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Source: JAMA Neurology
Condition: Stroke
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Total 364 results found since Jan 2013.
The High Risk of Low Distal Flow
Symptomatic atherosclerosis of the vertebral artery remains a challenging condition with no proven interventional therapy. Completed randomized trials of angioplasty with or without stenting involving patients with symptomatic vertebral artery stenosis include Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS), and Vertebral Artery Stenting Trial (VAST). As the largest (N = 115) completed trial, VAST illustrates many of the challenges of developing interventional therapy for this patient pop...
Source: JAMA Neurology - December 21, 2015 Category: Neurology Source Type: research
Migraine and the Risk of Carotid Artery Dissection
Stroke incidence is increasing among patients aged 40 to 60 years —faster than in older age cohorts. Preliminary evidence suggests that ischemic stroke—not hemorrhage or subarachnoid hemorrhage—accounts for the increase. Many speculate that increasing incidences of classic vascular risk factors among young patients contribute to the increased incidence of st roke. Certainly, we are all aware of the obesity epidemic and continued prevalence of smoking, leading to premature atherosclerosis. Furthermore, equally relevant causes of stroke in the young include migraine, drug abuse, cervical arterial dissections, patent fo...
Source: JAMA Neurology - March 6, 2017 Category: Neurology Source Type: research
Managing Patients With Large Ischemic Core
To the Editor We read with interest the article by Rebello and colleagues on endovascular treatment. There is still uncertainty on how best to manage patients who have a large ischemic core and a large artery clot. Using matched controls is an excellent approach when the study is not a randomized clinical trial. The authors modified the approach of Mandava and colleagues, who had proposed matching controls based on the National Institutes of Health Stroke Scales, age, and pretreatment glucose level. The authors had substituted an “ischemic core on computed tomography perfusion” for the National Institutes of Health Str...
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research
Crowdsourcing the Million Brains Initiative —Reply
In Reply The enthusiasm expressed for the Million Brains Initiative and the thoughtful consideration of ethical facets by Byram and Illes are much appreciated. The authors underscore a few of the inevitable ramifications that will undoubtedly parallel the realization of precision stroke medicine and the transformation from blissful ignorance to big data in stroke medicine. The current paradigm for cerebrovascular disorders from stroke to dementia is founded on individual clinical symptoms that prompt the acquisition, routine interpretation, and archiving of neuroimaging results. Impressions are readily generated and docume...
Source: JAMA Neurology - June 12, 2017 Category: Neurology Source Type: research
Impact of Birth Place and Geographic Location on Risk Disparities in Cerebrovascular Disease
The geographic disparities in stroke and cerebrovascular disease have long been recognized with high-risk areas, such as the states in the Southeast with the greatest risk and identified as the Stroke Belt. These epidemiologic observations have facilitated the identification of risk factors associated with the excess disease burden as well as the benefits of interventions focused on disease control. The geographic disparities in stroke risks prompted specific investigations and conferences to determine the factors associated with the excess risk burden for specific geographic areas, such as the southeastern United States, ...
Source: JAMA Neurology - July 31, 2017 Category: Neurology Source Type: research
Informing vs Changing the Practice of Carotid Revascularization
The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) was a multicenter randomized clinical trial directly comparing the risks and benefits of stenting with those of endarterectomy for symptomatic and asymptomatic high-grade stenosis. Involving 2502 patients across the United States and Canada followed-up for up to 10 years, the trial did not detect significant differences in the end point of perioperative stroke, myocardial infarction, or death or ipsilateral ischemic stroke after the perioperative period. Primary results were published in 2010. CREST clearly informed practice guidelines, but the extent t...
Source: JAMA Neurology - December 4, 2017 Category: Neurology Source Type: research
Treatment of Poststroke Aphasia With Transcranial Direct Current Stimulation
Stroke remains a leading cause of human disability. Important gains have been realized in the setting of acute ischemic stroke, where thrombolytic and catheter-based reperfusion therapies can substantially improve long-term behavioral outcomes. However, most patients with a new stroke are not eligible for such therapies because of delays in diagnosis or hemorrhagic etiology, for example, and many who are treated nonetheless have substantial long-term disability. Additional classes of poststroke therapy are needed.
Source: JAMA Neurology - August 20, 2018 Category: Neurology Source Type: research
Inclusivity of Diverse Patient Groups —Reply
In Reply We thank Reddy for his commendation of our report examining risk factors for incident stroke in black and white men and women in the US National Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. His comments align with our call for more epidemiologic studies to report sex-specific and race/ethnicity-specific research findings. Other epidemiologic studies, including the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study, examined sex differences in the association of risk factors with cardiovascular outcomes (but not stroke alone) in blacks and white individu...
Source: JAMA Neurology - June 3, 2019 Category: Neurology Source Type: research
Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research
Asymptomatic Intracranial Artery Stenosis —One Less Thing to Worry About
Intracranial artery stenosis (ICAS) is a leading cause of stroke worldwide. It is estimated to account for 10% of ischemic strokes in the US and perhaps up to 50% of strokes in Asia. Despite its frequency and role in stroke-related morbidity and mortality, ICAS has received less attention compared with extracranial atherosclerotic disease. In the past 15 years, clinical trials have refined the treatment approach for patients with recent stroke or transient ischemic attack (TIA) and ICAS. However, less information is available pertaining to asymptomatic ICAS.
Source: JAMA Neurology - May 26, 2020 Category: Neurology Source Type: research
Error in Figure
This article has been corrected online.
Source: JAMA Neurology - December 21, 2020 Category: Neurology Source Type: research
Streamlining the Path to Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the associations of repeated imaging on arrival at an endovascular thrombectomy (EVT) –capable hospital with clinical outcomes after EVT. They studied an observational cohort of 2533 patients who had ischemic stroke with large vessel occlusion within 24 hours of stroke onset. It is well understood that a favorable outcome depends on the time from stroke onset to reperfusion, and th ere is no doubt that proceeding directly to the angiography suite (DTA) saves time compared with repeating imaging (median time, 26 minutes shorter in Sarraj et al). Direct transfer to th...
Source: JAMA Neurology - June 14, 2021 Category: Neurology Source Type: research
Selection of Patients for Thrombectomy in the Extended Time Window
Based on the protocols used in the DAWN (Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trials (RCTs) of thrombectomy in the extended window, current guidelines recommend thrombectomy either in the 6- to 16-hour window in patients with a target perfusion imaging mismatch profile or in the 6- to 24-hour window in patients with a clinical imaging mismatch profile. However, these criteria ...
Source: JAMA Neurology - July 26, 2021 Category: Neurology Source Type: research
Errors in Results and Table 1
This article was corrected online.
Source: JAMA Neurology - August 16, 2021 Category: Neurology Source Type: research
Stepping Closer to Precision Rehabilitation
Stroke is the leading cause of adult disability. With substantial advances in acute stroke care, most individuals with stroke survive, but they do typically live with chronic impairments in body function and activity limitations that impact quality of life. Precision rehabilitation —that is, applying the optimal type and dose of therapy at the ideal time to maximize return of function for individual patients—is of high interest and has the potential to considerably reduce poststroke disability. While precision rehabilitation is conceptually appealing and, in some respects, inherent to clinical practice (clinicians prov...
Source: JAMA Neurology - February 23, 2023 Category: Neurology Source Type: research
