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Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks in Rural and Urban Medicare Patients
This cohort study describes trends among rural and urban patients with acute ischemic stroke or transient ischemic attack in the type of health care centers to which patients were admitted, what care was provided, and patient outcomes.
Source: JAMA Neurology - May 4, 2020 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

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

Association of Endovascular Treatment With Ischemic Stroke and Clinical Outcome in Pediatric Patients
This cohort study examines the use of endovascular recanalization in pediatric patients with arterial ischemic stroke and clinical outcomes.
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Endovascular Therapy for Childhood Stroke —Working Together to Reach Prime Time
The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset. The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disabili...
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke
This validation study describes the development of a prognostic model to predict swallowing recovery and guide the decision for enteral tube feeding in people with dysphagia after ischemic stroke.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

Potential New Horizons for the Prevention of Cerebrovascular Diseases and Dementia
In this issue ofJAMA Neurology, Spence et al discuss the effect of pioglitazone, an insulin-sensitizing agent that has been shown to reduce the risk of recurrent stroke and myocardial infarction in patients with insulin resistance, in patients with prediabetes. Prediabetes was defined according to the American Diabetes Association criteria, ie, a hemoglobin A1c level of 5.7% to 6.4% or a fasting plasma glucose level of 100 to 125 mg/dL. Data were taken from the Insulin Resistance Intervention after Stroke (IRIS) study, an international randomized clinical trial performed in patients with previous stroke or transient ischem...
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
This cohort study of 25  789 black and white individuals in the United States examines the incidence and risk factors for ischemic stroke by sex and race.
Source: JAMA Neurology - December 10, 2018 Category: Neurology Source Type: research

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke
To the Editor Simonsen et al concluded that general anesthesia (GA) did not influence infarct growth compared with conscious sedation in endovascular-treated patients with acute stroke. This is an interesting study that addresses topical questions. However, we would like to point out some limitations.
Source: JAMA Neurology - July 16, 2018 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

Presentation After TIA and Minor Stroke in Relation to the UK FAST Public Education Campaign
This population-based study investigates the association of public education with improving delays and failure in seeking medical attention among consecutive patients with first transient ischemic attack or stroke.
Source: JAMA Neurology - July 2, 2018 Category: Neurology Source Type: research

Considerations in Assessing Disability Trajectories
To the Editor We thank Dhamoon et al for their prospective longitudinal cohort study assessing the long-term disability trajectory before and after an ischemic stroke compared with myocardial infarction (MI). The authors found that the gradient of increasing disability was significantly steeper after a stroke but remained consistent after MI.
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

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