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Cerebrovascular Diseases

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September 22, 2017: Cerebrovascular Diseases
Caroline Kazandjian, Nicla Settembre, Fabien Lareyre, Benjamin Kretz, Agnès Soudry-Faure, Yannick Béjot, Sergueï Malikov, Reda Hassen-Khodja, Elixene Jean-Baptiste, Eric Steinmetz
INTRODUCTION: Although carotid stenosis can cause both territorial and border-zone (BZ) cerebral infarcts (CI), the influence of CI topography on postoperative complications after surgery remains unclear. We compared early outcomes after endarterectomy on the basis of CI location: territorial (T group) or BZ group. MATERIAL AND METHODS: During the period between 2009 and 2013, ischaemic stroke patients who had undergone surgery for symptomatic carotid stenosis were identified from prospective databases from 3 French centres...
September 15, 2017: Cerebrovascular Diseases
Christian Henke, Christian Foerch, Sriramya Lapa
BACKGROUND: Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke. METHODS: Our analysis was based on data from a prospective in-hospital registry...
September 14, 2017: Cerebrovascular Diseases
Mehdi Bouslama, Meredith T Bowen, Diogo C Haussen, Seena Dehkharghani, Jonathan A Grossberg, Letícia C Rebello, Srikant Rangaraju, Michael R Frankel, Raul G Nogueira
BACKGROUND: Optimal patient selection methods for thrombectomy in large vessel occlusion stroke (LVOS) are yet to be established. We sought to evaluate the ability of different selection paradigms to predict favorable outcomes. METHODS: Review of a prospectively collected database of endovascular patients with anterior circulation LVOS, adequate CT perfusion (CTP), National Institutes of Health Stroke Scale (NIHSS) ≥10 from September 2010 to March 2016. Patients were retrospectively assessed for thrombectomy eligibility by 4 mismatch criteria: Perfusion-Imaging Mismatch (PIM): between CTP-derived perfusion defect and ischemic core volumes; Clinical-Core Mismatch (CCM): between age-adjusted NIHSS and CTP core; Clinical-ASPECTS Mismatch (CAM-1): between age-adjusted NIHSS and ASPECTS; Clinical-ASPECTS Mismatch (CAM-2): between NIHSS and ASPECTS...
September 7, 2017: Cerebrovascular Diseases
Wolf-Dieter Heiss
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects...
September 5, 2017: Cerebrovascular Diseases
Hannes Holm, Katarina Nägga, Erik D Nilsson, Fabrizio Ricci, Eduardo Cinosi, Olle Melander, Oskar Hansson, Erasmus Bachus, Martin Magnusson, Artur Fedorowski
BACKGROUND: Increased somatostatin plasma concentration has been found in patients with vascular dementia. However, it is unknown whether or not somatostatin levels may predict dementia development in the general population. To this end, we sought to assess the association of circulating N-terminal prosomatostatin (NT-proSST) with incident dementia among community-dwelling older adults. METHODS: In the prospective population-based Malmö Preventive Project, 5,347 study participants (mean age: 69 ± 6years; 70% men) provided plasma for the determination of NT-proSST concentration...
August 31, 2017: Cerebrovascular Diseases
Wenjie Zi, Huaiming Wang, Dong Yang, Yonggang Hao, Meng Zhang, Yu Geng, Min Lin, Yue Wan, Zhonghua Shi, Zhiming Zhou, Wei Wang, Haowen Xu, Xiguang Tian, Penghua Lv, Shuiping Wang, Wenhua Liu, Zhen Wang, Xintong Liu, Fuqiang Guo, Dequan Zheng, Hua Li, Mingyi Tu, Ping Jin, Guodong Xiao, Yuxiu Liu, Gelin Xu, Yunyun Xiong, Xinfeng Liu
BACKGROUNDS AND PURPOSE: This study was aimed at investigating the outcomes and predictors for the poor functional outcome after endovascular treatment (EVT) in a large, mostly Asian population. METHODS: Between January 2014 and June 2016, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enrolled from 21 stroke centers in China. The main outcomes were modified Rankin Scale (0-2 as functional independence, 3-6 as poor) at 90 days, symptomatic intracranial hemorrhage (sICH) at 72 h, and death at 90 days...
August 26, 2017: Cerebrovascular Diseases
Dong Hoon Shin, Min-Ju Kang, Jin Wook Kim, Dong-Jin Shin, Hyeon-Mi Park, Young Hee Sung, Eung Yeop Kim
BACKGROUND: An accurate measurement of patient weight is important in determining the dosage for intravenous alteplase thrombolysis. In most emergency rooms, however, weight is not measured. We investigated the difference between stated and measured weight and its effect on hemorrhagic transformation and clinical outcomes. METHODS: We enrolled 128 consecutive patients who had hyperacute stroke and were treated by alteplase. Alteplase dose was calculated using the weight provided by patient or guardian/caregiver, and the actual weight was measured after administration...
August 26, 2017: Cerebrovascular Diseases
Herbert H G Castro, Airlane Pereira Alencar, Isabela M Benseñor, Paulo A Lotufo, Alessandra C Goulart
BACKGROUND: Stroke prognosis is related to the multimorbidity profile. Moreover, performing an individual evaluation of most common cerebrovascular risk factors (CVRF) not always identifies patients with poor prognosis. Thus, we decided to evaluate multimorbidity profile, focusing on the Charlson Comorbidity Index (CCI) validated by Goldstein for ischaemic stroke (IS) patients, a score that measures a burden of comorbidities and its related mortality in the long-term survival of the EMMA Study (Study of Stroke Mortality and Morbidity)...
August 19, 2017: Cerebrovascular Diseases
Sung-Min Cho, Cory Rice, Robert J Marquardt, Lucy Q Zhang, Jean Khoury, Prateek Thatikunta, Andrew B Buletko, Julian Hardman, Ken Uchino, Dolora Wisco
BACKGROUND: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aimed to describe the magnetic resonance imaging (MRI) characteristics of IIA. METHODS: We reviewed IIAs among 116 consecutive patients with active IE by conducting a neurological evaluation at a single tertiary referral center from January 2015 to July 2016. MRIs and digital cerebral angiograms (DSA) were reviewed to identify MRI characteristics of IIAs. MRI susceptibility weighted imaging (SWI) was performed to collect data on cerebral microbleeds (CMBs) and sulcal SWI lesions...
August 19, 2017: Cerebrovascular Diseases
Junji Uno, Katsuharu Kameda, Ryosuke Otsuji, Nice Ren, Shintaro Nagaoka, Kazushi Maeda, Yoshiaki Ikai, Hidefuku Gi
BACKGROUND: The natural history of basilar artery occlusion (BAO) is devastating, with morbidity rates increasing up to 80%. However, the efficacy of recanalization therapy for BAO has not been established as yet. OBJECTIVE: We analyzed consecutive cases of BAO treated with mechanical thrombectomy (MT) to evaluate its safety and efficacy and to determine factors associated with the prognosis. METHODS: Between October 2011 and September 2016, MT was performed in 34 patients with BAO...
August 19, 2017: Cerebrovascular Diseases
Kate Morrell, Megan Hyers, Tamela Stuchiner, Lindsay Lucas, Karissa Schwartz, Jenniffer Mako, Kateri J Spinelli, Lisa Yanase
BACKGROUND: Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. METHODS: A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP...
August 19, 2017: Cerebrovascular Diseases
Jillian Naylor, Leonid Churilov, Ziyuan Chen, Miriam Koome, Neil Rane, Bruce C V Campbell
BACKGROUND: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. METHODS: Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs...
August 16, 2017: Cerebrovascular Diseases
Yuki Sakamoto, Seiji Okubo, Chikako Nito, Satoshi Suda, Noriko Matsumoto, Arata Abe, Junya Aoki, Takashi Shimoyama, Kanako Muraga, Takuya Kanamaru, Kentaro Suzuki, Yuki Go, Masahiro Mishina, Kazumi Kimura
BACKGROUND: Thrombus visualization in patients with acute ischemic stroke has been detected and reported using various imaging modalities. T1-weighted imaging (T1-WI) can depict thrombi as hyperintense signals within vessels. Moreover, in addition to thrombi, T1-WI hyperintensities in arteries may suggest arterial dissection. However, the frequency of and factors related to the T1-hyperintense vessel sign (T1-HVS) are not fully known. The aim of this study was to clarify the prevalence of and related factors for the T1-HVS in patients with acute ischemic stroke...
August 16, 2017: Cerebrovascular Diseases
Maximilian I Sprügel, Joji B Kuramatsu, Stefan T Gerner, Jochen A Sembill, Julius Hartwich, Antje Giede-Jeppe, Dominik Madžar, Vanessa D Beuscher, Philip Hoelter, Hannes Lücking, Tobias Struffert, Stefan Schwab, Hagen B Huttner
BACKGROUND: Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited. METHODS: Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer...
August 3, 2017: Cerebrovascular Diseases
Yoshitaka Yamaguchi, Tomotaka Tanaka, Sohei Yoshimura, Masatoshi Koga, Kazuyuki Nagatsuka, Kazunori Toyoda
BACKGROUND: The aorta is a significant source of cerebral thromboembolisms. Aortic complicated lesions (ACLs) are key findings on transesophageal echocardiography (TEE) for assessing aortic sources of emboli to the brain. TEE is sometimes avoided due to its invasiveness. However, few reports have examined alternative methods for predicting ACLs. We investigated relationships between aortic arch calcification (AAC) on chest X-ray and ACLs. METHODS: Participants comprised 300 patients with acute ischemic stroke or transient ischemic attack who underwent TEE for the evaluation of the aortic arch and heart...
July 28, 2017: Cerebrovascular Diseases
Waleed Brinjikji, Deena M Nasr, Christopher P Wood, Vivek N Iyer
BACKGROUND AND PURPOSE: There is a high prevalence of right-to-left shunting pulmonary arteriovenous malformations (PAVMs), which are stroke risk factors, in hereditary hemorrhagic telangiectasia (HHT) patients. While the prevalence of ischemic complications in HHT patients is known, the prevalence of silent brain infarcts (SBI) remains unknown. The purpose of this study was to determine the prevalence and risk factors for SBI in HHT patients. MATERIALS AND METHODS: Our institutional HHT database was queried to identify HHT patients who received a baseline screening brain MRI from January 2000 to February 2017...
July 27, 2017: Cerebrovascular Diseases
Woo-Keun Seo, Jin-Man Jung, Ji Hyun Kim, Seong-Beom Koh, Oh Young Bang, Kyungmi Oh
BACKGROUND: Recently, the role of free fatty acids (FFAs) in thromboembolism has re-emerged in the context of cardioembolic stroke. Therefore, we attempted to determine the role of FFAs in embolic risk in various potential sources of cardioembolism (PSCE). We hypothesized that if elevated FFA levels in stroke patients are associated with thrombogenesis, then patients with a well-known high risk of embolic sources would have high FFA levels. METHODS: Data collected from 2 hospital-based stroke registries were analyzed to investigate the association between FFA and PSCE...
July 18, 2017: Cerebrovascular Diseases
Zubair Shah, Reza Masoomi, Rashmi Thapa, Mashhood Wani, John Chen, Buddhadeb Dawn, Marilyn Rymer, Kamal Gupta
BACKGROUND AND PURPOSE: To assess the effect of optimal medical management including atherosclerotic risk factor control on ischemic stroke (IS), transient ischemic attack (TIA), carotid revascularization (CRV), and progression of severity of carotid stenosis (PSCS) in patients with asymptomatic carotid artery stenosis (ACAS). METHODS: We conducted a retrospective analysis of patients with ACAS (who had at least 3 serial carotid duplex ultrasounds) for incidence of IS, TIA, and PSCS...
July 8, 2017: Cerebrovascular Diseases
Alexis Nétis Simpkins, Christian Dias, Gina Norato, Eunhee Kim, Richard Leigh
BACKGROUND: Reliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI)...
July 7, 2017: Cerebrovascular Diseases
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