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Recombinant Tissue Plasminogen Activator Stroke Therapy
The results of recently completed clinical trials of acute ischemic stroke that report a clear and unequivocal benefit of stent-retriever devices used with intravenous recombinant tissue plasminogen activator (rtPA) vs rtPA alone are the second revolutionary therapeutic breakthrough in acute stroke care in the last 50 years. This breakthrough makes the case for a new standard of care for the treatment of acute ischemic stroke. When we look back at the controversy surrounding interventional acute stroke therapies after multiple trials of interventional treatment, most notably International Management of Stroke III (IMS III)...
Source: JAMA Neurology - January 25, 2016 Category: Neurology Source Type: research

Carotid Stenting—Why Treating an Artery May Not Treat the Patient
In this issue of JAMA Neurology, Jalbert and colleagues present the results of a detailed analysis of Centers for Medicare & Medicaid Services (CMS) administrative data on patients with carotid artery stenosis treated with carotid artery stenting. Their well-written manuscript and timely study included more than 22 000 patients treated and followed up between 2000 and 2009. They analyzed periprocedural complications (defined as stroke, transient ischemic attack [TIA], myocardial infarction [MI], and death within 30 days), as well as long-term stroke and mortality. Important variables that were analyzed included the degre...
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research

Outcomes After Carotid Artery Stenting in Medicare Beneficiaries, 2005 to 2009
Conclusions and RelevanceCompeting risks may limit the benefits of CAS in certain Medicare beneficiaries, particularly among older and symptomatic patients who have higher periprocedural and long-term mortality risks. The generalizability of trials like the SAPPHIRE or CREST to the Medicare population may be limited, underscoring the need to evaluate real-world effectiveness of carotid stenosis treatments.
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research