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acute ischemic stroke treatment

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https://www.readbyqxmd.com/read/28436307/choice-of-anesthesia-for-endovascular-treatment-of-acute-ischemic-stroke-protocol-for-a-randomized-controlled-canvas-trial
#1
Yuming Peng, Yan Li, Minyu Jian, Xiaoyuan Liu, Jian Sun, Bo Jia, Jia Dong, Min Zeng, Nan Lin, Li Zhang, Adrian W Gelb, Matthew Tv Chan, Ruquan Han
Background Observational studies indicate that the type of anesthesia, local or general, may be associated with the post-procedural neurological function in patients with acute ischemic stroke undergoing endovascular treatment. However, these results need further confirmation, and the causal relationship has not yet been established. Methods This is a randomized controlled equivalence trial. Permuted block randomization stratified by culprit vessels will be used. Six hundred and forty patients with acute ischemic stroke undergoing endovascular recanalization will be randomized one to one to receive either general anesthesia or local anesthesia...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28436305/quality-of-life-after-intra-arterial-treatment-for-acute-ischemic-stroke-in-the-mr-clean-trial-update
#2
Jennifer Schreuders, Lucie A van den Berg, Puck Ss Fransen, Olvert A Berkhemer, Debbie Beumer, Hester F Lingsma, Robert J van Oostenbrugge, Wim H van Zwam, Charles Blm Majoie, Aad van der Lugt, Paul Lm de Kort, Yvo Bwem Roos, Diederik Wj Dippel
Background Health-related quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire was one of the secondary outcomes in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN). We reported no statistically significant difference in EuroQol Group 5-Dimension Self-Report Questionnaire score between the intervention and control groups, but deaths were not included. Aims Reanalyze the effect of intra-arterial treatment for large vessel occlusion in acute ischemic stroke patients on health-related quality of life in more detail...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28435627/outcome-of-acute-ischemic-stroke-after-intra-arterial-thrombolysis-a-study-from-india
#3
Jaydip Ray Chaudhuri, Randhir Kumar, Matapathi Umamahesh, Kandadai Rukmini Mridula, Suvarnal Alladi, Srinivasarao Bandaru
Background: Intravenous recombinant tissue plasminogen activator (rt-PA) is the currently standard treatment of acute ischemic stroke within 4.5 hours of the onset of stroke. Recent studies have looked at the benefits of administration of intra-arterial (IA) rt-PA within 8 hours onset of symptoms. Our objective was to assess the outcome of stroke after administration of IA rt-PA in patients with acute ischemic stroke. Methods: We recruited 10 consecutive acute ischemic stroke patients with onset of stroke from 4...
October 7, 2016: Iranian Journal of Neurology
https://www.readbyqxmd.com/read/28432266/baseline-blood-pressure-effect-on-the-benefit-and-safety-of-intra-arterial-treatment-in-mr-clean-multicenter-randomized-clinical-trial-of-endovascular-treatment-of-acute-ischemic-stroke-in-the-netherlands
#4
Maxim J H L Mulder, Saliha Ergezen, Hester F Lingsma, Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Lucie A van den Berg, Geert Lycklama À Nijeholt, Bart J Emmer, H Bart van der Worp, Paul J Nederkoorn, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Charles B L M Majoie, Aad van der Lugt, Diederik W J Dippel
BACKGROUND AND PURPOSE: High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. METHODS: This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)...
April 21, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28432265/artemida-trial-a-randomized-trial-of-efficacy-12-months-international-double-blind-actovegin-a-randomized-controlled-trial-to-assess-the-efficacy-of-actovegin-in-poststroke-cognitive-impairment
#5
Alla Guekht, Ingmar Skoog, Sally Edmundson, Vladimir Zakharov, Amos D Korczyn
BACKGROUND AND PURPOSE: Poststroke cognitive impairment is a debilitating consequence of stroke. The aim of this study was to assess whether Actovegin confers cognitive benefit in patients who have had an ischemic stroke. METHODS: This was a 12-month, parallel-group, randomized, multicenter, double-blind, placebo-controlled study. Eligible patients were ≥60 years of age with a Montreal Cognitive Assessment test score of ≤25 points. Patients were randomized into 2 groups within 1 week of acute supratentorial ischemic stroke in a 1:1 ratio: Actovegin (a deproteinized hemoderivative of calf blood, 2000 mg/d for ≤20 intravenous infusions followed by 1200 mg/d orally) or placebo for 6 months...
April 21, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28431590/delays-in-door-to-needle-time-for-acute-ischemic-stroke-in-the-emergency-department-a-comprehensive-stroke-center-experience
#6
Ashkan Mowla, Jordan Doyle, Navdeep S Lail, Hamidreza Rajabzadeh-Oghaz, Christopher Deline, Peyman Shirani, Marilou Ching, Annemarie Crumlish, Deborah A Steck, David Janicke, Elad I Levy, Robert N Sawyer
BACKGROUND: Current American Stroke Association guidelines recommend initiating intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) within 60min of patient arrival, given the benefits of IVT for AIS are time dependent. This study aimed to identify the delaying factors in door-to-needle time (DTN) in the emergency department of one of the largest comprehensive stroke centers in New York State. We also recommended measures to reduce the delays. METHODS: We retrospectively reviewed the medical charts of all AIS patients who received IVT in our emergency department patients between April 1, 2012 and December 31, 2015 to identify those with a DTN time of >60min...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28431475/validation-of-the-essen-stroke-risk-score-in-different-subtypes-of-ischemic-stroke
#7
Yi Liu, Yongjun Wang, William A Li, Aoshuang Yan, Yilong Wang
OBJECTIVE: Predictive scores are important tools for stratifying patients based on their risk of future vascular events and for selecting preventive therapies. The aim of this study is to validate the Essen Stroke Risk Score (ESRS) for stratifying stroke recurrence in different subtypes of non-atrial fibrillation ischemic stroke in a large Chinese cohort. METHODS: Data were derived from the Blood pressure and clinical Outcome in Stroke Survivors registry, which includes a cohort of 2204 stroke patients...
April 21, 2017: Neurological Research
https://www.readbyqxmd.com/read/28431023/safety-and-efficacy-of-the-sofia-6f-plus-distal-access-reperfusion-catheter-in-the-endovascular-treatment-of-acute-ischemic-stroke
#8
Hussain Shallwani, Hakeem J Shakir, Leonardo Rangel-Castilla, Jason M Davies, Ashish Sonig, Mithun G Sattur, Bernard R Bendok, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neuroendovascular intervention has become a key treatment option for acute ischemic stroke. The Sofia (6F) PLUS catheter was designed for neurovascular access for diagnostic or therapeutic interventions. OBJECTIVE: To report the first series describing use of the Sofia PLUS intermediate/distal access reperfusion catheter in the treatment of acute ischemic stroke. METHODS: In this retrospective study, 41 stroke cases were identified in which the catheter was utilized for thrombolysis/thrombectomy...
April 19, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28429356/thrombolysis-in-acute-stroke-without-angiographically-documented-occlusion
#9
M-C Shi, F-N Chu, C Li, S-C Wang
OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) using urokinase (UK) in acute stroke patients without angiographically-documented occlusion, and to define predictors of clinical outcome. PATIENTS AND METHODS: We analyzed clinical and radiological data of acute ischemic stroke patients whose angiography did not show an arterial occlusion within six hours of symptom onset and who were further treated with IAT using UK...
April 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28428348/predictors-of-the-aspiration-component-success-of-a-direct-aspiration-first-pass-technique-adapt-for-the-endovascular-treatment-of-stroke-reperfusion-strategy-in-anterior-circulation-acute-stroke
#10
Raphaël Blanc, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Jean-Philippes Desilles, Eliane Orng, Guillaume Taylor, Elodie Drumez, Robert Fahed, Julien Labreuche, Mikael Mazighi, Bertrand Lapergue, Michel Piotin
BACKGROUND AND PURPOSE: The technique of a direct aspiration first pass technique (ADAPT) for the endovascular treatment of stroke has been reported to be fast, safe, and effective for the treatment of acute ischemic stroke. The aim of this study is to determine the preoperative factors that affect success of the aspiration component of the technique in ischemic stroke patients with large vessel occlusion in the anterior circulation. METHODS: We enrolled all 347 consecutive patients with anterior circulation acute ischemic stroke admitted for mechanical thrombectomy at our institution from August 2013 to October 2015 and treated by ADAPT for the endovascular treatment of stroke...
April 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28427162/effect-of-age-on-long-term-outcomes-after-stroke-with-atrial-fibrillation-a-hospital-based-follow-up-study-in-china
#11
Tao Wang, Bin Li, Hongfei Gu, Yongzhong Lou, Xianjia Ning, Jinghua Wang, Zhongping An
Atrial fibrillation (AF) is an established predictor of poor outcomes after stroke. We aimed to assess the effect of age on outcomes at 1 year and 3 years in stroke patients with AF.We recruited acute ischemic stroke patients with AF between January 2006 and September 2014 in Tianjin, China. Clinical features and outcomes at 1 year and 3 years after stroke were compared between younger group and elderly group. Overall, 951 consecutive stroke patients with AF were included in this study. There was a higher mortality and dependency rate in the elderly group than in the young group at both 1 and 3 years after stroke...
February 25, 2017: Oncotarget
https://www.readbyqxmd.com/read/28427054/preceding-intravenous-thrombolysis-in-patients-receiving-endovascular-therapy
#12
Hong-Kyun Park, Jong-Won Chung, Jeong-Ho Hong, Min Uk Jang, Hyun-Du Noh, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Moon-Ku Han, Beom Joon Kim, Tai Hwan Park, Sang-Soon Park, Kyung Bok Lee, Jun Lee, Keun-Sik Hong, Yong-Jin Cho, Byung-Chul Lee, Kyung-Ho Yu, Mi-Sun Oh, Ki-Hyun Cho, Joon-Tae Kim, Dong-Eog Kim, Wi-Sun Ryu, Jay Chol Choi, Wook-Joo Kim, Dong-Ick Shin, Min-Ju Yeo, Sung Il Sohn, Ji Sung Lee, Juneyoung Lee, Byung-Woo Yoon, Hee-Joon Bae
BACKGROUND: The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. METHODS: From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013...
April 21, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28424269/risks-and-benefits-of-clopidogrel-aspirin-in-minor-stroke-or-tia-time-course-analysis-of-chance
#13
Yuesong Pan, Jing Jing, Weiqi Chen, Xia Meng, Hao Li, Xingquan Zhao, Liping Liu, David Wang, S Claiborne Johnston, Yilong Wang, Yongjun Wang
OBJECTIVE: To investigate the short-term time course risks and benefits of clopidogrel with aspirin in minor ischemic stroke or TIA. METHODS: Data were derived from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. The primary outcome was a new ischemic stroke. Safety outcomes included any bleeding and moderate to severe bleeding. Time course analyses were performed for the outcomes of both stroke and bleeding. RESULTS: A total of 145 (71...
April 19, 2017: Neurology
https://www.readbyqxmd.com/read/28424044/emergent-carotid-thromboendarterectomy-for-acute-symptomatic-occlusion-of-the-extracranial-internal-carotid-artery
#14
Igor Gunka, Dagmar Krajickova, Michal Lesko, Stanislav Jiska, Jan Raupach, Miroslav Lojik, Radovan Maly
BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28424039/endovascular-treatment-of-ischemic-stroke-an-updated-meta-analysis-of-efficacy-and-safety
#15
Simone Vidale, Elio Agostoni
BACKGROUND: Recent randomized trials demonstrated the superiority of the mechanical thrombectomy over the best medical treatment in patients with acute ischemic stroke due to an occlusion of arteries of proximal anterior circulation. In this updated meta-analysis, we aimed to summarize the total clinical effects of the treatment, including the last trials. METHODS: We performed literature search of Randomized Crontrolled Trials (RCTs) published between 2010 and October 2016, comparing endovenous thrombolysis plus mechanical thrombectomy (intervention group) with best medical care alone (control group)...
May 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28424015/susceptibility-weighted-imaging-in-acute-cerebral-ischemia-review-of-emerging-technical-concepts-and-clinical-applications
#16
Charlie Chia-Tsong Hsu, Gigi Nga Chi Kwan, Sachintha Hapugoda, Michelle Craigie, Trevor William Watkins, E Mark Haacke
Susceptibility weighted imaging (SWI) is an essential magnetic resonance imaging sequence in the assessment of acute ischemic stroke. In this article, we discuss the physics principals and clinical application of conventional SWI and multi-echo SWI sequences. We review the research evidence and practical approach of SWI in acute ischemic stroke by focusing on the detection and characterization of thromboembolism in the cerebral circulation. In addition, we discuss the role of SWI in the assessment of neuroparenchyma by depiction of asymmetric hypointense cortical veins in the ischemic territory (surrogate tissue perfusion), detection of existing microbleeds before stroke treatment and monitoring for hemorrhagic transformation post-treatment...
April 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28422279/efficacy-and-safety-of-mechanical-thrombectomy-in-older-adults-with-acute-ischemic-stoke
#17
Fabrizio Sallustio, Giacomo Koch, Caterina Motta, Marina Diomedi, Fana Alemseged, Vittoria C D'Agostino, Simone Napolitano, Domenico Samà, Alessandro Davoli, Daniel Konda, Daniele Morosetti, Enrico Pampana, Roberto Floris, Roberto Gandini
OBJECTIVES: To evaluate the safety and efficacy of endovascular therapy in elderly adults treated for acute ischemic stroke. DESIGN: Retrospective cohort study. SETTING: Comprehensive Stroke Center, University of Tor Vergata, Rome, Italy. PARTICIPANTS: Elderly adults treated for acute ischemic stroke (N = 219). MEASUREMENTS: Participants were divided into two groups based on their age (n = 62, ≥80; n = 157, <80)...
April 19, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28420862/clinical-characteristics-treatment-and-prognosis-of-patients-with-acute-severe-heart-failure-of-ischemic-and-non-ischemic-etiology-analysis-from-the-commit-ahf-registry
#18
Mateusz Ostręga, Marek J Gierlotka, Grzegorz Słonka, Paweł Nadziakiewicz, Mariusz Gąsior
INTRODUCTION    There are limited data on the impact of ischemic etiology on clinical status and long-term prognosis among patients with acute severe heart failure (ASHF) not associated with acute coronary syndrome (ACS).  OBJECTIVES    To assess clinical characteristics, treatment and the 12-month mortality of patients with no-ACS ASHF according to etiology.  PATIENTS AND METHODS    The data from 112 patients with ASHF that was not associated with ACS were analyzed: 61 with ischemic (IASHF) and 51 with non-ischemic (NIASHF) etiology...
April 18, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28412317/medical-treatment-for-spontaneous-anticoagulation-related-intracerebral-hemorrhage-in-the-netherlands
#19
Laura J de Schipper, M Irem Baharoglu, Yvo B W E M Roos, Frank de Beer
BACKGROUND: Spontaneous anticoagulation-related intracerebral hemorrhage accounts for up to a quarter of spontaneous intracerebral hemorrhage cases and is associated with higher hematoma volume and a worse outcome. Guidelines recommend rapid anticoagulant reversal but mode and timing are not specified and optimal strategy is uncertain. Variability in everyday practice is unknown. METHODS: An invitation to a web-based survey was sent to 85 Dutch stroke neurologists in different hospitals, with questions about importance, timing, and medical management of spontaneous anticoagulation-related intracerebral hemorrhage...
April 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28411260/the-fast-ed-app-a-smartphone-platform-for-the-field-triage-of-patients-with-stroke
#20
Raul G Nogueira, Gisele S Silva, Fabricio O Lima, Yu-Chih Yeh, Carol Fleming, Daniel Branco, Arthur H Yancey, Jonathan J Ratcliff, Robert Keith Wages, Earnest Doss, Mehdi Bouslama, Jonathan A Grossberg, Diogo C Haussen, Teppei Sakano, Michael R Frankel
BACKGROUND AND PURPOSE: The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. METHODS: Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved...
April 14, 2017: Stroke; a Journal of Cerebral Circulation
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