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Acute ischemic stroke

Nicholas W Russo, Giovanna Petrucci, Bianca Rocca
Low-dose aspirin, alone or in combination, is recommended for the secondary prevention of acute non-cardioembolic ischemic stroke and transient ischemic attack, starting soon after the acute event. Clinically-relevant drug-drug interactions (DDIs) are a major concern of regulatory agencies and practicing physicians. Drug's pharmacodynamics and/or pharmacokinetics account for clinically-relevant DDIs that modify efficacy and/or safety of one or more of the co-administered drugs. Some non-steroidal anti-inflammatory drugs interact with aspirin pharmacodynamics by competing on the drug target, i...
October 17, 2016: Vascular Pharmacology
Marc P Bonaca, Mark A Creager, Jeffrey Olin, Benjamin M Scirica, Ian C Gilchrist, Sabina A Murphy, Erica L Goodrich, Eugene Braunwald, David A Morrow
OBJECTIVES: The aim of this study was to determine whether the reduction in peripheral revascularization with vorapaxar in patients with peripheral artery disease (PAD) is directionally consistent across indications, including acute limb ischemia, progressively disabling symptoms, or both. BACKGROUND: The protease-activated receptor-1 antagonist vorapaxar reduces peripheral revascularization in patients with PAD. METHODS: The TRA 2°P-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50) trial randomized 26,449 patients with histories of myocardial infarction, stroke, or symptomatic PAD to vorapaxar or placebo on a background of standard therapy...
October 24, 2016: JACC. Cardiovascular Interventions
Kostas Delaunay, Florence Le Jeune, Etienne Garin, Anne Devillers, Xavier Palard-Novello
A 75-year-old man with a history of prostate cancer was referred to our department to perform F-choline (FCH) PET/CT. FCH PET/CT showed a markedly increased uptake in the right temporoparietal junction brain. Three weeks earlier, acute ischemic stroke was diagnosed in the right temporoparietal junction brain on diffusion-weighted sequence and thrombosis in a distal branch of the right middle cerebral artery on MR angiography. Choline precursors promote repair and growth of cell membranes in neurologic diseases, so FCH PET/CT uptake could be explained by repair processes during early outcome of acute ischemic stroke...
October 18, 2016: Clinical Nuclear Medicine
Yasheng Chen, Rajat Dhar, Laura Heitsch, Andria Ford, Israel Fernandez-Cadenas, Caty Carrera, Joan Montaner, Weili Lin, Dinggang Shen, Hongyu An, Jin-Moo Lee
Although cerebral edema is a major cause of death and deterioration following hemispheric stroke, there remains no validated biomarker that captures the full spectrum of this critical complication. We recently demonstrated that reduction in intracranial cerebrospinal fluid (CSF) volume (∆ CSF) on serial computed tomography (CT) scans provides an accurate measure of cerebral edema severity, which may aid in early triaging of stroke patients for craniectomy. However, application of such a volumetric approach would be too cumbersome to perform manually on serial scans in a real-world setting...
2016: NeuroImage: Clinical
Andrea Gruneir, Lauren E Griffith, Kathryn Fisher, Dilzayn Panjwani, Sima Gandhi, Li Sheng, Chris Patterson, Amiram Gafni, Jenny Ploeg, Maureen Markle-Reid
OBJECTIVE: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. METHODS: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions...
October 19, 2016: Neurology
Luca Liberale, Fabrizio Montecucco, Ilaria Casetta, Silva Saraceni, Alessandro Trentini, Marina Padroni, Franco Dallegri, François Mach, Enrico Fainardi, Federico Carbone
BACKGROUND: Soluble mediators have been investigated to predict the prognosis of acute ischemic stroke (AIS). Among them, proprotein convertase subtilisin/kexin type 9 (PCSK9) might have both clinical and pathophysiological relevance. MATERIALS AND METHODS: All available serum samples from a cohort of patients with first AIS (n=72) were tested for PCSK9 and included in this sub-study analysis. The primary endpoint investigated the predictive value of early PCSK9 level variations (ΔPCSK9) from AIS onset to day 7 or from day 1 to day 7, towards a 90-day outcome by modified Rankin Scale (mRS)...
October 19, 2016: European Journal of Clinical Investigation
Sergio Amaro, Carlos Laredo, Arturo Renú, Laura Llull, Salvatore Rudilosso, Víctor Obach, Xabier Urra, Anna M Planas, Ángel Chamorro
BACKGROUND AND PURPOSE: Identification of neuroprotective therapies in acute ischemic stroke is imperative. We report a predefined analysis of the URICO-ICTUS trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke) assessing the efficacy of uric acid (UA) compared with placebo to prevent early ischemic worsening (EIW) and the relevance of collateral circulation. METHODS: URICO-ICTUS was a double-blind, placebo-controlled, phase 2b trial where a total of 411 patients treated with alteplase within 4...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Joan Montaner, Alejandro Bustamante, Silvia García-Matas, Maite Martínez-Zabaleta, Carmen Jiménez, Javier de la Torre, Francisco R Rubio, Tomás Segura, Jaime Masjuán, David Cánovas, Mar Freijo, Raquel Delgado-Mederos, Javier Tejada, Aida Lago, Yolanda Bravo, Natália Corbeto, Dolors Giralt, Bárbara Vives-Pastor, Anna de Arce, Francisco Moniche, Pilar Delgado, Marc Ribó
BACKGROUND AND PURPOSE: The STARS trial (Stroke Treatment With Acute Reperfusion and Simvastatin) was conducted to demonstrate the efficacy and safety of simvastatin treatment in acute stroke. METHODS: STARS07 was a multicentre, phase IV, prospective, randomized, double-blind, placebo-controlled trial. Patients with Acute ischemic stroke recruited within 12 hours from symptom onset were randomized to oral simvastatin 40 mg or placebo, once daily for 90 days. Primary outcome was proportion of independent patients (modified Rankin Scale score of ≤2) at 90 days...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Wolfgang G Kunz, M G Myriam Hunink, Wieland H Sommer, Sebastian E Beyer, Felix G Meinel, Franziska Dorn, Stefan Wirth, Maximilian F Reiser, Birgit Ertl-Wagner, Kolja M Thierfelder
BACKGROUND AND PURPOSE: Endovascular therapy in addition to standard care (EVT+SC) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke. Our aim was to determine the cost-effectiveness of EVT+SC depending on patients' initial National Institutes of Health Stroke Scale (NIHSS) score, time from symptom onset, Alberta Stroke Program Early CT Score (ASPECTS), and occlusion location. METHODS: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with both strategies applied in a US setting...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Zixiao Li, Chunjuan Wang, Xingquan Zhao, Liping Liu, Chunxue Wang, Hao Li, Haipeng Shen, Li Liang, Janet Bettger, Qing Yang, David Wang, Anxin Wang, Yuesong Pan, Yong Jiang, Xiaomeng Yang, Changqing Zhang, Gregg C Fonarow, Lee H Schwamm, Bo Hu, Eric D Peterson, Ying Xian, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. METHODS: Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Yuesong Pan, Ruoling Chen, Zixiao Li, Hao Li, Xingquan Zhao, Liping Liu, Chunxue Wang, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care. METHODS: We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
S Payabvash, S Taleb, J C Benson, A M McKinney
BACKGROUND AND PURPOSE: Acute stroke presentation and outcome depend on both ischemic infarct volume and location. We aimed to determine the association between acute ischemic infarct topology and lesion volume and stroke severity at presentation and discharge. MATERIALS AND METHODS: Patients with acute ischemic stroke who underwent MR imaging within 24 hours of symptom onset or last seen well were included. Infarcts were segmented and coregistered on the Montreal Neurological Institute-152 brain map...
October 6, 2016: AJNR. American Journal of Neuroradiology
S Dehkharghani, M Bowen, D C Haussen, T Gleason, A Prater, Q Cai, J Kang, R G Nogueira
BACKGROUND AND PURPOSE: The neuronal substrate is highly sensitive to temperature elevation; however, its impact on the fate of the ischemic penumbra has not been established. We analyzed interactions between temperature and penumbral expansion among successfully reperfused patients with acute ischemic stroke, hypothesizing infarction growth and worse outcomes among patients with fever who achieve full reperfusion. MATERIALS AND METHODS: Data from 129 successfully reperfused (modified TICI 2b/3) patients (mean age, 65 ± 15 years) presenting within 12 hours of onset were examined from a prospectively collected acute ischemic stroke registry...
October 6, 2016: AJNR. American Journal of Neuroradiology
Pavel Šiarnik, Zuzana Čarnická, Zuzana Krivošíková, Katarína Klobučníková, Ingrid Žitňanová, Branislav Kollár, Marek Sýkora, Peter Turčáni
Hypercholesterolemia represents a risk factor for the development of atherosclerosis. Lipoprotein research has recently been focused on the phenomenon of atherogenic and non-atherogenic lipoproteins. The aim of this study was to explore the association of lipoprotein subfractions with a measure for endothelial function (represented by reactive hyperemia index [RHI]) and arterial stiffness (represented by augmentation index [AI]) in patients with acute ischemic stroke. We enrolled 51 patients with acute ischemic stroke...
October 19, 2016: Scandinavian Journal of Clinical and Laboratory Investigation
Babak Bakhshayesh-Eghbali, Seyed-Ali Roudbary, Seddigheh Basir Jafari, Seyedeh-Parand Nabizadeh, Naghmeh Naderi-Asrami, Reza Sohrabnejad
BACKGROUND: Stroke is one of the leading causes of mortality and long-term morbidity. The aim of the present study was to determine the ability of baseline serum C-reactive protein (CRP) and white blood cell count (WBC) values in predicting the outcome of acute ischemic stroke (AIS). METHODS: This study consisted of patients with first AIS referred to Poursina Hospital, Rasht, Iran. Severity of stroke was determined according to the National Institute of Health (NIH) Stroke Scale at the time of admission...
2016: Caspian Journal of Internal Medicine
Yu Hasegawa, Shokei Kim-Mitsuyama
OBJECTIVE: Although hypertensive patients show significant elevation of blood pressure (BP) in acute phase after cerebral infarction, it is still unknown how it should be managed to carry the best prognosis. To address this issue, we investigated the effect of acute control of elevated BP by bilateral renal denervation (RD) against ischemic stroke in SHRSP rats with 90 minutes transient middle cerebral arterial occlusion (MCAO). DESIGN AND METHOD: Seventy-five male SHRSP rats of 15 weeks of age were assigned to sham-operated (control, n = 15) and MCAO + sham (sham, n = 30), and MCAO + RD (RD, n = 30)...
September 2016: Journal of Hypertension
Juhwan Noh, Jungwoo Sohn, Jaelim Cho, Changsoo Kim, Dong Chun Shin
OBJECTIVE: Epidemiological studies have been published acute or chronic adverse association between ambient particulate matter and cardiovascular/respiratory diseases. Recently, there has been increased interest in investigating the role of fine particulate matter on major adverse cardiovascular event (MACE). For the long-term effects, the external validity of studies has rarely been satisfied due to the representativeness of cohorts. The aim of this study was to investigate the potential impact of fine particulate matter long-term exposure on MACE, defined as time to incidence of acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or death due to cardiovascular cause...
September 2016: Journal of Hypertension
Craig Anderson, Doug McEvoy, Jiguang Wang
OBJECTIVE: There is uncertainty over whether treatment of obstructive sleep apnea (OSA) can prevent serious cardiovascular (CV) events. DESIGN AND METHOD: SAVE (NCT00738179; ACTRN12608000409370) was designed to determine whether treatment of OSA with CPAP reduces the risk of serious CV events in patients with established CV disease. Participants were centrally randomised to CPAP treatment or usual care between 2008 and 2013,with follow-up completed late 2015 and the results will be announced in August 2016...
September 2016: Journal of Hypertension
Madhumita Chatterjee, Meinrad Gawaz
Platelet membrane bedecked with a wide array of receptors offers a platform to regulate platelet responsiveness, thrombotic propensity, inflammatory disposition, and immune reactivity under diverse pathophysiological conditions. Ectopic proteolytic cleavage of such receptors irreversibly inactivates receptor-mediated intracellular signaling governing cellular functions, further releases soluble fragments into circulation which might modulate functions of target cells. Glycoprotein VI-(GPVI) is a membrane glycoprotein expressed in platelets and megakaryocytes...
October 18, 2016: Platelets
David Roshal
This case report describes a 41-year-old previously healthy male who presented with stuttering transient ischemic symptoms and radiographic evidence of a left common carotid artery thrombus as well as acute and subacute ischemic infarcts in the left middle cerebral artery territory. An exhaustive stroke work-up did not provide a plausible etiology for his symptoms. His complete blood count and iron studies, however, revealed evidence of severe iron-deficiency anemia without reactive thrombocytosis. His stool guaiac test was positive...
2016: Case Reports in Neurological Medicine
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