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Intracerebral hemorrhage randomized

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https://www.readbyqxmd.com/read/28730950/statistical-analysis-plan-for-the-head-position-in-stroke-trial-headpost-an-international-cluster-cross-over-randomized-trial
#1
Laurent Billot, Mark Woodward, Hisatomi Arima, Maree L Hackett, Paula Muñoz Venturelli, Pablo M Lavados, Alejandro Brunser, Bin Peng, Liying Cui, Lily Song, Stephane Heritier, Stephen Jan, Sandy Middleton, Verónica V Olavarría, Joyce Lim, Thompson Robinson, Octavio Pontes-Neto, Caroline Watkins, Craig S Anderson
Background There is evidence to indicate that the lying flat head position increases cerebral blood flow and oxygenation in patients with acute ischemic stroke, but how these physiological effects translate into clinical outcomes is uncertain. The Head Position in Stroke Trial aims to determine the comparative effectiveness of lying flat (0°) compared to sitting up (≥30°) head positioning, initiated within 24 h of hospital admission for patients with acute stroke. Design An international, pragmatic, cluster-randomized, crossover, open, blinded outcome assessed clinical trial...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28706113/pd-l1-programmed-death-ligand-1-protects-against-experimental-intracerebral-hemorrhage-induced-brain-injury
#2
Ranran Han, Jiaying Luo, Yanchao Shi, Yang Yao, Junwei Hao
BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is a neurologically destructive stroke, for which no valid treatment is available. This preclinical study examined the therapeutic effect of PD-L1 (programmed death ligand 1), a B7 family member and a ligand for both PD-1 (programmed death 1) and B7-1 (CD80), in a murine ICH model. METHODS: ICH was induced by injecting autologous blood into 252 male C57BL/6 and Rag1(-/-) mice. One hour later, ICH mice were randomly assigned to receive an intraperitoneal injection of vehicle, PD-L1, or anti-PD-L1 antibody...
July 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28701501/blood-pressure-reduction-and-noncontrast-ct-markers-of-intracerebral-hemorrhage-expansion
#3
Andrea Morotti, Gregoire Boulouis, Javier M Romero, H Bart Brouwers, Michael J Jessel, Anastasia Vashkevich, Kristin Schwab, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Reneé Hebert Martin, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
OBJECTIVE: To validate various noncontrast CT (NCCT) predictors of hematoma expansion in a large international cohort of ICH patients and investigate whether intensive blood pressure (BP) treatment reduces ICH growth and improves outcome in patients with these markers. METHODS: We analyzed patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized controlled trial. Participants were assigned to intensive (systolic BP <140 mm Hg) vs standard (systolic BP <180 mm Hg) treatment within 4...
July 12, 2017: Neurology
https://www.readbyqxmd.com/read/28681745/a-randomized-controlled-study-of-operative-versus-nonoperative-treatment-for-large-spontaneous-supratentorial-intracerebral-hemorrhage
#4
Mukesh K Bhaskar, Rakesh Kumar, Balakrishna Ojha, Sunil K Singh, Nishant Verma, Rajesh Verma, Anil Chandra, Chhitij Srivastava, Manish Jaiswal, Somil Jaiswal, Harsha Huliyappa
CONTEXT: Spontaneous intracerebral haemorrhage (ICH) accounts for 4-14% of all strokes and has a high mortality rate of 30-50% during the first month. Management of large hematomas is controversial, with some advocating medical management while others favoring surgical evacuation. AIM: This study was undertaken to compare the outcome of patients with a spontaneous supratentorial intracerebral hemorrhage (SSICH) managed with or without surgical evacuation. SETTINGS AND DESIGN: Four hundred and eighty-two SSICH patients admitted from September 2013 to August 2015 were evaluated based on the inclusion and exclusion criteria...
July 2017: Neurology India
https://www.readbyqxmd.com/read/28664399/metformin-attenuates-neurological-deficit-after-intracerebral-hemorrhage-by-inhibiting-apoptosis-oxidative-stress-and-neuroinflammation-in-rats
#5
Boxiang Qi, Libao Hu, Lei Zhu, Lei Shang, Xuecheng Wang, Na Liu, Nana Wen, Yao Hong, Daihua Fang
Intracerebral hemorrhage (ICH) can lead to brain damage and even death, and there is lack of effective therapeutic methods for treating ICH. Although recent studies have focused on the administration of metformin in treating stroke, there is no literature to support whether it can be used to treat ICH. Therefore, the aim of this study was to evaluate the possible effects of metformin on ICH and the underlying mechanisms of those effects. An ICH model was established in adult male Sprague-Dawley rats. Rats were randomly divided into three groups: sham group, ICH group, and ICH+metformin group...
June 29, 2017: Neurochemical Research
https://www.readbyqxmd.com/read/28658126/antihypertensive-treatments-for-spontaneous-intracerebral-hemorrhage-in-patients-with-cerebrovascular-stenosis-a-randomized-clinical-trial-atichst
#6
RANDOMIZED CONTROLLED TRIAL
Zengpanpan Ye, Xiaolin Ai, Jun Zheng, Xin Hu, Sen Lin, Chao You, Hao Li
INTRODUCTION: Antihypertensive treatment is associated with clinical outcomes in patients with spontaneous intracerebral hemorrhage (sICH). ADAPT showed that intensive blood pressure lowering (<140 mm Hg) does not reduce peri-hematoma regional cerebral blood flow (rCBF) in patients with sICH. However, the stenosis of main cerebral arteries that has a high presence in patients with sICH is well-known related to the brain ischemia. The effect of intensive BP lowering for sICH in patients with cerebrovascular stenosis is still unknown...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28655601/the-effect-of-monascin-on-hematoma-clearance-and-edema-after-intracerebral-hemorrhage-in-rats
#7
Juan Wang, Gaiqing Wang, Jinying Yi, Yi Xu, Shuna Duan, Tong Li, Xin-Gang Sun, Liang Dong
BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is a particularly devastating form of stroke with high mortality and morbidity. Hematomas are the primary cause of neurologic deficits associated with ICH. The products of hematoma are recognized as neurotoxins and the main contributors to edema formation and tissue damage after ICH. Finding a means to efficiently promote absorption of hematoma is a novel clinical challenge for ICH. Peroxisome proliferator-activated receptor gamma (PPARγ) and nuclear factor erythroid 2-related factor 2 (Nrf2), had been shown that, can take potential roles in the endogenous hematoma clearance...
June 24, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28644250/cholesterol-levels-and-hemorrhagic-stroke-risk-in-east-asian-versus-non-east-asian-populations-a-systematic-review-and-meta-analysis
#8
Liang Xie, Wei Wu, Jin Chen, Jianglong Tu, Jun Zhou, Xueliang Qi, Xiaoping Yin
BACKGROUND: The aim of this work was to evaluate the relationships between cholesterol levels and risk of hemorrhagic stroke [including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)] in East Asian versus non-East Asian populations. MATERIALS AND METHODS: Relevant prospective studies were identified from systematic searches of PubMed and EMBASE. A random-effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) that were used to compare the relationships between cholesterol levels and risk of hemorrhagic stroke in East Asian versus non-East Asian populations...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28630871/a-systematic-review-and-meta-analysis-on-the-treatment-of-cerebral-hemorrhage-with-naoxueshu-oral-liquid
#9
REVIEW
Lijun Wu, Yanda Li, Xiaofeng Wang, Xiaomeng Ren, Haiyan Zhu, Yikun Sun, Yanwei Xing, Lingqun Zhu, Yonghong Gao, Hongcai Shang
NaoXueShu oral liquid invigorates Qi and promotes blood circulation, which is mainly used for treating the acute stage of the meridian of hemorrhagic apoplexy and acute blood stasis syndrome during early convalescence. Its main clinical manifestations include hemiplegia, mouth askew, hemianesthesia, and inarticulateness. It is used mainly in patients with lobar hemorrhage, basal ganglia, and thalamus of the small amount of bleeding without disturbing consciousness of hypertensive cerebral. The purpose of this study was to evaluate the efficacy and adverse effects of NaoXueShu oral liquid on the treatment of cerebral hemorrhage...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28628707/intensive-blood-pressure-reduction-and-spot-sign-in-intracerebral-hemorrhage-a-secondary-analysis-of-a-randomized-clinical-trial
#10
Andrea Morotti, H Bart Brouwers, Javier M Romero, Michael J Jessel, Anastasia Vashkevich, Kristin Schwab, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Renee Hebert Martin, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
Importance: The computed tomographic angiography (CTA) spot sign is associated with intracerebral hemorrhage (ICH) expansion and may mark those patients most likely to benefit from intensive blood pressure (BP) reduction. Objective: To investigate whether the spot sign is associated with ICH expansion across a wide range of centers and whether intensive BP reduction decreases hematoma expansion and improves outcome in patients with ICH and a spot sign. Design, Setting, and Participants: SCORE-IT (Spot Sign Score in Restricting ICH Growth) is a preplanned prospective observational study nested in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized clinical trial...
June 19, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28619989/low-versus-standard-dose-alteplase-in-patients-on-prior-antiplatelet-therapy-the-enchanted-trial-enhanced-control-of-hypertension-and-thrombolysis-stroke-study
#11
RANDOMIZED CONTROLLED TRIAL
Thompson G Robinson, Xia Wang, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph P Broderick, Andrew M Demchuk, Geoffery A Donnan, Jong S Kim, Pablo M Lavados, Tsong-Hai Lee, Richard I Lindley, Sheila C O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Thang H Nguyen, Ji-Guang Wang, Mark Woodward, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Many patients receiving thrombolysis for acute ischemic stroke are on prior antiplatelet therapy (APT), which may increase symptomatic intracerebral hemorrhage risk. In a prespecified subgroup analysis, we report comparative effects of different doses of intravenous alteplase according to prior APT use among participants of the international multicenter ENCHANTED study (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS: Among 3285 alteplase-treated patients (mean age, 66...
July 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28605557/practice-patterns-for-neurosurgical-utilization-and-outcome-in-acute-intracerebral-hemorrhage-intensive-blood-pressure-reduction-in-acute-cerebral-hemorrhage-trials-1-and-2-studies
#12
Rui Guo, David J Blacker, Xia Wang, Hisatomi Arima, Pablo M Lavados, Richard I Lindley, John Chalmers, Craig S Anderson, Thompson Robinson
BACKGROUND: The prognosis in acute spontaneous intracerebral hemorrhage (ICH) is related to hematoma volume, where >30 mL is commonly used to define large ICH as a threshold for neurosurgical decompression but without clear supporting evidence. OBJECTIVES: To determine the factors associated with large ICH and neurosurgical intervention among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT). METHODS: We performed pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2839) studies of ICH patients (<6 h of onset) with elevated systolic blood pressure (SBP, 150-220 mm Hg) who were randomized to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-recommended (target SBP < 180 mm Hg) management...
June 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28600010/hemicraniectomy-for-ischemic-and-hemorrhagic-stroke-facts-and-controversies
#13
REVIEW
Aman Gupta, Mithun G Sattur, Rami James N Aoun, Chandan Krishna, Patrick B Bolton, Brian W Chong, Bart M Demaerschalk, Mark K Lyons, Jamal McClendon, Naresh Patel, Ayan Sen, Kristin Swanson, Richard S Zimmerman, Bernard R Bendok
Malignant large artery stroke is associated with high mortality of 70% to 80% with best medical management. Decompressive craniectomy (DC) is a highly effective tool in reducing mortality. Convincing evidence has accumulated from several randomized trials, in addition to multiple retrospective studies, that demonstrate not only survival benefit but also improved functional outcome with DC in appropriately selected patients. This article explores in detail the evidence for DC, nuances regarding patient selection, and applicability of DC for supratentorial intracerebral hemorrhage and posterior fossa ischemic and hemorrhagic stroke...
July 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28592775/blood-pressure-management-for-stroke-prevention-and-in-acute-stroke
#14
REVIEW
Keun-Sik Hong
Elevated blood pressure (BP) is the leading modifiable risk factor for stroke and the benefit of BP lowering therapy on the stroke risk reduction is well established. The optimal BP target for preventing stroke and other vascular events have been controversial, but the evidences from epidemiological studies and randomized controlled trials (RCTs) support intensive BP lowering for greater vascular protection, particularly for stroke prevention. For secondary stroke prevention, the evidence of intensive BP lowering benefit is limited since only a single RCT for patients with lacunar infarctions was conducted and most data were driven by exploratory analyses...
May 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28586894/association-between-cirrhosis-and-stroke-in-a-nationally-representative-cohort
#15
Neal S Parikh, Babak B Navi, Yecheskel Schneider, Arun Jesudian, Hooman Kamel
Importance: Cirrhosis is associated with hemorrhagic and thrombotic extrahepatic complications. The risk of cerebrovascular complications is less well understood. Objective: To investigate the association between cirrhosis and various stroke types. Design, Setting, and Participants: We performed a retrospective cohort study using inpatient and outpatient Medicare claims data from January 1, 2008, through December 31, 2014, for a random 5% sample of 1 618 059 Medicare beneficiaries older than 66 years...
June 5, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28571544/programmed-cell-death-after-intracerebral-hemorrhage
#16
Tobias Bobinger, Petra Burkardt, Hagen B Huttner, Anatol Manaenko
Intracerebral hemorrhage (ICH) accounts for up to 15% of all strokes and is characterized by high rates of mortality and morbidity. At present, treatment of ICH patients is based on oral anticoagulant reversal and management of blood pressure and other medical complications. The primary damage is caused by the hematoma's extensive effects, which cause disruption and mechanical deformation of the cellular architecture. Damage secondary to the primary insult is induced by mitochondrial dysfunction, microglia activation and neurotransmitter and inflammatory mediator release...
June 1, 2017: Current Neuropharmacology
https://www.readbyqxmd.com/read/28527588/mechanical-thrombectomy-for-acute-ischemic-stroke-in-a-patient-with-concomitant-spontaneous-intracerebral-hemorrhage
#17
Stefano Forlivesi, Paolo Bovi, Manuel Cappellari
Data from randomized clinical trials and current guidelines suggest that patients with anterior circulation occlusion with contraindications to intravenous thrombolysis may benefit from direct mechanical thrombectomy. Nevertheless, no data are available on the efficacy and safety of direct mechanical thrombectomy in patients with concomitant spontaneous intracerebral hemorrhage. We report the case of a 51-year-old woman with a spontaneous intracerebral hemorrhage in the right parietal and occipital lobes, who experienced, 7 days later, an occlusion of the proximal left middle cerebral artery...
August 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28525977/the-intracerebral-hemorrhage-acutely-decreasing-arterial-pressure-trial-ii-ich-adapt-ii-protocol
#18
Laura Gioia, Ana Klahr, Mahesh Kate, Brian Buck, Dariush Dowlatshahi, Thomas Jeerakathil, Derek Emery, Kenneth Butcher
BACKGROUND: Aggressively lowering blood pressure (BP) in acute intracerebral hemorrhage (ICH) may improve outcome. Although there is no evidence that BP reduction changes cerebral blood flow, retrospective magnetic resonance imaging (MRI) studies have demonstrated sub-acute ischemic lesions in ICH patients. The primary aim of this study is to assess ischemic lesion development in patients randomized to two different BP treatment strategies. We hypothesize aggressive BP reduction is not associated with ischemic injury after ICH...
May 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28512445/the-therapeutic-value-of-bone-marrow-derived-endothelial-progenitor-cell-transplantation-after-intracerebral-hemorrhage-in-rats
#19
Rui Zhang, Jing Yang, Jingjing Yuan, Bo Song, Yan Wang, Yuming Xu
AIMS: To study the effect of endothelial progenitor cell (EPC) treatment on intracerebral hemorrhage (ICH) in rats and elucidate possible mechanisms. METHODS: The rats were randomly divided into three groups: (1) EPC group: ICH + EPC, (2) phosphate-buffered saline group: ICH + PBS, and (3) sham group. EPCs were transplanted intravenously 6 h after ICH. Modified neurological severity score was used to evaluate neurological function. Blood-brain barrier (BBB) integrity was evaluated...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28507269/randomized-multicenter-trial-of-artss-2-argatroban-with-recombinant-tissue-plasminogen-activator-for-acute-stroke
#20
RANDOMIZED CONTROLLED TRIAL
Andrew D Barreto, Gary A Ford, Loren Shen, Claudia Pedroza, Jon Tyson, Chunyan Cai, Mohammad H Rahbar, James C Grotta
BACKGROUND AND PURPOSE: We conducted a randomized exploratory study to assess safety and the probability of a favorable outcome with adjunctive argatroban, a direct thrombin-inhibitor, administered to recombinant tissue-type plasminogen activator (r-tPA)-treated ischemic stroke patients. METHODS: Patients treated with standard-dose r-tPA, not receiving endovascular therapy, were randomized to receive no argatroban or argatroban (100 μg/kg bolus) followed by infusion of either 1 (low dose) or 3 μg/kg per minute (high dose) for 48 hours...
June 2017: Stroke; a Journal of Cerebral Circulation
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