.
Source: International Journal of Stroke - August 26, 2015 Category: Neurology Authors: Timothy E. Ang, Andrew Bivard, Christopher Levi, Henry Ma, Chung Y. Hsu, Bruce Campbell, Geoffrey Donnan, Stephen M. Davis, Mark Parsons Tags: Research Source Type: research

Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015
The 2015 update of the Canadian Stroke Best Practice Recommendations Hyperacute Stroke Care guideline highlights key elements involved in the initial assessment, stabilization, and treatment of patients with transient ischemic attack (TIA), ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and acute venous sinus thrombosis. The most notable change in this 5th edition is the addition of new recommendations for the use of endovascular therapy for patients with acute ischemic stroke and proximal intracranial arterial occlusion. This includes an overview of the infrastructure and resources required ...
Source: International Journal of Stroke - July 6, 2015 Category: Neurology Authors: Leanne K. Casaubon, Jean‐Martin Boulanger, Dylan Blacquiere, Scott Boucher, Kyla Brown, Tom Goddard, Jacqueline Gordon, Myles Horton, Jeffrey Lalonde, Christian LaRivière, Pascale Lavoie, Paul Leslie, Jeanne McNeill, Bijoy K. Menon, Brian Moses, Melani Tags: Guidelines Source Type: research

Acute nephropathy after contrast agent administration for computed tomography perfusion and computed tomography angiography in patients with acute ischemic stroke
Source: International Journal of Stroke - May 14, 2015 Category: Neurology Authors: Merel J. A. Luitse, Meenakshi Dauwan, Tom Seeters, Alexander D. Horsch, Joris M. Niesten, L. Jaap Kappelle, Geert Jan Biessels, Birgitta K. Velthuis, Tags: Letter to the editor Source Type: research

National Institutes of Health Stroke Scale score is an unreliable predictor of perfusion deficits in acute stroke
ConclusionsAlthough higher National Institutes of Health Stroke Scale scores are predictive of perfusion deficits, many patients with no clinically detectable signs have persisting cerebral blood flow changes. A National Institutes of Health Stroke Scale score threshold should therefore not be used to select patients for perfusion‐weighted magnetic resonance imaging. Perfusion‐weighted magnetic resonance imaging should be considered in all patients presenting with acute focal neurological deficits, even if these deficits are transient.
Source: International Journal of Stroke - April 6, 2015 Category: Neurology Authors: Victor Choi, Mahesh Kate, Jayme C. Kosior, Brian Buck, Trevor Steve, Rebecca McCourt, Thomas Jeerakathil, Ashfaq Shuaib, Derek Emery, Ken Butcher Tags: Research Source Type: research

International survey of acute Stroke imaging used to make revascularization treatment decisions
ConclusionThere were significant variations among sites and geographical areas in terms of stroke imaging work‐up used tomake decisions both for intravenous and endovascular revascularization. Clinical trials using advanced imaging as a selection tool for acute revascularization therapy should address the need for additional resources and technical support, and take into consideration the lack of routine use of such techniques in trial planning.
Source: International Journal of Stroke - April 1, 2015 Category: Neurology Authors: Max Wintermark, Marie Luby, Natan M. Bornstein, Andrew Demchuk, Jens Fiehler, Kohsuke Kudo, Kennedy R. Lees, David S. Liebeskind, Patrik Michel, Raul G. Nogueira, Mark W. Parsons, Makoto Sasaki, Joanna M. Wardlaw, Ona Wu, Weiwei Zhang, Guangming Zhu, Stev Tags: Research Source Type: research

Symptomatic intracranial hemorrhage in the ALIAS Multicenter Trial: relationship to endovascular thrombolytic therapy
ConclusionsEndovascular thrombolysis was the major factor predisposing to symptomatic intracranial hemorrhage, and albumin contributed to this predisposition. The latter may be mediated by albumin's influence on platelet aggregation or collateral perfusion.
Source: International Journal of Stroke - March 22, 2015 Category: Neurology Authors: Myron D. Ginsberg, Michael D. Hill Tags: Research Source Type: research

Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke
RationaleEarly reperfusion in patients experiencing acute ischemic stroke is critical, especially for patients with large vessel occlusion who have poor prognosis without revascularization. Solitaire™ stent retriever devices have been shown to immediately restore vascular perfusion safely, rapidly, and effectively in acute ischemic stroke patients with large vessel occlusions. AimThe aim of the study was to demonstrate that, among patients with large vessel, anterior circulation occlusion who have received intravenous tissue plasminogen activator, treatment with Solitaire revascularization devices reduces degree of disab...
Source: International Journal of Stroke - March 16, 2015 Category: Neurology Authors: Jeffrey L. Saver, Mayank Goyal, Alain Bonafe, Hans‐Christoph Diener, Elad I. Levy, Vitor M. Pereira, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Olav Jansen, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqu Tags: Protocols Source Type: research

Factors affecting clinical outcome in large‐vessel occlusive ischemic strokes
Clinical outcome after large‐vessel occlusive strokes depends on admitting clinical condition, successful recanalization, and robust collateral circulation. However, predicting successful recanalization and quantifying collateral status in the acute setting remain elusive. Successful recanalization has many predictive factors. Strong evidence supports increasing clot length being associated with poor recanalization. Current imaging techniques completed in the acute setting suggest that clot length can be estimated with a clot burden score. In vitro evidence suggests that clots with more red blood cells and less thrombin ...
Source: International Journal of Stroke - December 3, 2014 Category: Neurology Authors: Michelle P. Lin, Georgios Tsivgoulis, Andrei V. Alexandrov, Jason J. Chang Tags: Review Source Type: research

Imaging selection in ischemic stroke: Feasibility of automated CT‐perfusion analysis
ConclusionsAutomated CTP‐based mismatch selection is rapid, robust in clinical practice, and associated with faster treatment decisions than MRI. This technological advance has the potential to improve the standardization and reproducibility of interpretation of advanced imaging and extend use to practice settings beyond highly specialized academic centers.
Source: International Journal of Stroke - October 16, 2014 Category: Neurology Authors: Bruce C.V. Campbell, Nawaf Yassi, Henry Ma, Gagan Sharma, Simon Salinas, Leonid Churilov, Atte Meretoja, Mark W. Parsons, Patricia M. Desmond, Maarten G. Lansberg, Geoffrey A. Donnan, Stephen M. Davis Tags: Research Source Type: research

Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging
ConclusionsIn conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.
Source: International Journal of Stroke - July 15, 2014 Category: Neurology Authors: Craig A. Robertson, Christopher McCabe, M. Rosario Lopez‐Gonzalez, Graeme A. Deuchar, Krishna Dani, William M. Holmes, Keith W. Muir, Celestine Santosh, I. Mhairi Macrae Tags: Research Source Type: research

Acute imaging does not improve ASTRAL score's accuracy despite having a prognostic value
ConclusionsThe addition of information derived from multimodal imaging does not increase ASTRAL score's accuracy to predict functional outcome despite having an independent prognostic value. More selected radiological parameters applied in specific subgroups of stroke patients may add prognostic value of multimodal imaging.
Source: International Journal of Stroke - June 1, 2014 Category: Neurology Authors: George Ntaios, Vasileios Papavasileiou, Mohamed Faouzi, Peter Vanacker, Max Wintermark, Patrik Michel Tags: Research Source Type: research

Salvage of the PWI/DWI mismatch up to 48 h from stroke onset leads to favorable clinical outcome
ConclusionUsing coregistered perfusion/diffusion‐weighted image criteria, mismatch persists up to 48 h post stroke. For the whole group, the proportion of mismatch salvage remains independent of time and, although the effect is small, its salvage is independently associated with improved clinical outcomes at three‐months. Larger sample sizes are needed to determine the time limit for mismatch salvage.
Source: International Journal of Stroke - February 1, 2014 Category: Neurology Authors: H. Ma, P. Wright, L. Allport, T. G. Phan, L. Churilov, J. Ly, J. A. Zavala, S. Arakawa, B. Campbell, S. M Davis, G. A. Donnan Tags: Research Source Type: research

Patients with single distal MCA perfusion lesions have a high rate of good outcome with or without reperfusion
ConclusionsThe overall high rate of good outcomes in patients with distal MCA perfusion lesions might obscure a potential benefit from reperfusion in this population. A larger pooled analysis evaluating the effect of reperfusion in patients with distal MCA branch occlusions is warranted as confirmation of our results could have implications for the design of future stroke trials.
Source: International Journal of Stroke - December 23, 2013 Category: Neurology Authors: Robin Lemmens, Søren Christensen, Matus Straka, Deidre A. De Silva, Michael Mlynash, Bruce C. V. Campbell, Roland Bammer, Jean‐Marc Olivot, Patricia Desmond, Michael P. Marks, Stephen M. Davis, Geoffrey A. Donnan, Gregory W. Albers, Maarten G. Lansberg Tags: Research Source Type: research

Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry
There are limited data on the utilization of diagnostics and the variation of treatments at the national level in acute stroke care. Clinical Research Center for Stroke – 5th division stroke registry aimed to describe stroke statistics and quality of care in Korea and to implement quality indicators. Clinical Research Center for Stroke – 5th division registry was established in April 2008 and covers pretreatment demographics, medical and stroke severity measures, diagnostic evaluation, hyperacute revascularization, in‐hospital management, discharge disposition, quality indicators, and long‐term functional outcomes....
Source: International Journal of Stroke - November 21, 2013 Category: Neurology Authors: Beom Joon Kim, Moon‐Ku Han, Tai Hwan Park, Sang‐Soon Park, Kyung Bok Lee, Byung‐Chul Lee, Kyung‐Ho Yu, Jae Kwan Cha, Dae‐Hyun Kim, Jun Lee, Soo Joo Lee, Youngchai Ko, Jong‐Moo Park, Kyusik Kang, Yong‐Jin Cho, Keun‐Sik Hong, Ki‐Hyun Cho, Tags: Panorama Source Type: research

A score based on age and DWI volume predicts poor outcome following endovascular treatment for acute ischemic stroke
ConclusionsThe Stanford Age and Diffusion‐Weighted Imaging and Houston Intra‐Arterial Therapy scores can be used to predict poor functional outcome following endovascular therapy with good accuracy. However, these scores do not predict the clinical response to reperfusion. This limits their utility as tools to select patients for acute stroke interventions.
Source: International Journal of Stroke - November 10, 2013 Category: Neurology Authors: John T. P. Liggins, Albert J. Yoo, Nishant K. Mishra, Hayley M. Wheeler, Matus Straka, Thabele M. Leslie‐Mazwi, Zeshan A. Chaudhry, Stephanie Kemp, Michael Mlynash, Roland Bammer, Gregory W. Albers, Maarten G. Lansberg, Tags: Research Source Type: research

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