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Source: JAMA Neurology
Condition: Ischemic Stroke
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Total 201 results found since Jan 2013.
Prehospital Thrombolysis for Stroke An Idea Whose Golden Hour Has Arrived
Soon after thrombolytic therapy was established as a therapy for ischemic stroke, our colleague Anthony Furlan, MD, famously circulated a cartoon of a computed tomographic (CT) scanner visible through the back doors of an ambulance, where a happy stroke physician had hung a bottle dripping tissue plasminogen activator (tPA) into the scanned patient’s arm. Because the time interval from stroke onset to initiation of thrombolysis after ischemic stroke is inversely related to the probability of disability-free recovery, prehospital initiation of thrombolytic therapy seemed a compelling and logical ambition, if one could rul...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research
Associations Between Sex-Specific Risk Factors and Stroke
This systematic review and meta-analysis examines sex-specific risk factors for ischemic stroke, hemorrhagic stroke, any stroke, and stroke mortality.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research
Thrombectomy for Acute Ischemic Stroke
In this issue ofJAMA Neurology, Nogueira et al report the results of a trial comparing aspiration-assisted stent retrieval with aspiration alone in patients with acute ischemic stroke. In a few years ’ time, mechanical thrombectomy has become a standard for treatment of acute ischemic stroke caused by proximal intracranial thromboembolic occlusions. This progress is amazing when one considers where we stood in 2013, with 3 neutral trials of intra-arterial treatment for stroke. The next 5 trial s that were published in quick succession in early 2015 and 2 later ones all indicated that early thrombectomy has a strong benef...
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research
Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research
Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients With Suspected LVO Stroke
This preimplementation-postimplementation study evaluates the association of a regional prehospital transport policy for comprehensive stroke center triage for patients with suspected acute ischemic stroke and large vessel occlusion with rates of endovascular therapy.
Source: JAMA Neurology - August 9, 2021 Category: Neurology Source Type: research
Factors Associated With Neurological Outcome After Childhood Stroke
In Reply We thank Goh and Sivakumaran for their interest in and comments on our article, which was a retrospective study of blood pressure, blood glucose, and fever and their associations with outcome after arterial ischemic stroke (AIS) in children. Although we did not find a significant association between hypertension and neurological outcome or death at 3 months after stroke, we found that when carefully tracked, vital sign abnormalities were very common in the poststroke period. In our future directions section, we proposed a larger prospective study precisely because of the limitations of our study design and conflic...
Source: JAMA Neurology - August 22, 2016 Category: Neurology Source Type: research
Lesion Size and Perspective in Acute Ischemic Stroke
The computed tomographic (CT) or magnetic resonance imaging (MRI) findings of early cerebral ischemia are literally, and figuratively, shades of gray in decision making regarding the triage of patients with acute ischemic stroke for revascularization. The subtleties and areas of uncertainty on imaging of this dynamic process, where an arterial occlusion is mitigated by collateral perfusion in the brain, defy concrete rules or thresholds that are equally consequential across individual patients. Imaging criteria, whether more than one-third of the middle cerebral artery territory, Alberta Stroke Program Early CT (ASPECT) sc...
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research
Which Patients With Ischemic Stroke and Insulin Resistance May Benefit From Pioglitazone?
The Insulin Resistance Intervention After Stroke (IRIS) trial has reported that treating insulin resistance with the peroxisome proliferator –activated receptor γ agonist pioglitazone hydrochloride reduced recurrent stroke or myocardial infarction (MI) by about one-fourth compared with placebo (pioglitazone, 9.0% vs placebo, 11.8%; hazard ratio [HR], 0.76; 95% CI, 0.62-0.93) in 3876 patients with recent (<6 months) ischemic stroke or transient ischemic attack and insulin resistance but without diabetes, heart failure, or bladder cancer. Pioglitazone was also associated with less incident diabetes vs placebo (3.8% vs ...
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research
Targeting Pioglitazone Therapy After Stroke or Transient Ischemic Attack
This secondary analysis of the Insulin Resistance Intervention After Stroke trial estimates the relative and absolute effectiveness of pioglitazone after ischemic stroke or transient ischemic attack in subgroups of patients defined by pretreatment risk for stroke or myocardial infarction.
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research
Remote Ischemic Perconditioning for the Treatment of Acute Ischemic Stroke —Reply
In Reply We thank Zhao et al for the interest in our randomized clinical trial. We agree that it is of interest to evaluate remote ischemic perconditioning specifically in patients with acute ischemic stroke and mismatch. We did not target these patients exclusively, because when the Remote Ischemic Conditioning in Acute Brain Infarction (RESCUE BRAIN) was designed in 2012, there was no proof of the efficacy of this approach; the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) and Endovascular Therapy Following Imaging Evaluati...
Source: JAMA Neurology - September 28, 2020 Category: Neurology Source Type: research
Risk of Hemorrhagic Stroke in Patients With Coronavirus Disease 2019
To the Editor We read with interest the article by Merkler et al regarding the increased incidence of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) compared with those with influenza. The authors also reported that 13% of patients with COVID-19 were receiving anticoagulation at the time of the stroke. Could the authors comment on the rate of anticoagulant use in patients with COVID-19 who did not have an ischemic stroke? This would also be helpful to assess the possibility that anticoagulation may have been protective.
Source: JAMA Neurology - March 8, 2021 Category: Neurology Source Type: research
Mobile Stroke Unit or Usual Care for Acute Ischemic Stroke Management
This systematic review and meta-analysis investigates whether mobile stroke unit use is associated with better functional outcomes in patients with acute ischemic stroke.
Source: JAMA Neurology - February 7, 2022 Category: Neurology Source Type: research
Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease
This prespecified analysis of the Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) randomized clinical trial investigates the association of commonly assessed risk factors with undiagnosed atrial fibrillation in patients with ischemic stroke from large- or small-vessel disease.
Source: JAMA Neurology - November 14, 2022 Category: Neurology Source Type: research
Endovascular Therapy for Acute Ischemic Stroke
Patients with an occlusion of the distal internal carotid or proximal middle cerebral artery have among the most severe types of ischemic stroke that typically produce life-altering disabilities. Prior to a few months ago, the standard of care for such patients included intravenous (IV) alteplase and comprehensive peristroke care to avoid complications, including measures to prevent another stroke and comprehensive rehabilitation.
Source: JAMA Neurology - August 3, 2015 Category: Neurology Source Type: research
Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke
This observational study using data from the Get With the Guidelines–Stroke registry investigates the risks and benefits associated with long-term antiplatelet therapy among adult patients with ischemic stroke who receive intravenous tissue plasminogen activator.
Source: JAMA Neurology - November 9, 2015 Category: Neurology Source Type: research
