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Acute ischemic stroke

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https://www.readbyqxmd.com/read/28345479/imaging-the-physiological-evolution-of-the-ischemic-penumbra-in-acute-ischemic-stroke
#1
Richard Leigh, Linda Knutsson, Jinyuan Zhou, Peter Cm van Zijl
We review the hemodynamic, metabolic and cellular parameters affected during early ischemia and their changes as a function of approximate cerebral blood flow ( CBF) thresholds. These parameters underlie the current practical definition of an ischemic penumbra, namely metabolically affected but still viable brain tissue. Such tissue is at risk of infarction under continuing conditions of reduced CBF, but can be rescued through timely intervention. This definition will be useful in clinical diagnosis only if imaging techniques exist that can rapidly, and with sufficient accuracy, visualize the existence of a mismatch between such a metabolically affected area and regions that have suffered cell depolarization...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28345431/collaterals-2016-translating-the-collaterome-around-the-globe
#2
David S Liebeskind, Graham W Woolf, Ashfaq Shuaib
Collaterals 2016 (third International Symposium on Collaterals to the Brain) was a multidisciplinary scientific conference focused on collateral circulation in acute ischemic stroke. Decisive challenges include generalizability of optimal triage and selection paradigms based on collateral status for definitive treatment of acute ischemic stroke, rapid dissemination of expert methods, and the urgent need to leverage networking opportunities for stroke science related to the hemodynamics of collaterals. The collaterome, or individual capacity to offset ischemia in the brain, and determination of a favorable collateral profile have become pivotal factors in consideration of the precision medicine of stroke decision-making...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28345373/infarct-topography-and-functional-outcomes
#3
Mark R Etherton, Natalia S Rost, Ona Wu
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28344655/interactions-among-cox-2-gpiiia-and-p2y1-variants-are-associated-with-aspirin-responsiveness-and-adverse-events-in-patients-with-ischemic-stroke
#4
Xingyang Yi, Zhao Han, Qiang Zhou, Jing Lin, Chun Wang
BACKGROUND: The effect of gene variants and their interactions on response to aspirin and clinical adverse outcomes after an acute ischemic stroke (IS) is not fully understood. The aim of this study was to investigate the association of aspirin-relevant gene variants and their interactions with clinical adverse outcomes in IS patients taking aspirin. METHODS: A total of 14 variants from six genes encoding COX enzymes (COX-1, COX-2), platelet membrane receptors (TXAS1, P2Y1, P2Y12) and glycoprotein receptor (GPIIIa) were examined in 850 acute IS patients...
March 2017: Therapeutic Advances in Neurological Disorders
https://www.readbyqxmd.com/read/28343220/hemorrhagic-transformations-after-thrombectomy-risk-factors-and-clinical-relevance
#5
Johannes Kaesmacher, Mirjam Kaesmacher, Christian Maegerlein, Claus Zimmer, Alexandra S Gersing, Silke Wunderlich, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Hemorrhagic transformation (HT) is a major complication of acute ischemic stroke, potentially associated with clinical deterioration. We attempted to identify risk factors and evaluated clinical relevance of minor and major HTs following endovascular thrombectomy (ET) in isolated middle cerebral artery (MCA) occlusions. METHODS: This is a retrospective single-center analysis of 409 patients with isolated MCA occlusion treated with ET. Patients' and procedural characteristics, severity of HT according to the European Cooperative Acute Stroke Study criteria, and clinical outcomes were analyzed...
March 25, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28343192/post-stroke-fatigue-and-its-dimensions-within-first-3-months-after-stroke
#6
Iryna I Delva, Nataliya V Lytvynenko, Mykhaylo Y Delva
INTRODUCTION: Post-stroke fatigue (PSF) is a common stroke complication with long-term negative consequences. AIM: Assess the qualitative and quantitative PSF characteristics during 3 month post-stroke period. MATERIALS AND METHODS: There were examined 141 patients with acute ischemic or hemorrhagic strokes at hospital stay, in 1, 2 and 3 months after stroke. PSF was measured by fatigue assessment scale (FAS), multidimensional fatigue inventory-20 (MFI-20) and fatigue severity scale (FSS)...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/28342656/nurses-are-as-specific-and-are-earlier-in-calling-in-hospital-stroke-alerts-compared-to-physicians
#7
Pravin George, Dolora R Wisco, James Gebel, Ken Uchino, Christopher R Newey
INTRODUCTION: In-hospital stroke alerts are typically activated by nurses or physicians when a patient's neurological status acutely changes from baseline. It is unclear if knowledge of stroke symptoms translates to accurate activation of the acute stroke team. We hypothesized that nurses who activate the stroke alert system would correctly identify as great a proportion of acute strokes as physicians. We also investigated the time to activation of these in-hospital stroke alerts. METHODS: We retrospectively reviewed consecutive inpatient stroke team calls over a 12-month period at a single, tertiary care center...
March 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28341523/intracranial-stents-in-the-endovascular-treatment-of-acute-ischemic-stroke
#8
F Delgado Acosta, E Jiménez Gómez, I Bravo Rey, F A Bravo Rodríguez, J J Ochoa Sepúlveda, R Oteros Fernández
OBJECTIVE: To evaluate the efficacy and safety of intracranial stenting as a rescue therapy after failed mechanical thrombectomy in patients with acute ischemic stroke. MATERIAL AND METHODS: We retrospectively studied 42 patients treated with intracranial stenting after failed mechanical thrombectomy between December 2008 and January 2016. We compared outcomes before and after the incorporation of stentrievers. We assessed the degree of recanalization in the carotid and basilar territories (modified TIMI score), prognostic factors, and outcome (modified Rankin Score at 3 months)...
March 21, 2017: Radiología
https://www.readbyqxmd.com/read/28341074/long-term-prognosis-in-ischemic-stroke-patients-treated-with-intravenous-thrombolytic-therapy
#9
Maja Stefanovic Budimkic, Tatjana Pekmezovic, Ljiljana Beslac-Bumbasirevic, Marko Ercegovac, Ivana Berisavac, Predrag Stanarcevic, Visnja Padjen, Dejana R Jovanović
BACKGROUND AND PURPOSE: It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke. METHODS: This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013...
January 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28339617/searching-for-the-smoker-s-paradox-in-acute-stroke-patients-treated-with-intravenous-thrombolysis
#10
Haitham M Hussein, Nicki Niemann, Emily D Parker, Adnan I Qureshi
Background: Inconsistent evidence supports better outcome in smokers after stroke. Our study examines this association in a large sample of ischemic stroke treated with intravenous thrombolysis. Method: Virtual International Stroke Trials Archive (VISTA) database, composed of individual patient data of multiple clinical trials, was queried. The primary outcome was functional independence at 3 months noted by modified Rankin Scale (mRS; a 7-point scale ranging from 0 [no deficit] to 6 [death]) score≤ 2...
January 28, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28336740/towards-personalised-intra-arterial-treatment-of-patients-with-acute-ischaemic-stroke-a-study-protocol-for-development-and-validation-of-a-clinical-decision-aid
#11
Maxim J H L Mulder, Esmee Venema, Bob Roozenbeek, Joseph P Broderick, Sharon D Yeatts, Pooja Khatri, Olvert A Berkhemer, Yvo B W E M Roos, Charles B L M Majoie, Robert J van Oostenbrugge, Wim H van Zwam, Aad van der Lugt, Ewout W Steyerberg, Diederik W J Dippel, Hester F Lingsma
INTRODUCTION: Overall, intra-arterial treatment (IAT) proved to be beneficial in patients with acute ischaemic stroke due to a proximal occlusion in the anterior circulation. However, heterogeneity in treatment benefit may be relevant for personalised clinical decision-making. Our aim is to improve selection of patients for IAT by predicting individual treatment benefit or harm. METHODS AND ANALYSIS: We will use data collected in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial to analyse the effect of baseline characteristics on outcome and treatment effect...
March 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/28336679/transfer-to-high-volume-centers-associated-with-reduced-mortality-after-endovascular-treatment-of-acute-stroke
#12
Lorenzo Rinaldo, Waleed Brinjikji, Alejandro A Rabinstein
BACKGROUND AND PURPOSE: Some have argued that it may be beneficial to expand the availability of endovascular revascularization services to lower-volume hospitals to minimize the morbidity associated with transfer to larger endovascular centers. We compared the outcomes after revascularization of patients directly admitted to a low-volume center and those transferred to a high-volume center. METHODS: We searched a national database of hospital-reported outcomes for patients who underwent endovascular revascularization for acute ischemic stroke...
March 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28335706/transcarotid-artery-revascularization-with-flow-reversal
#13
Alper Alpaslan, Max Wintermark, László Pintér, Sumaira Macdonald, Richard Ruedy, Ralf Kolvenbach
PURPOSE: To report a study evaluating the safety and efficacy of stenting via direct carotid access with flow reversal using the ENROUTE Transcarotid Neuroprotection System. METHODS: Between March 2009 and June 2012, 75 patients (mean age 72.6 years; 45 men) underwent carotid artery stenting with the ENROUTE System; the majority of patients (63, 84%) were asymptomatic. The primary safety endpoint was the composite of major stroke, myocardial infarction, or death at 30 days...
April 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28334591/crossing-the-communication-chasm-challenges-and-opportunities-in-transitions-of-care-from-the-hospital-to-the-primary-care-clinic
#14
Nicholas A Rattray, Jason J Sico, LeeAnn M Cox, Alissa L Russ, Marianne S Matthias, Richard M Frankel
BACKGROUND: Transitions of care from specialty and acute settings to primary care abound. Compared to the continuity in end-of-shift handoffs, care transitions involve provider communication between practices and facilities with their own cultures and bureaucracies. Using the transition from acute care to outpatient primary care for stroke/transient ischemic attack (TIA) patients as a case study, this qualitative research explored communication practices and institutional arrangements among clinical providers responsible for longitudinal management of hypertension...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28333925/video-based-educational-intervention-associated-with-improved-stroke-literacy-self-efficacy-and-patient-satisfaction
#15
Mary Carter Denny, Farhaan Vahidy, Kim Y T Vu, Anjail Z Sharrief, Sean I Savitz
BACKGROUND AND PURPOSE: Interventions are needed to improve stroke literacy among recent stroke survivors. We developed an educational video for patients hospitalized with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). METHODS: A 5-minute stroke education video was shown to our AIS and ICH patients admitted from March to June 2015. Demographics and a 5-minute protocol Montreal Cognitive Assessment were also collected. Questions related to stroke knowledge, self-efficacy, and patient satisfaction were answered before, immediately after, and 30 days after the video...
2017: PloS One
https://www.readbyqxmd.com/read/28330447/cigarette-smoking-is-an-independent-risk-factor-for-post-stroke-delirium
#16
Tae Sung Lim, Jin Soo Lee, Jung Han Yoon, So Young Moon, In Soo Joo, Kyoon Huh, Ji Man Hong
BACKGROUND: Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. METHODS: A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65...
March 23, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28330015/contact-aspiration-versus-stent-retriever-front-line-for-recanalisation-in-acute-cerebral-infarction-the-aster-trial
#17
Bertrand Lapergue, Julien Labreuche, Michel Piotin
RATIONALE: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion (LVO). Favorable outcome is strongly associated with the successful reperfusion status. New techniques for MT such as contact aspiration (CA) seem promising to increase reperfusion status and clinical outcome in retrospective studies. We aim at ascertaining whether CA is more efficient than stent retriever as a front-line endovascular procedure...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28330012/mechanical-thrombectomy-for-minor-and-mild-stroke-patients-harboring-large-vessel-occlusion-in-the-anterior-circulation-a-multicenter-case-control-study
#18
Cyril Dargazanli, Caroline Arquizan, Arturo Consoli, Benjamin Gory, Omer Eker, Xavier Ayrignac, Jean-Pierre Decroix, Astrid Corlobé, Isabelle Mourand, Grégory Gascou, Mahmoud Charif, Julien Labreuche, Alain Duhamel, Paul-Emile Labeyrie, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Carlos Riquelme, Oguzhan Coskun, Jean-Philippe Desilles, Frédéric Bourdain, Roberto Riva, Mikael Obadia, Francis Turjman, Georges Rodesch, Pierre Labauge, Alain Bonafé, Mikael Mazighi, Vincent Costalat, Michel Piotin, Raphaël Blanc, Bertrand Lapergue
BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. There is no proven effectiveness of MT in the subgroup of minor stroke with LVO in the anterior circulation and data about mechanical thrombectomy (MT) in this subgroup of patients are sparse, with optimal management of these patients being yet not definitely addressed. The purpose of this case-control study was to evaluate MT in patients suffering from acute ischemic stroke (AIS) and LVO in the anterior circulation, presenting with minor to mild stroke symptoms (NIHSS<8)...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28327964/imaging-approaches-to-stroke-and-neurovascular-disease
#19
Seena Dehkharghani, Jalal Andre
Imaging is paramount to the diagnosis and management of ischemic stroke, offering a battery of structural and functional probes of cerebrovascular physiology. The technical underpinnings of stroke imaging continue to evolve, bringing the neuroscience community increasingly closer to high-resolution, tissue-level biomarkers of brain perfusion, metabolism, and viability. The rapid expansion of neuroimaging in this domain has met with controversies, and in many respects, a lack of generalizable conclusions regarding optimized use in cerebrovascular disease...
January 28, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28327054/effects-of-low-frequency-repetitive-transcranial-magnetic-stimulation-and-neuromuscular-electrical-stimulation-on-upper-extremity-motor-recovery-in-the-early-period-after-stroke-a-preliminary-study
#20
Aliye Tosun, Sabiha Türe, Ayhan Askin, Engin Ugur Yardimci, Secil Umit Demirdal, Tülay Kurt Incesu, Ozgur Tosun, Hikmet Kocyigit, Galip Akhan, Fazıl Mustafa Gelal
OBJECTIVE: To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on upper extremity motor function in patients with acute/subacute ischemic stroke. METHODS: Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT...
March 22, 2017: Topics in Stroke Rehabilitation
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