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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

Broadening Our SCOPE of Understanding Patent Foramen Ovale High-risk Features and Stroke
Paradoxical embolization of a blood clot of presumed venous origin through a patent foramen ovale (PFO) is increasingly recognized as a legitimate cause of otherwise cryptogenic ischemic stroke (CIS). The term PFO-associated stroke has been proposed, as has where and how to classify this entity in the nomenclature of various ischemic stroke subtyping systems. PFOs are common, with prevalence as high as 25% in the general population. The prevalence of PFO is further increased in patients with CIS (overall 2.9 times higher), and especially so in the subset of younger patients (<55 years, 5.1 times higher). One estimate of...
Source: JAMA Neurology - October 10, 2022 Category: Neurology Source Type: research

Association Between ASPECTS and Efficacy and Safety Outcomes With EVT in Patients With Stroke
This secondary analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism —Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT) evaluates the safety and efficacy of endovascular therapy in patients with acute large ischemic stroke by Alberta Stroke Program Early Computed Tomography Score.
Source: JAMA Neurology - October 10, 2022 Category: Neurology Source Type: research

Prevalence of Atherosclerotic Risk Factors Among Children and Young Adults With Arterial Ischemic Stroke
This case-control study assesses hypertension, hyperlipidemia, obesity, smoking, and diabetes as risk factors associated with incident arterial ischemic stroke in children and young adults, stratified by decade of age.
Source: JAMA Neurology - August 1, 2022 Category: Neurology Source Type: research

Time for a New Perspective on Intracerebral Hemorrhage
More than 3 million people worldwide experience intracerebral hemorrhage (ICH) each year. Although the incidence of ICH is much lower than that of ischemic stroke, ICH imposes a 50% greater worldwide burden of disability. ICH has a 30-day case fatality rate of more than 40%, and most survivors are left with permanent disabilities. Because of the high likelihood of poor outcomes, physicians caring for patients with ICH tend to use clinical severity scores early on to estimate the risk of mortality or future disability to determine the aggressiveness of medical care and to guide conversations with patients ’ surrogates aro...
Source: JAMA Neurology - July 25, 2022 Category: Neurology Source Type: research

Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice
This cohort study investigates the outcomes of combination endovascular thrombectomy with alteplase compared with endovascular thrombectomy alone for the treatment of patients with acute ischemic stroke attributable to large vessel occlusion.
Source: JAMA Neurology - June 13, 2022 Category: Neurology Source Type: research

Diagnostic Challenges and Uncertainties of Embolic Strokes of Undetermined Source in Young Adults
Nearly 10% to 15% of acute ischemic strokes occur in young adults, with the incidence steadily increasing over the past few decades. Approximately 20% to 40% of these young patients with stroke are classified as having embolic strokes of undetermined source (ESUS), as the underlying stroke etiology cannot be reliably identified despite recommended diagnostic workup. The young ESUS population is an understudied group, as only a few studies, limited by their small size and the lack of prospective follow-up, have assessed their characteristics and outcomes.
Source: JAMA Neurology - March 14, 2022 Category: Neurology Source Type: research

Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source
This cohort study evaluates rates of and factors associated with recurrent ischemic stroke and death as well as new-onset atrial fibrillation among younger adults.
Source: JAMA Neurology - March 14, 2022 Category: Neurology Source Type: research

Low-Density Lipoprotein Cholesterol Level After a Stroke
Randomized clinical trials (RCTs) of statins as the primary prevention for patients with a high serum low-density lipoprotein cholesterol (LDL-C) level and as the secondary prevention after an acute coronary event have shown that lowering serum LDL-C levels reduces the risks of myocardial infarction, stroke, and vascular death. These trials included stroke as a secondary end point but not as an entry criterion. The benefit of LDL-C lowering to reduce the risk of ischemic strokes in primary prevention trials and for patients with coronary heart disease is not necessarily seen among patients who have had a stroke. The Stroke...
Source: JAMA Neurology - February 21, 2022 Category: Neurology Source Type: research

Intensity of LDL Cholesterol Lowering and Secondary Stroke Prevention
This meta-analysis of randomized clinical trials evaluates the association of more intensive vs less intensive low-density lipoprotein cholesterol –lowering statin-based therapies with outcomes for patients with ischemic stroke.
Source: JAMA Neurology - February 21, 2022 Category: Neurology Source Type: research

Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval
To the Editor The Diffusion-Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo (DAWN) trial demonstrated benefit of endovascular treatment (EVT) in select patients 6 to 24 hours after last known well (LKW) with clinical imaging mismatch. The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) trial demonstrated benefit of EVT in select patients 6 to 16 hours after LKW with target perfusion-imaging mismatch. In the article by Albers et al, the authors present indepe...
Source: JAMA Neurology - February 14, 2022 Category: Neurology Source Type: research

Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval —Reply
In Reply We thank Powers for his comments regarding our article. He raises the question if the positive result for patients with target perfusion-imaging mismatch in the 12.8- to 24-hour tercile in the Analysis of Pooled Data From Randomized Studies of Thrombectomy More Than 6 Hours After Last Well Known (AURORA) study could solely be due to a benefit from 12.8 to 16 hours since last known well subgroup, with neutral or negative effects in the 16- to 24-hour time period. This was not the case. Data for patients in the 16- to 24-hour group with the target mismatch profile demonstrated an odds ratio of 3.82 (95% CI, 1.07-13....
Source: JAMA Neurology - February 14, 2022 Category: Neurology Source Type: research

Disentangling Workflow Paradigms and Treatment Decision-making in Acute Ischemic Stroke
To the Editor We congratulate Requena and colleagues on their randomized trial, in which they compared a direct-to-angiography suite (DTAS) paradigm with a conventional workflow paradigm, ie, cross-sectional imaging, followed by transport to the angiography suite for endovascular treatment (EVT) when appropriate. The authors found that a DTAS paradigm not only decreased in-hospital workflow times but also increased the odds of patients undergoing EVT, both of which may have contributed to the improved clinical outcomes in the DTAS group.
Source: JAMA Neurology - February 7, 2022 Category: Neurology Source Type: research

Disentangling Workflow Paradigms and Treatment Decision-Making in Acute Ischemic Stroke —Reply
In Reply We thank Ospel and Goyal for their interest in the Evaluation of Direct Transfer to Angiography Suite vs Computed Tomography Suite in Endovascular Treatment (ANGIOCAT) study and read with interest their letter in which they express some concerns in relation to the direct-to-angiography suite (DTAS) paradigm. In the ANGIOCAT study, patients adjudicated to the conventional imaging group, despite receiving computed tomography perfusion (CTP) in some cases, achieved one of the shortest workflow times reported ever (door-to-puncture time of 44 minutes). According to guidelines, CTP was never used to exclude patients fr...
Source: JAMA Neurology - February 7, 2022 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

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