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Stroke TIA

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https://www.readbyqxmd.com/read/29350390/dual-antiplatelet-therapy-is-safe-and-efficient-after-left-atrial-appendage-closure
#1
Jakub Maksym, Tomasz Mazurek, Janusz Kochman, Marek Grygier, Agnieszka Kapłon-Cieślicka, Michał Marchel, Piotr Lodziński, Radosław Piątkowski, Radosław Wilimski, Paweł Czub, Anna Fojt, Natalia Karolczak, Piotr Hendzel, Grzegorz Opolski
BACKGROUND: Despite of PROTECT AF trial results many patients undergoing left atrial appendage closure (LAAC) have unconditional contraindications to warfarin. AIM: We sought to investigate whether double antiplatelet therapy (DAPT) is safe in patients after LAAC. METHODS: 44 (22 males, mean age 74±7.8) consecutive patients with non-valvular atrial fibrillation (NVAF) underwent LAAC procedure using Watchman device followed by DAPT (75 mg Aspirin and 75 mg Clopidogrel)...
January 19, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29348993/delayed-presentation-of-cerebral-air-embolism-from-a-left-atrial-esophageal-fistula-a-case-report-and-review-of-the-literature
#2
Catherine Peterson, Clay Elswick, Vicki Diaz, R Shane Tubbs, Marc Moisi
Air embolism developing from an atrial-esophageal fistula that was created as a complication from an atrial ablation procedure is a rare, yet usually fatal diagnosis. Neurologic manifestations such as meningitis, altered mental status, seizures, strokes, transient ischemic attacks (TIAs), psychiatric changes, and coma can ensue. Imaging of the brain might reveal infarcts, cerebral edema, as well as signs of pneumocephalus. This case describes a 42-year-old male with recent cardiac ablation procedure at an outside hospital for refractory atrial fibrillation (A-fib) who presented with altered mental status, dyspnea and diaphoresis...
November 15, 2017: Curēus
https://www.readbyqxmd.com/read/29345587/is-there-a-role-for-oral-triple-therapy-in-patients-with-acute-coronary-syndromes-without-atrial-fibrillation
#3
Nikolaos Spinthakis, Mohamed Farag, Zaki Akhtar, Diana Adrienne Gorog
BACKGROUND: Acute coronary syndrome (ACS) patients, despite treatment with dual antiplatelet therapy (DAPT), have up to 10% risk of recurrent major adverse cardiac events (MACE) in the short term. METHODS: Here we review studies using more potent antithrombotic agent combinations to reduce this risk, namely triple therapy (TT) with the addition of an oral anticoagulant, PAR-1 antagonist, or cilostazol to DAPT (mainly aspirin and clopidogrel), and discuss the limitations of trials to date...
January 16, 2018: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29343466/long-term-cardiovascular-prognosis-after-transient-ischemic-attack-associated-predictors
#4
Angel Ois, Ana Zabalza, Antia Moreira, Elisa Cuadrado-Godia, Jordi Jimenez-Conde, Eva Giralt-Steinhauer, Ana Rodríguez-Campello, Carolina Soriano-Tarraga, Jaume Roquer
OBJECTIVE: To determine long-term cardiovascular risk after TIA and to identify the factors associated with increased risk. METHODS: This was a prospective observational registry of TIA patients admitted to the emergency room of our tertiary stroke center from June 2006 to January 2016. New vascular events (NVEs) were recorded from 3 months after TIA onset until June 2017, including both stroke and nonstroke events (coronary and peripheral disease). We registered TIA etiology, age, sex, vascular risk factors, radiologic data, and clinical TIA features and analyzed these variables in relation to NVE long-term risk...
January 17, 2018: Neurology
https://www.readbyqxmd.com/read/29338604/clinical-significance-of-cerebral-microbleeds-on-mri-a-comprehensive-meta-analysis-of-risk-of-intracerebral-hemorrhage-ischemic-stroke-mortality-and-dementia-in-cohort-studies-v1
#5
Andreas Charidimou, Sara Shams, Jose R Romero, Jie Ding, Roland Veltkamp, Solveig Horstmann, Gudny Eiriksdottir, Mark A van Buchem, Vilmundur Gudnason, Jayandra J Himali, M Edip Gurol, Anand Viswanathan, Toshio Imaizumi, Meike W Vernooij, Sudha Seshadri, Steven M Greenberg, Oscar R Benavente, Lenore J Launer, Ashkan Shoamanesh
Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, "high risk" elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29336708/emergency-dispatcher-stroke-recognition-associations-with-downstream-care
#6
J Adam Oostema, Todd Chassee, Mathew Reeves
OBJECTIVE: As the first point of contact for patients activating emergency medical services (EMS), emergency dispatchers have the earliest opportunity to recognize stroke. We sought to quantify dispatcher stroke recognition and its relationships with EMS stroke recognition and response speed. METHODS: We assembled a cohort of consecutive EMS-transported patients with a dispatcher suspected stroke or a hospital discharge diagnosis of stroke or transient ischemic attack (TIA)...
January 16, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29336359/white-matter-lesions-predict-recurrent-vascular-events-in-patients-with-transient-ischemic-attacks
#7
Xiao-Mei Ren, Shu-Wei Qiu, Ren-Yuan Liu, Wen-Bo Wu, Yun Xu, Hong Zhou
BACKGROUND: White matter lesions (WMLs) are common findings in brain magnetic resonance imaging (MRI) and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship between WMLs and transient ischemic attacks (TIAs) is not well established. This study aimed to determine the clinical significance of WMLs in patients with TIA. METHODS: A total of 181 consecutive inpatients with first-ever TIA were enrolled. Brain MRIs within 2 days of symptom onset were used to measure WML volumes...
January 20, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29335335/closure-of-patent-foramen-ovale-versus-medical-therapy-in-patients-with-cryptogenic-stroke-or-transient-ischemic-attack-updated-systematic-review-and-meta-analysis
#8
George Ntaios, Vasileios Papavasileiou, Dimitrios Sagris, Konstantinos Makaritsis, Konstantinos Vemmos, Thorsten Steiner, Patrik Michel
BACKGROUND AND PURPOSE: Previous systematic reviews and meta-analyses compared the efficacy and safety of patent foramen ovale (PFO) closure versus medical treatment in patients with cryptogenic stroke or transient ischemic attack (TIA). Recently, new evidence from randomized trials became available. METHODS: We searched PubMed until September 24, 2017, for trials comparing PFO closure with medical treatment in patients with cryptogenic stroke/TIA using the items: stroke or cerebrovascular accident or TIA and patent foramen ovale or paradoxical embolism and trial or study...
January 15, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29331614/the-burden-of-stroke-mimics-present-and-future-projections
#9
Kashif Waqar Faiz, Angela Susan Labberton, Bente Thommessen, Ole Morten Rønning, Fredrik A Dahl, Mathias Barra
BACKGROUND AND PURPOSE: An increasing proportion of patients presenting with suspected stroke prove to have other conditions, often referred to as stroke mimics. The aim of this study was to present a projection of the number of hospitalized strokes, transient ischemic attacks (TIAs), and stroke mimics in Norway up to the year 2050 based on expected demographic changes, to estimate the burden of stroke mimics in the coming decades. MATERIALS AND METHODS: This prospective study included all admissions to the stroke unit of Akershus University Hospital from March 1, 2012, to February 28, 2013...
January 10, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29330312/high-sensitive-c-reactive-protein-and-dual-antiplatelet-in-intracranial-arterial-stenosis
#10
Jiejie Li, Anxin Wang, Xingquan Zhao, Liping Liu, Xia Meng, Jinxi Lin, Jing Jing, Xinying Zou, Yilong Wang, Yongjun Wang
OBJECTIVE: To determine the relationship of high-sensitive C-reactive protein (hsCRP) and the efficacy and safety of dual antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. METHODS: A subgroup of 807 patients with both magnetic resonance angiography images and hsCRP measurement was analyzed. Cox proportional hazards models were used to assess the interaction of hsCRP levels with the effects of dual and single antiplatelet therapy...
January 12, 2018: Neurology
https://www.readbyqxmd.com/read/29330254/increased-levels-of-lectin-like-oxidized-low-density-lipoprotein-receptor-1-in-ischemic-stroke-and-transient-ischemic-attack
#11
Tonje Skarpengland, Mona Skjelland, Xiang Yi Kong, Karolina Skagen, Sverre Holm, Kari Otterdal, Christen P Dahl, Kirsten Krohg-Sørensen, Ellen L Sagen, Vigdis Bjerkeli, Anne Hege Aamodt, Azhar Abbas, Ida Gregersen, Pål Aukrust, Bente Halvorsen, Tuva B Dahl
BACKGROUND: Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) has been shown to be increased in patients with acute ischemic stroke. Here, we evaluated plasma sLOX-1 levels and vascular carotid plaque LOX-1 (ie, OLR1) gene expression in patients with ischemic stroke and transient ischemic attack (TIA) with particular focus on their relation to time since symptom onset. METHODS AND RESULTS: Plasma sLOX-1 (n=232) and carotid plaque OLR1 gene expression (n=146) were evaluated in patients who were referred to evaluation for carotid endarterectomy, as well as in healthy control plasma (n=81)...
January 12, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29329538/peripheral-blood-gene-expression-signatures-which-reflect-smoking-and-aspirin-exposure-are-associated-with-cardiovascular-events
#12
James A Wingrove, Karen Fitch, Brian Rhees, Steven Rosenberg, Deepak Voora
BACKGROUND: Cardiovascular disease and its sequelae are major causes of global mortality, and better methods are needed to identify patients at risk for future cardiovascular events. Gene expression analysis can inform on the molecular underpinnings of risk factors for cardiovascular events. Smoking and aspirin have known opposing effects on platelet reactivity and MACE, however their effects on each other and on MACE are not well described. METHODS: We measured peripheral blood gene expression levels of ITGA2B, which is upregulated by aspirin and correlates with platelet reactivity on aspirin, and a 5 gene validated smoking gene expression score (sGES) where higher expression correlates with smoking status, in participants from the previously reported PREDICT trial (NCT 00500617)...
January 12, 2018: BMC Medical Genomics
https://www.readbyqxmd.com/read/29327286/abcd3-i-score-and-the-risk-of-early-or-3-month-stroke-recurrence-in-tissue-and-time-based-definitions-of-tia-and-minor-stroke
#13
Lukas Mayer, Julia Ferrari, Stefan Krebs, Christian Boehme, Thomas Toell, Benjamin Matosevic, Alexander Tinchon, Michael Brainin, Thomas Gattringer, Peter Sommer, Peter Thun, Johann Willeit, Wilfried Lang, Stefan Kiechl, Michael Knoflach
Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving < 24 h after symptom onset in a phase where it is unclear, if the event turns out to be a TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke...
January 11, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29324452/adjudication-of-transient-ischemic-attack-and-stroke-in-the-multi-ethnic-study-of-atherosclerosis
#14
W T Longstreth, Natalie C Gasca, Rebecca F Gottesman, John B Pearce, Ralph L Sacco
BACKGROUND: To describe adjudication of transient ischemic attack (TIA) and stroke in an observational study. METHODS: We detail the process used to adjudicate TIA and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA), a large longitudinal cohort study. Two of three vascular neurologists adjudicated each event using specific protocols. We examined the initial agreement, effect of imaging on diagnosis of TIA versus ischemic stroke, and effect of strict and less strict criteria on the number of ischemic stroke subtypes classified as undetermined...
January 11, 2018: Neuroepidemiology
https://www.readbyqxmd.com/read/29321708/holter-monitorisation-results-in-early-period-of-acute-ischemic-stroke
#15
Sefer Günaydin, Birgül Baştan, Hürtan Acar, Belgin Petek Balci, Aytül Mutlu, Özlem Çokar
Introduction: Paroxysmal atrial fibrillation (PAF) has a similar risk with persistent AF for ischemic stroke. Holter monitorization (HM) and other long-term monitorization methods increased the detection of PAF and short-lasting runs of tachyarrhythmias. Their classification as PAF and roles in the etiology of ischemic stroke is controversial. In this study, we aimed to investigate the frequency of any duration of PAF and clinical characteristics of the patients with acute ischemic stroke who have undergone 24-hrs HM...
December 2017: Noro Psikiyatri Arsivi
https://www.readbyqxmd.com/read/29321704/efficacy-and-safety-of-warfarin-experience-in-a-stroke-polyclinic-in-stroke-patients
#16
Eda Çoban, Dursun Kirbaş, Dilek Atakli, Aysun Soysal
Introduction: Cardioembolic stroke is associated with high morbidity and mortality, with an increased risk of recurrent stroke. Oral anticoagulation is highly effective in reducing the risk of stroke and mortality compared with placebo. Our study aimed to highlight the safety and efficacy of warfarin by analyzing the 20-year follow-up of patients on warfarin therapy. Methods: A retrospective observational study was performed with ischemic stroke patients receiving warfarin at our stroke polyclinic between 1992 and 2012...
December 2017: Noro Psikiyatri Arsivi
https://www.readbyqxmd.com/read/29321107/can-i-send-this-patient-with-stroke-home-strategies-managing-transient-ischemic-attack-and-minor-stroke-in-the-emergency-department
#17
Bernard P Chang, Sara Rostanski, Joshua Willey, Benjamin Kummer, Eliza Miller, Mitchell Elkind
BACKGROUND: While transient ischemic attack and minor stroke (TIAMS) are common conditions evaluated in the emergency department (ED), there is controversy regarding the most effective and efficient strategies for managing them in the ED. Some patients are discharged after evaluation in the ED and cared for in the outpatient setting, while others remain in an observation unit without being admitted or discharged, and others experience prolonged and potentially costly inpatient admissions...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29317012/prehospital-identification-of-patients-with-a-final-hospital-diagnosis-of-stroke
#18
Elin Andersson, Linda Bohlin, Johan Herlitz, Annelie J Sundler, Zoltán Fekete, Magnus Andersson Hagiwara
Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke...
January 10, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29316357/cerebrovascular-events-in-systemic-lupus-erythematosus
#19
John G Hanly, Qiuju Li, Li Su, Murray B Urowitz, Caroline Gordon, Sang-Cheol Bae, Juanita Romero-Diaz, Jorge Sanchez-Guerrero, Sasha Bernatsky, Ann E Clarke, Daniel J Wallace, David A Isenberg, Anisur Rahman, Joan T Merrill, Paul Fortin, Dafna D Gladman, Ian N Bruce, Michelle Petri, Ellen M Ginzler, M A Dooley, Kristjan Steinsson, Rosalind Ramsey-Goldman, Asad A Zoma, Susan Manzi, Ola Nived, Andreas Jonsen, Munther A Khamashta, Graciela S Alarcón, Winn Chatham, Ronald F van Vollenhoven, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz-Irastorza, Manuel Ramos-Casals, S Sam Lim, Murat Inanc, Kenneth C Kalunian, Soren Jacobsen, Christine A Peschken, Diane L Kamen, Anca Askanase, Chris Theriault, Vernon Farewell
OBJECTIVE: To determine the frequency, associations and outcomes of cerebrovascular events (CerVEs) in a multi-ethnic/racial, prospective, SLE disease inception cohort. METHODS: Patients were assessed annually for 19 neuropsychiatric (NP) events including 5 types of CerVEs: (i) Stroke; (ii) Transient ischemia; (iii) Chronic multifocal ischemia; (iv) Subarachnoid/intracranial hemorrhage; (v) Sinus thrombosis. Global disease activity (SLEDAI-2K), SLICC/ACR damage index (SDI) and SF-36 scores were collected...
January 5, 2018: Arthritis Care & Research
https://www.readbyqxmd.com/read/29310133/percutaneous-closure-versus-medical-treatment-in-stroke-patients-with-patent-foramen-ovale-a-systematic-review-and-meta-analysis
#20
Salvatore De Rosa, Horst Sievert, Jolanda Sabatino, Alberto Polimeni, Sabato Sorrentino, Ciro Indolfi
Background: New evidence emerged recently regarding the percutaneous closure of patent foramen ovale (PFO) to prevent recurrent stroke in patients with cryptogenic stroke. Purpose: To compare risks for recurrent cerebrovascular events in adults with PFO and cryptogenic stroke who underwent PFO closure versus those who received medical therapy alone. Data Sources: PubMed, Scopus, and Google Scholar from 1 December 2004 through 14 September 2017; references of eligible studies; relevant scientific session abstracts; and cardiology Web sites...
January 9, 2018: Annals of Internal Medicine
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