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Infarct Progression in Patients During Mechanical Thrombectomy Transfer
This cohort study examines the clinical imaging factors associated with unfavorable imaging profile evolution for thrombectomy in patients with ischemic stroke initially transferred to non –thrombectomy-capable stroke centers.
Source: JAMA Neurology - September 25, 2017 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

Anticoagulation Timing for Atrial Fibrillation in Acute Ischemic Stroke
Most stroke physicians will have been asked the best time to start anticoagulation for a patient with atrial fibrillation (AF) and acute ischemic stroke. There is no question that long-term anticoagulation with a direct oral anticoagulant or warfarin sodium reduces the risk of strokes in patients with AF, but the right time to start anticoagulation is uncertain.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Rivaroxaban vs Warfarin Sodium Early After AF-Related Mild Ischemic Stroke
This randomized clinical trial examines whether rivaroxaban or warfarin sodium is safer and more effective for preventing early recurrent stroke in patients with atrial fibrillation –related acute ischemic stroke.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Childhood Body Mass Index and First Adult Ischemic Stroke
This population-based cohort study of schoolchildren born from the 1930s through the 1980s in Denmark investigates whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and assesses whether the associations are age dependent or influenced by birth weight.
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research

Mechanical Thrombectomy in Acute Stroke —Reply
In Reply We read with interest the letter by Seners and colleagues regarding our recent publication. The possibility of early recanalization among patients with acute ischemic stroke and a proximal intracranial occlusion was underestimated in the recent trials on mechanical thrombectomy (MT) because vascular imaging was in part done after starting intravenous thrombolysis (IVT), particularly in the MR CLEAN trial. However, Seners et al observed higher recanalization rates for M1 and M2 occlusions at an early stage, but this was not the case for carotid occlusions. Additionally, they defined early recanalization as happenin...
Source: JAMA Neurology - July 10, 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

Endovascular Thrombectomy for Acute Ischemic Stroke
This study compares the functional independence at 3 months between patients treated for acute ischemic stroke under the drip-and-ship paradigm and those treated on site (mothership paradigm).
Source: JAMA Neurology - March 20, 2017 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

Association Between Migraine and Cervical Artery Dissection
This cohort study examines the association between migraine and ischemic stroke due to cervical artery dissection in young patients with ischemic stroke.
Source: JAMA Neurology - March 6, 2017 Category: Neurology Source Type: research

Stroke Etiologic Classification —Moving From Prediction to Precision
It is a truism of vascular neurology that secondary prevention depends on the cause of an ischemic stroke. We revascularize those with extracranial carotid stenosis, we anticoagulate those with cardioembolic infarcts due to atrial fibrillation, and we treat with antibiotics those with infective endocarditis. Determining the etiologic subtype, or cause, of stroke is therefore rightly considered the main objective of the evaluation of the patient with stroke. Despite the central role of this evaluation, it is surprising that our ability to determine the cause of stroke in many cases is quite limited, and that the process of ...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Not All Middle Cerebral Artery M2 Segments Are the Same
To the Editor In the research article “Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment,” Sarraj and colleagues describe the advantage of endovascular therapy in addition to best medical therapy for patients with acute M2 occlusions. The article does not describe the distribution of the left- and right-sided lesions. It would be of interest to know whether the overall benefits hold true regardless of lesion lateralization or whether the results are primarily driven by benefits on one side.
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Response to Endovascular Therapy for Acute Ischemic Stroke
To the Editor Recent data from randomized clinical trials provide clear evidence that endovascular treatment for acute ischemic stroke because of large vessel anterior circulation occlusion improves clinical outcomes for patients. These studies reported that most patients had an occlusion of the first segment (M1) of the middle cerebral artery and less than 10% in the M2 segment. The retrospective multicenter study conducted by Sarraj et al reports that endovascular treatment is safe and effective for an occlusion of the M2 segment. However, the literature reports different definitions for the M1 and M2 segments, which may...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Response to Endovascular Therapy for Acute Ischemic Stroke —Reply
In Reply We thank Silver and Morelli for their interest in our article. We agree that is it always of interest to look into the side of the lesion, specifically into dominance more than right vs left. Although this was not addressed in the recent randomized clinical trials, we looked into this aspect in our initial analyses. When performing our univariate analysis, we looked at factors that independently correlated with good outcomes with endovascular therapy (EVT) as detailed in the Results section of our article and further discussed in eTable 2 in our Supplement. The side of the lesion was tested in the univariate analy...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

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