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Presenting to Primary Stroke Centers for Thrombolysis —Reply
In Reply We thank Uchino for his letter on our recently published article in which he discusses potential limitations of our study. The first criticism concerns the unexpected less favorable outcome in the mothership (MS) group despite significantly shorter onset-to-needle and onset-to-recanalization times. It is true that even though the difference was not statistically significant, the MS group had fewer patients with a 3-month favorable functional outcome (50.8%) when compared with the drip-and-ship (DS) group (61 [61.0%];P = .26). As we mentioned in our article, patients in the MS group had slightly but significant...
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke —Reply
In Reply We thank Chabanne and Futier for the relevant question concerning ventilator parameters in the General or Local Anesthesia in Intra Arterial Therapy (GOLIATH) trial. Unfortunately, it was not possible for us to obtain periprocedural arterial blood gas parameters because of resource constraints. However, we have recently reported the end tidal carbon dioxide (EtCO2) levels in the general anesthesia (GA) arm (4.4 kPa; interquartile range, 4.2-4.8 kPa). Taking the normal arterial to EtCO2 gradient into account, our data indicate a normoventilation, which was the intention in the study protocol. The EtCO2 levels were ...
Source: JAMA Neurology - July 16, 2018 Category: Neurology Source Type: research

Variations in Modeling for Treating All Patients With Stroke With Suspected Large Vessel Occlusion
To the Editor We read the article by Holodinsky et al, who reported the results of a modeling study to identify the optimal triage and transport strategy for patients suspected of having large-vessel occlusion, with interest.
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Prevention of Dementia —Thinking Beyond the Age and Amyloid Boxes
It is increasingly recognized that the declines in brain structure and function in persons with no clinical brain disease that we call brain aging and the 2 brain diseases that most frequently affect older adults (dementia and stroke) are the theoretically predictable consequences of a lifetime of injury that overcomes genetically and environmentally determined reserve and resilience, a concept encapsulated in the shorthand phrase life-course illness. Despite this insight, details of the various factors that adversely affect the brain health of older adults (and clarity on which times during life have the greatest effect a...
Source: JAMA Neurology - November 4, 2019 Category: Neurology Source Type: research

Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy
Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS). With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiab...
Source: JAMA Neurology - December 9, 2019 Category: Neurology Source Type: research

Blood Pressure Thresholds in Endovascular Therapy for Acute Ischemic Stroke
This cohort study investigates whether procedural blood pressure parameters, including specific blood pressure thresholds, are associated with neurological outcomes after endovascular therapy.
Source: JAMA Neurology - January 27, 2020 Category: Neurology Source Type: research

Distributional Validity and Prognostic Power of the NIHSS in US Administrative Claims Data
This cross-sectional study analyzes the distributional, convergent, and predictive validity of National Institutes of Health Stroke Scale (NIHSS) values in the National Inpatient Sample.
Source: JAMA Neurology - February 17, 2020 Category: Neurology Source Type: research

Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry
This nonrandomized cohort study evaluates the association between endovascular treatment and the clinical outcomes of patients with stroke and acute basilar artery occlusion, compared with patients who received standard medical treatment only.
Source: JAMA Neurology - February 20, 2020 Category: Neurology Source Type: research

Magnetic Resonance Imaging for Acute Minor Neurological Symptoms
To the Editor An observational study of magnetic resonance imaging (MRI) in acute minor neurological symptoms revealed imaging evidence for acute infarction in 13.5% and revision of clinical diagnosis in 30%. This “implies a considerable percentage of patients’ negative MRI findings resulted in a different diagnosis, likely that a presumed stroke did not exist.” This conclusion is misleading in 2 respects.
Source: JAMA Neurology - April 20, 2020 Category: Neurology Source Type: research

Importance of the Intention-to-Treat Principle
To the Editor The recent study by Goyal et al represents the third largest cohort study on patients with large vessel occlusions (LVOs) who present with mild deficits (National Institutes of Health Stroke Scale score, 0-5) and, to our knowledge, the largest meta-analysis regarding this topic. This highlights the growing interest on how to optimally treat such patients.
Source: JAMA Neurology - May 4, 2020 Category: Neurology Source Type: research

Prehospital Prediction of Large Anterior Vessel Occlusion
This cohort study performs external validations, head-to-head comparisons, and feasibility ratings of 7 scales used by emergency medical services in the field to predict symptomatic large anterior vessel occlusion among patients suspected of acute stroke.
Source: JAMA Neurology - November 30, 2020 Category: Neurology Source Type: research

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke
This case-control study analyzes the clinical, functional, and safety outcomes associated with endovascular therapy for patients with posterior circulation distal, medium vessel occlusion.
Source: JAMA Neurology - February 22, 2021 Category: Neurology Source Type: research

Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events
This analysis of pooled cohort data from 4 popluation-based cohort studies evaluates whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction.
Source: JAMA Neurology - May 3, 2021 Category: Neurology Source Type: research

Statewide Emergency Medical Services Protocols for Suspected Stroke and Large Vessel Occlusion
This cross-sectional study characterizes prehospital large vessel occlusion transport algorithms across the US.
Source: JAMA Neurology - September 20, 2021 Category: Neurology Source Type: research

Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes
This cohort study assesses secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population.
Source: JAMA Neurology - December 6, 2021 Category: Neurology Source Type: research

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