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Considerations in Assessing Disability Trajectories —Reply
In Reply We agree with Pan et al that endovascular thrombectomy for large vessel occlusions may improve long-term disability trajectories for those who receive this treatment. However, few patients with ischemic stroke currently receive this treatment, and it is not certain how much of an association endovascular thrombectomy will have with long-term disability trajectories for patients with ischemic stroke as a whole. It is certainly hoped that more trained specialists are available to provide the treatment, more capable stroke centers will be developed, and more patients will present within an amenable time window. Howev...
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

Keeping Faith With Patients After Stroke or Transient Ischemic Attack
I recently recommended statin therapy to a 68-year-old patient, explaining that it would reduce his risk of a major coronary event or stroke in the next 10 years from 18% to 15%. He asked, “But how will we know if it works?” I confessed we never would because success would be an uneventful walk through good health. He was not sold.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Care Quality for Veterans With Transient Ischemic Attack and Stroke
This cohort study assesses the quality of guideline-recommended transient ischemic attack and minor stroke care across the Veterans Health Administration system nationwide.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Medical Specialties and Thrombectomy for Patients With Acute Ischemic Stroke
This cross-sectional analysis of Medicare data determined the specialty of physicians providing mechanical thrombectomy to patients with ischemic stroke.
Source: JAMA Neurology - January 25, 2018 Category: Neurology Source Type: research

Reperfusion and Brain Edema in Patients With Acute Ischemic Stroke
This study examines the association between reperfusion and brain edema in patients with acute ischemic stroke.
Source: JAMA Neurology - January 24, 2018 Category: Neurology Source Type: research

Effect of General Anesthesia and Conscious Sedation on Infarct Growth and Outcomes in Stroke
This randomized clinical trial analyzes the effect of general anesthesia and conscious sedation on infarct growth and clinical outcome of patients who underwent endovascular therapy for acute ischemic stroke.
Source: JAMA Neurology - January 16, 2018 Category: Neurology Source Type: research

Enoxaparin vs Aspirin in Patients With Cancer and Ischemic Stroke
This randomized clinical trial compares anticoagulation vs antiplatelet therapy in patients with cancer and acute ischemic stroke.
Source: JAMA Neurology - January 8, 2018 Category: Neurology Source Type: research

Errors in Abstract and Figures 2 and 3
This article was c orrected online.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Thrombectomy for Acute Ischemic Stroke
In this issue ofJAMA Neurology, Nogueira et al report the results of a trial comparing aspiration-assisted stent retrieval with aspiration alone in patients with acute ischemic stroke. In a few years ’ time, mechanical thrombectomy has become a standard for treatment of acute ischemic stroke caused by proximal intracranial thromboembolic occlusions. This progress is amazing when one considers where we stood in 2013, with 3 neutral trials of intra-arterial treatment for stroke. The next 5 trial s that were published in quick succession in early 2015 and 2 later ones all indicated that early thrombectomy has a strong benef...
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Safety and Efficacy of a 3-D Stent Retriever With Aspiration-Based Thrombectomy
This randomized clinical noninferiority trial assesses a novel 3-dimensional stent retriever when used in conjunction with aspiration-based mechanical thrombectomy compared with aspiration-based mechanical thrombectomy alone in patients with acute ischemic stroke.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Evidence-Based Management of Patent Foramen Ovale in Patients With Ischemic Stroke
This Viewpoint describes the results of 5 randomized clinical trials of devices that occlude patent foramen ovale, discusses the cerebrovascular outcomes associated with treatment, and outlines judicious use of closure procedures.
Source: JAMA Neurology - December 26, 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

Low-Dose vs Standard-Dose Alteplase for Patients With Acute Ischemic Stroke
This secondary analysis reports on the association of low-dose and standard-dose intravenous alteplase treatment with age, ethnicity (Asian vs non-Asian), and severity of acute ischemic stroke among patients in the ENCHANTED randomized clinical trial.
Source: JAMA Neurology - October 2, 2017 Category: Neurology Source Type: research

Stroke Imaging
In this issue ofJAMA Neurology, Boulouis et al report on the crucial influence of pretreatment collateral blood vessel status in determining the benefit of transfer for endovascular thrombectomy for large vessel acute ischemic stroke. All patients had relatively little evidence of irreversible injury on noncontrast computed tomography (CT) at their referring hospitals. However, when imaging was repeated at the comprehensive stroke center, a substantial proportion of patients had evolved large infarcts that caused them not to proceed to endovascular therapy or foreshadowed a poor outcome. These data contribute to the weight...
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

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