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Association of Collateral Blood Vessels With Neurological Outcome After Stroke
This cohort study assesses the association between the presence of collateral vessels identified using arterial spin labeling magnetic resonance imaging and neurologic outcome in patients after acute ischemic stroke.
Source: JAMA Neurology - February 13, 2017 Category: Neurology Source Type: research

Recurrence of Posterior Circulation Childhood Arterial Ischemic Stroke
This cohort study investigates the incidence of the recurrence of childhood arterial ischemic stroke in the posterior and anterior circulations to determine if the risk differs between the 2 locations.
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke
Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory –adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and their report appears in this issue ofJAMA Neurology. Given that 85% of the patients in mechanical thrombectomy (MT) trials received intravenous thrombolysis (IVT), they highlight an important group of patients in whom MT was successful without IVT. The recent IVT and MT trials have clearly established the new standard in therapy for...
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

Thrombolysis and Thrombectomy vs Thrombectomy Alone for Ischemic Stroke
This study examines whether treatment with intravenous thrombolysis before mechanical thrombectomy with a stent retriever is beneficial in patients undergoing mechanical thrombectomy.
Source: JAMA Neurology - January 9, 2017 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

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

Endovascular Treatment for Patients With Stroke and Large Ischemic Cores and Mismatch Imaging Profiles
This case-control study compares the outcomes of patients following stroke with large baseline ischemic cores on computed tomographic perfusion undergoing endovascular therapy with the outcomes of matched controls who had medical care alone.
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

Mechanical Thrombectomy for Stroke
The publication of 5 randomized trials in 2015 unequivocally established that mechanical thrombectomy is the new standard of care for patients with acute ischemic stroke and an occlusion of the proximal anterior circulation. Although those trials mark a huge advancement in the field of stroke, important questions regarding the implementation of mechanical thrombectomy in routine clinical care remain. One of the more important of these questions is what constitutes the definition of a proximal occlusion. In those trials, most of the patients had an occlusion of the distal internal carotid artery or of the first segment (M1)...
Source: JAMA Neurology - September 12, 2016 Category: Neurology Source Type: research

Endovascular Therapy for Acute Ischemic Stroke
This pooled cohort study evaluates the safety and effectiveness of endovascular therapy for occlusions of the M2 segment of the middle cerebral artery in patients with ischemic stroke.
Source: JAMA Neurology - September 12, 2016 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

The Dark Matter of Cerebral Microbleeds
In Reply We thank Charidimou for reading our recently published article in JAMA Neurology on the risk for symptomatic intracerebral hemorrhage after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and high cerebral microbleed (CMB) burden on pre-IVT magnetic resonance imaging (MRI) screening, and for his timely discussion on the topic.
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Stent Retrievers for Treating Anterior Circulation Acute Ischemic Stroke
To the Editor Touma et al reported a comprehensive systematic review and meta-analysis of 5 randomized clinical trials evaluating the benefits and risks of stent retrievers in addition to recombinant tissue plasminogen activator (rtPA) for the treatment of acute ischemic stroke (AIS). The main conclusion of the study was that “the use of stent retrievers in conjunction with rtPA vs rtPA alone is associated with significant improvement of functional independence 90 days after AIS.” However, as pointed out by the authors, all studies included in their meta-analysis selected only patients with anterior circulation acute i...
Source: JAMA Neurology - July 5, 2016 Category: Neurology Source Type: research

Computed Tomography Perfusion and Diffusion-Weighted Imaging in Acute Stroke
To the Editor In JAMA Neurology, Rudilosso and colleagues presented 2 cases using computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI). They suggested that CTP was superior to DWI in the identification of ischemic changes in acute stroke. In most patients, DWI findings appear positive within several minutes to several hours of the onset of acute cerebral infarction. Positive DWI findings depend on cytotoxic edema. The morphology of the brain maintains intact when cerebral blood flow is decreased to 30% of its normal level. If perfusion is returned to normal, no abnormality will be detected by DWI. When ...
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research

Instrument for Predicting Early Stroke Recurrence
In Reply Our recently published article in JAMA Neurology was the third in a series of studies that assessed the ability of the Recurrence Risk Estimator (RRE) to predict the 90-day risk for recurrence after an ischemic stroke. The first 2 were internal validation studies that demonstrated good discrimination (C statistics, 0.80-0.85). The last assessed the validity of RRE in an international multicenter setting and revealed a comparable discriminative value (C statistic, 0.76), confirming the results of prior studies.
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research

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