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Stroke TIA

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https://www.readbyqxmd.com/read/27935736/pioglitazone-and-risk-for-bone-fracture-safety-data-from-a-randomized-clinical-trial
#1
Catherine M Viscoli, Silvio E Inzucchi, Lawrence H Young, Karl L Insogna, Robin Conwit, Karen L Furie, Mark Gorman, Michael A Kelly, Anne M Lovejoy, Walter N Kernan
CONTEXT: Pioglitazone reduces cardiovascular risk in non-diabetic patients after an ischemic stroke or transient ischemic attack (TIA) but is associated with increased risk for bone fracture. OBJECTIVE: To characterize fractures associated with pioglitazone by location, mechanism, severity, timing, and sex. DESIGN, SETTING AND PATIENTS: Patients were 3876 non-diabetic participants in the Insulin Resistance Intervention after Stroke trial randomized to pioglitazone or placebo after an ischemic stroke or TIA and followed for a median of 4...
December 9, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27933666/risk-of-stroke-and-recurrence-after-af-ablation-in-patients-with-an-initial-event-free-period-of-12-months
#2
Simon Kochhäuser, Pouria Alipour, Tanjah Haig-Carter, Kathleen Trought, Philip Hache, Yaariv Khaykin, Zaev Wulffhart, Alfredo Pantanomd, Bernice Tsang, David Birnie, Atul Verma
INTRODUCTION: Because of the unclear prognostic effects of ablation of atrial fibrillation (AF), oral anticoagulation (OAC) is often continued after ablation even in asymptomatic patients. We sought to determine the frequency of stroke and AF recurrence in patients on and off therapeutic OAC one year after a successful AF ablation. METHODS AND RESULTS: Patients that underwent AF ablation and were free of AF 12 months after ablation were selected from our AF database...
December 9, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27932558/petct-imaging-of-unstable-carotid-plaque-with-ga-68-labelled-somatostatin-receptor-ligand
#3
Ming Young Simon Wan, Raymond Endozo, Sofia Michopoulou, Robert Shortman, Manuel Rodriguez-Justo, Leon Menezes, Syed Yusuf, Toby Richards, Damian Wild, Beatrice Waser, Jean Claude Reubi, Ashley Groves
BACKGROUND: Ga68 labelled somatostatin receptor ligand PET imaging has recently been shown in preclinical and early human studies to have a potential role in the evaluation of vulnerable arterial plaques. We prospectively evaluated carotid plaque Ga68-DOTATATE uptake in patients with recent carotid events, assessed inter- and intra- observer variability of such measurements, and explored the mechanism of any plaque DOTATATE activity with immunohistochemistry in resected specimens. MATERIALS & METHODS: 20 consecutively consenting patients with recent symptomatic carotid events (transient ischaemic attack [TIA], stroke or amaurosis fugax), due for carotid endarterectomy were prospectively recruited...
December 8, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/27927939/have-clinicians-adopted-the-use-of-brain-mri-for-patients-with-tia-and-minor-stroke
#4
Seemant Chaturvedi, Susan Ofner, Fitsum Baye, Laura J Myers, Mike Phipps, Jason J Sico, Teresa Damush, Edward Miech, Mat Reeves, Jason Johanning, Linda S Williams, Greg Arling, Eric Cheng, Zhangsheng Yu, Dawn Bravata
BACKGROUND: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. METHODS: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables...
December 7, 2016: Neurology
https://www.readbyqxmd.com/read/27927817/perioperative-management-of-adult-patients-with-a-history-of-stroke-or-transient-ischaemic-attack-undergoing-elective-non-cardiac-surgery
#5
Zehra Mehdi, Jonathan Birns, Judith Partridge, Ajay Bhalla, Jugdeep Dhesi
It is increasingly common for physicians and anaesthetists to be asked for advice in the medical management of surgical patients who have an incidental history of stroke or transient ischaemic attack (TIA). Advising clinicians requires an understanding of the common predictors, outcomes and management of perioperative stroke. The most important predictor of perioperative stroke is a previous history of stroke, and outcomes associated with such an event are extremely poor. The perioperative management of this patient group needs careful consideration to minimise the thrombotic risk and a comprehensive, individualised approach is crucial...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27919935/secondary-prevention-lifestyle-interventions-initiated-within-90-days-after-tia-or-minor-stroke-a-systematic-review-and-meta-analysis-of-rehabilitation-programmes
#6
Neil Heron, Frank Kee, Christopher Cardwell, Mark A Tully, Michael Donnelly, Margaret E Cupples
BACKGROUND: Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear. AIM: To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke...
December 5, 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/27917212/stroke-in-patients-with-diabetes-mellitus-a-study-from-north-western-nigeria
#7
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
#8
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/27916638/therapeutical-options-in-the-management-of-carotid-dissection
#9
Ombretta Martinelli, Salvatore Venosi, Jamila BenHamida, Alban Malay, Cristina Belli, Francesco Giosue' Irace, Roberto Gattuso, Giacomo Frati, Bruno Gossetti, Luigi Irace
OBJECTIVE: The best management of carotid artery dissection (CAD) is still controversial ranging from antiplatelet medication to open surgery or endovascular treatment. In this retrospective study we assessed the safety and efficacy of endovascular stent angioplasty for the treatment of CAD. METHODS: From February 2006 to February 2016, 44 patients (28 females and 16 males, age range 25-65 years, mean 42) with CAD were included in this study. The internal carotid artery (ICA) dissection was spontaneous in origin in 32 patients and post-traumatic in the remaining 12 (1 case it was bilateral)...
December 1, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27912198/usefulness-of-chads2-score-for-prognostic-stratification-of-patients-with-coronary-artery-disease-a-systematic-review-and-meta-analysis-of-cohort-studies
#10
Xiaobo Zhou, Kaiwu Cao, Shuangqing Kou, Shencheng Qu, Hongling Li, Ying Yu, Cong Wang, Yu Liu, Pengying Li, Dan Li
OBJECTIVE: To evaluate the role of CHADS2 score on predicting ischaemic stroke or transient ischaemic attack (TIA) and death in patients with coronary artery disease (CAD), irrespective of the presence or absence of atrial fibrillation (AF). METHODS: We searched for cohort studies that reported risk estimates for incidence of ischaemic stroke/TIA or mortality by levels of CHADS2 score in Medline/PubMed and Embase. Random effects models were used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs)...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27904593/the-role-of-endothelial-progenitor-cells-in-transient-ischemic-attack-patients-for-future-cerebrovascular-events
#11
Rokhsareh Meamar, Hamidreza Nikyar, Leila Dehghani, Maedeh Talebi, Marzieh Dehghani, Marzieh Ghasemi, Behnaz Ansari, Mohammad Saadatnia
BACKGROUND: The role of endothelial progenitor cells (EPCs) in the maintenance of vascularization following ischemic brain after experimental stroke has been established. Accordingly, in this study, we evaluated the role of circulating EPCs in transient ischemic attack (TIA) patients for future cerebrovascular (CV) events. MATERIALS AND METHODS: The level of circulating EPCs (staining markers: CD34, CD309) were determined using flow cytometry at 24 h after TIA in thirty consecutive patients...
2016: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/27901323/safety-of-carotid-revascularization-within-48-hours-of-symptomatic-presentation
#12
Kosmas I Paraskevas, Ian M Loftus
In the last few years, there has been a gradual shift in the recommendations of carotid guidelines towards performance of carotid endarterectomy (CEA) earlier in patients with >70% carotid artery stenosis suffering an ipsilateral transient ischemic attack (TIA)/minor stroke episode. The "6-month" threshold in the early guidelines was subsequently replaced with a "14-day" target. More recently, an even earlier intervention (i.e. "within 48 hours") gains support as the optimal timing for the performance of CEA in patients with symptomatic carotid artery stenosis...
November 30, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27899517/endovascular-management-of-cerebral-septic-embolism-three-recent-cases-and-review-of-the-literature
#13
Eugene L Scharf, Tia Chakraborty, Alejandro Rabinstein, Amrendra S Miranpuri
Endovascular management of acute ischemic stroke secondary to septic emboli from bacterial endocarditis is case-specific and outside established guidelines. We report three new cases of an acute ischemic stroke secondary to septic embolus from two different centers. All cases reported here were large vessel occlusions of the middle cerebral artery in anticoagulated patients. In one case the embolus was noted to be firm and aspiration thrombectomy was attempted in lieu of stent retrieval. Thrombolysis in Cerebral Ischemia (TICI) 3 recanalization was achieved and the patient experienced a good outcome with resolution of deficits...
November 29, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27898582/antithrombotic-therapy-in-patients-with-cerebral-microbleeds
#14
Duncan Wilson, David J Werring
PURPOSE OF REVIEW: Cerebral microbleeds (CMBs) are a radiological marker of cerebral small vessel disease corresponding to small haemosiderin foci identified by blood-sensitive MRI. CMBs are common in older community populations, and in individuals with ischaemic stroke or transient ischaemic attack (TIA), and intracerebral haemorrhage (ICH). We summarize how CMBs might contribute to assessing the future risk of ischaemic stroke and ICH to inform antithrombotic (antiplatelet or anticoagulant) decisions...
November 24, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27898406/low-incidence-of-atrial-fibrillation-in-patients-with-transient-ischemic-attack
#15
Kenneth Bruun Pedersen, Alexander Chemnitz, Charlotte Madsen, Niels C F Sandgaard, Søren Bak, Axel Brandes
BACKGROUND: Atrial fibrillation (AF) is a major cause of stroke. Therefore, all patients with ischemic stroke or transient ischemic attack (TIA) should be examined with 12-lead electrocardiogram (ECG) and continuous monitoring to detect AF. Current guidelines recommend at least 24 h continuous ECG monitoring, which is primarily based on studies investigating patients with ischemic stroke. The aim of our study was to investigate the diagnostic yield of 12-lead ECG and Holter monitoring in patients with TIA...
November 30, 2016: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/27894896/systematic-review-and-meta-analysis-of-dual-versus-single-antiplatelet-therapy-in-carotid-interventions
#16
REVIEW
M Barkat, S Hajibandeh, S Hajibandeh, F Torella, G A Antoniou
BACKGROUND: The importance of antiplatelet therapy for the management and prevention of ischaemic stroke cannot be overstated. Despite the established guidelines, there is no clear consensus on how to manage antiplatelet therapy during and after carotid interventions. OBJECTIVE: The objective was to undertake a systematic literature review and perform a meta-analysis to assess the effects of dual antiplatelet therapy in carotid endarterectomy (CEA) and stenting (CAS)...
November 26, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27881629/risk-of-fractures-after-stroke-results-from-the-ontario-stroke-registry
#17
Moira K Kapral, Jiming Fang, Shabbir M H Alibhai, Peter Cram, Angela M Cheung, Leanne K Casaubon, Marla Prager, Melissa Stamplecoski, Brennan Rashkovan, Peter C Austin
OBJECTIVE: To determine the risk of fractures after stroke. METHODS: Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n = 23,751) or TIA (n = 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors...
November 23, 2016: Neurology
https://www.readbyqxmd.com/read/27876659/surgical-treatment-for-patients-with-moyamoya-syndrome-and-type-1-neurofibromatosis
#18
Jose L Porras, Wuyang Yang, Tomas Garzon-Muvdi, Risheng Xu, Jaishri Blakeley, Allan Belzberg, Justin M Caplan, Syed Khalid, Geoffrey P Colby, Alexander L Coon, Rafael J Tamargo, Edward S Ahn, Judy Huang
INTRODUCTION: The current study describes the impact of surgery in preventing follow-up ipsilateral TIAs/strokes in an East Coast North American cohort of patients with both moyamoya syndrome (MMS) and neurofibromatosis type 1 (NF1) (MMS-NF1). METHODS: We retrospectively reviewed records of patients with MMS and NF1 at the Johns Hopkins Medical Institutions from 1990-2014. Baseline characteristics and follow-up results including subsequent ipsilateral strokes were collected, and compared between a revascularization group (group1) and a conservatively managed group (group2) on a per-hemisphere basis...
November 19, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27876328/best-clinical-practice-controversies-in-transient-ischemic-attack-evaluation-and-disposition-in-the-emergency-department
#19
Brit Long, Alex Koyfman
BACKGROUND: Transient ischemic attack (TIA) affects over 200,000 patients annually in the United States, and it precedes approximately 14% to 23% of strokes. Patients are typically admitted for evaluation and management. OBJECTIVE: This review investigates the controversies of emergency department (ED) evaluation of TIA, including imaging, clinical risk scores, rapid diagnostic protocols, and disposition. DISCUSSION: TIA is a common condition, with over 200,000 patients affected annually, and is associated with risk of stroke...
November 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27857223/non-high-density-lipoprotein-cholesterol-levels-on-the-risk-of-asymptomatic-intracranial-arterial-stenosis-a-result-from-the-apac-study
#20
Jianwei Wu, Anxin Wang, Xin Li, Shouling Wu, Xingquan Zhao
Intracranial arterial stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack (TIA), and the correlation between the plasma non-high density cholesterol (non-HDLC) levels and ICAS, especially asymptomatic ICAS (AICAS) is not clear. The Asymptomatic Polyvascular Abnormalities Community(APAC) study is a community-based, prospective, long-term follow-up observational study. 3387 participants were enrolled in this study. The diagnosis of AICAS was made by transcranial Doppler ultrasonography...
November 18, 2016: Scientific Reports
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