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Stroke clinical outcomes

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https://www.readbyqxmd.com/read/27922810/impact-of-chronic-total-occlusion-revascularization-attempts-on-subsequent-clinical-outcomes
#1
Ahmad Jabbar, Georgios Christopoulos, Aris Karatasakis, Omar M Jeroudi, Georgios E Christakopoulos, Abdallah El Sabbagh, Barbara Danek, Judit Karacsonyi, Michele Roesle, Bavana V Rangan, Jerrold Grodin, Michael Luna, Shuaib Abdullah, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVES: We examined a contemporary, unselected cohort of patients with coronary chronic total occlusions (CTOs) to determine the impact of CTO revascularization on long-term outcomes. METHODS: We retrospectively assessed the impact of CTO revascularization on clinical outcomes of consecutive patients found to have a CTO during coronary angiography performed at our institution during 2011 and 2012. The primary endpoint was the incidence of a major adverse cardiac event (MACE, defined as a composite of death, myocardial infarction, stroke, and target-vessel revascularization [TVR])...
December 2016: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/27920364/an-optimal-wilcoxon-mann-whitney-test-of-mortality-and-a-continuous-outcome
#2
Roland A Matsouaka, Aneesh B Singhal, Rebecca A Betensky
We consider a two-group randomized clinical trial, where mortality affects the assessment of a follow-up continuous outcome. Using the worst-rank composite endpoint, we develop a weighted Wilcoxon-Mann-Whitney test statistic to analyze the data. We determine the optimal weights for the Wilcoxon-Mann-Whitney test statistic that maximize its power. We derive a formula for its power and demonstrate its accuracy in simulations. Finally, we apply the method to data from an acute ischemic stroke clinical trial of normobaric oxygen therapy...
December 5, 2016: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/27920262/home-exercise-programmes-supported-by-video-and-automated-reminders-compared-with-standard-paper-based-home-exercise-programmes-in-patients-with-stroke-a-randomized-controlled-trial
#3
Kellie B Emmerson, Katherine E Harding, Nicholas F Taylor
OBJECTIVE: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. DESIGN: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes...
December 5, 2016: Clinical Rehabilitation
https://www.readbyqxmd.com/read/27919826/should-blood-pressure-goal-be-individualized-in-hypertensive-patients
#4
REVIEW
Alexandra Yannoutsos, Rania Kheder-Elfekih, Jean-Michel Halimi, Michel E Safar, Jacques Blacher
The aim of the present review is to consider the clinical relevance of individualized blood pressure (BP) goal under treatment in hypertensive patients according to their age, comorbidities or established cardiovascular (CV) disease. Evidence from large-scale randomized trials to support a lower BP goal, as initially recommended by guidelines in high-risk hypertensive patients, were lacking. Recently, the randomized intervention SPRINT trial studied two treatment targets for systolic BP (120mm Hg versus 140mm Hg in the intensive and standard treatment group, respectively) among high-risk hypertensive patients, without diabetes and without a history of prior stroke...
December 2, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27919610/renal-artery-stenosis-in-patients-with-peripheral-artery-disease-prevalence-risk-factors-and-long-term-prognosis
#5
V Aboyans, I Desormais, J Magne, G Morange, D Mohty, P Lacroix
OBJECTIVE/BACKGROUND: The objective was to determine the prevalence and clinical determinants of renal artery stenosis (RAS) in patients undergoing digital subtraction angiography (DSA) for the assessment of peripheral artery disease (PAD), and to evaluate its prognostic significance. METHODS: All DSAs performed from January 2000 to January 2006 were retrospectively reviewed for assessment of PAD in patients naive for any prior revascularisation of lower-limb arteries...
December 2, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27919293/perioperative-statin-therapy-in-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#6
Alessandro Putzu, Bruno Capelli, Alessandro Belletti, Tiziano Cassina, Enrico Ferrari, Michele Gallo, Gabriele Casso, Giovanni Landoni
BACKGROUND: Several studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients. METHODS: Electronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery...
December 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27918088/cerebrolysin-for-acute-ischaemic-stroke
#7
REVIEW
Liliya Eugenevna Ziganshina, Tatyana Abakumova, Ludivine Vernay
BACKGROUND: Cerebrolysin is a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue, which has potential neuroprotective and neurotrophic properties. It is widely used in the treatment of acute ischaemic stroke in Russia, Eastern Europe, China, and other Asian and post-Soviet countries. OBJECTIVES: To assess the benefits and risks of cerebrolysin for treating acute ischaemic stroke. SEARCH METHODS: In May 2016 we searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, Web of Science Core Collection, with Science Citation Index, LILACS, OpenGrey, and a number of Russian Databases...
December 5, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27917948/association-of-cortical-vein-filling-with-clot-location-and-clinical-outcomes-in-acute-ischaemic-stroke-patients
#8
Sonu Bhaskar, Andrew Bivard, Peter Stanwell, John R Attia, Mark Parsons, Michael Nilsson, Christopher Levi
Delay in cortical vein filling during the late-venous phase (delayed-LCVF) is characterized by opacification of cerebral veins despite contrast clearance from contralateral veins on dynamic computed tomography angiography (dCTA) in acute ischemic stroke (AIS) patients. The aim of the study was to investigate the associations of delayed-LCVF with clot location, reperfusion status at 24 hours, and 90-days functional outcome in AIS patients who received reperfusion therapy. A prospective cohort of AIS patients treated with intravenous thrombolysis was studied...
December 5, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27917212/stroke-in-patients-with-diabetes-mellitus-a-study-from-north-western-nigeria
#9
Lukman Owolabi, Mansur Nagode, Aliyu Ibrahim, Andrew Uloko, Ibrahim Gezawa, Mohammad Datti
BACKGROUND: Stroke is one of the major causes of morbidity and mortality worldwide and apart from being exceedingly harmful in diabetics, stroke is a disabling disorder. The study was undertaken to describe the clinical characteristics, outcome pattern and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North Western Nigeria. METHOD: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two tertiary hospitals in Kano were consecutively recruited for the study...
September 2016: African Health Sciences
https://www.readbyqxmd.com/read/27917150/nurse-led-intervention-to-improve-knowledge-of-medications-in-survivors-of-stroke-or-transient-ischemic-attack-a-cluster-randomized-controlled-trial
#10
Muideen T Olaiya, Dominique A Cadilhac, Joosup Kim, David Ung, Mark R Nelson, Velandai K Srikanth, Christopher F Bladin, Richard P Gerraty, Sharyn M Fitzgerald, Thanh G Phan, Judith Frayne, Amanda G Thrift
INTRODUCTION: Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). METHODS: Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27916776/favorable-clinical-outcomes-of-transcatheter-aortic-valve-implantation-in-japanese-patients%C3%A3-first-report-from-the-post-approval-k-tavi-registry
#11
Shinya Takimoto, Naritatsu Saito, Kenji Minakata, Shinichi Shirai, Akihiro Isotani, Yoshio Arai, Michiya Hanyu, Tatsuhiko Komiya, Takeshi Shimamoto, Tsuyoshi Goto, Yasushi Fuku, Natsuhiko Ehara, Yutaka Furukawa, Tadaaki Koyama, Atsuhi Nagasawa, Toshihiro Tamura, Makoto Miyake, Kazuo Yamanaka, Hisashi Sakaguchi, Koichiro Murata, Tomoya Onodera, Fumio Yamazaki, Masanao Nakai, Tomohiko Taniguchi, Ryuzo Sakata, Takeshi Kimura
BACKGROUND: Very limited data exist on the outcomes of transcatheter aortic valve implantation (TAVI) since Japanese marketing approval of the first TAVI device.Methods and Results:The Kyoto University-related hospital Transcatheter Aortic Valve Implantation (K-TAVI) registry includes prospectively collected data from 6 participating hospitals in Japan. We included 302 patients with severe aortic stenosis who underwent TAVI using the SAPIEN XT balloon-expandable valve via transfemoral (TF; n=203, 67%) or transapical (TA; n=99, 33%) approach between October 2013 and September 2015...
December 3, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/27916514/dipeptidyl-peptidase-4-inhibitors-and-protection-against-stroke-a-systematic-review-and-meta-analysis
#12
REVIEW
F Barkas, M Elisaf, V Tsimihodimos, H Milionis
BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of stroke and an unfavourable outcome following stroke. Apart from pioglitazone, glucose-lowering modalities have not been shown to protect against stroke. Nevertheless, there is evidence from experimental studies of potential neuroprotective effects with dipeptidyl peptidase (DPP)-4 inhibitors, especially if treatment starts before stroke. OBJECTIVE: To perform a meta-analysis of available evidence regarding the risk of stroke in individuals taking DPP-4 inhibitors...
December 1, 2016: Diabetes & Metabolism
https://www.readbyqxmd.com/read/27916486/apixaban-in-patients-with%C3%A2-atrial%C3%A2-fibrillation%C3%A2-after-transfemoral-aortic-valve%C3%A2-replacement
#13
Julia Seeger, Birgid Gonska, Christoph Rodewald, Wolfgang Rottbauer, Jochen Wöhrle
OBJECTIVES: The aims of this study were to assess the impact of atrial fibrillation (AF) on outcome in transfemoral aortic valve replacement (TAVR) and to evaluate the safety and efficacy of apixaban compared with a vitamin K antagonist (VKA) in patients with AF after TAVR. BACKGROUND: Non-VKA oral anticoagulant agents have not been systematically used in patients with AF after TAVR. METHODS: Of the 617 patients enrolled, 55.9% (n = 345) were in sinus rhythm and 44...
December 1, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27915393/role-of-prothrombin-complex-concentrate-pcc-in-acute-intracerebral-hemorrhage-with-positive-cta-spot-sign-an-institutional-experience-at-a-regional-and-state-designated-stroke-center
#14
Razia Rehmani, Angela Han, Jawaad Hassan, Jeffrey Farkas
PURPOSE: Our objective is to identify the effect of prothrombin complex concentrate (PCC) in acute intracranial hemorrhage (ICH) by evaluating intraparenchymal hematoma expansion between initial and follow-up head CT at 5-24 h, in those with positive CTA spot sign (CTASS). CTASS is an independent predictor of hematoma growth (1). Acute ICH, regardless of etiology, can present with quick mental status decline often resulting in irreversible brain damage. Hematoma expansion appears to be a modifiable predictor of clinical outcome and an appropriate target for medical therapy...
December 3, 2016: Emergency Radiology
https://www.readbyqxmd.com/read/27914503/rationale-and-design-of-the-transcatheter-aortic-valve-replacement-to-unload-the-left-ventricle-in-patients-with-advanced-heart-failure-tavr-unload-trial
#15
Ernest Spitzer, Nicolas M Van Mieghem, Philippe Pibarot, Rebecca T Hahn, Susheel Kodali, Mathew S Maurer, Tamim M Nazif, Josep Rodés-Cabau, Jean-Michel Paradis, Arie-Pieter Kappetein, Ori Ben-Yehuda, Gerrit-Anne van Es, Faouzi Kallel, William N Anderson, Jan Tijssen, Martin B Leon
BACKGROUND: Coexistence of moderate aortic stenosis (AS) in patients with heart failure (HF) with reduced ejection fraction is not uncommon. Moderate AS increases afterload, whereas pharmacologic reduction of afterload is a pillar of contemporary HF management. HYPOTHESIS: Unloading the left ventricle by reducing the transaortic gradient with transfemoral transcatheter aortic valve replacement (TAVR) may improve clinical outcomes in patients with moderate AS and HF with reduced ejection fraction...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27914497/acute-management-of-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-addressing-real-world-anticoagulant-management-issues-in-stroke-aramis-registry-design-and-rationale
#16
Ying Xian, Adrian F Hernandez, Tina Harding, Gregg C Fonarow, Deepak L Bhatt, Robert E Suter, Yosef Khan, Lee H Schwamm, Eric D Peterson
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs, dabigatran, rivaroxaban, apixaban, and edoxaban) have been increasingly used as alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation. Yet there is substantial lack of information on how patients on NOACs are currently treated when they have an acute ischemic stroke and the best strategies for treating intracerebral hemorrhage for those on chronic anticoagulation with warfarin or a NOAC. These are critical unmet needs for real world clinical decision making in these emergent patients...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27913538/sickle-cell-disease-when-and-how-to-transfuse
#17
Jo Howard
Blood transfusion remains an important therapeutic intervention in patients with sickle cell disease (SCD), aiming to both increase the oxygen carrying capacity of blood and to reduce the complications of vaso-occlusion. Simple, manual exchange and automated exchange can be effective in reducing the acute and chronic complications of SCD, and the advantages and disadvantages of each methodology mean they all have a role in different situations. Evidence for the role of emergency transfusion in the management of the acute complications of SCD, including acute pain and acute chest syndrome, comes from observational data...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913263/experience-with-adapt-for-thrombectomy-in-distal-cerebral-artery-occlusions-causing-acute-ischemic-stroke
#18
Jan Vargas, Alex M Spiotta, Kyle Fargen, Raymond D Turner, Imran Chaudry, Aquilla Turk
BACKGROUND: Thromboembolic occlusion of distal branches in anterior and posterior circulation may produce severe clinical deficits. The ADAPT technique is a simple, fast method for achieving good angiographic and clinical outcomes using large bore catheters in large vessel occlusions. OBJECTIVE: We present our results using the ADAPT technique with distal cerebral artery occlusions. METHODS: Thirty-five patients with acute ischemic stroke with thrombus in the distal MCA, ACA, or PCA were treated with the ADAPT technique...
November 29, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27913059/cha2ds2-vasc-scores-and-major-bleeding-in-patients-with-nonvalvular-atrial-fibrillation-who-are-receiving-rivaroxaban
#19
W Frank Peacock, Sally Tamayo, Manesh Patel, Nicholas Sicignano, Kathleen P Hopf, Zhong Yuan
STUDY OBJECTIVE: Assessing stroke risk associated with nonvalvular atrial fibrillation depends on the evaluation of patient characteristics and clinical features. Clinicians must determine that the net clinical benefit from anticoagulation therapy outweighs its risk, namely, bleeding. Risk assessment for stroke is commonly performed by calculating a CHA2DS2-VASc (congestive heart failure/left ventricular dysfunction, hypertension, ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack or thromboembolism, vascular disease, aged 65 to 74 years, sex female) score...
November 29, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27912776/improving-stroke-prevention-therapy-for-patients-with-atrial-fibrillation-in-primary-care-protocol-for-a-pragmatic-cluster-randomized-trial
#20
Theresa M Lee, Noah M Ivers, Sacha Bhatia, Debra A Butt, Paul Dorian, Liisa Jaakkimainen, Kori Leblanc, Dan Legge, Dante Morra, Alissia Valentinis, Laura Wing, Jacqueline Young, Karen Tu
BACKGROUND: The prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers. METHODS: We will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a "toolkit" of quality improvement interventions in primary care...
December 3, 2016: Implementation Science: IS
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