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Stroke trials

Ayşegül İdil Soylu, Sümeyra Arıkan Cortcu, Fatih Uzunkaya, Yunus Oktay Atalay, Tumay Bekçi, Levent Güngör, Ümit Belet
OBJECTIVES: Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke. METHODS: Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio...
October 20, 2016: Vascular
Franziska Hopfner, Dietrich Haubenberger, Wendy R Galpern, Katrina Gwinn, Ashlee Van't Veer, Samantha White, Kailash Bhatia, Charles H Adler, David Eidelberg, William Ondo, Glenn T Stebbins, Caroline M Tanner, Rick C Helmich, Fred A Lenz, Roy V Sillitoe, David Vaillancourt, Jerrold L Vitek, Elan D Louis, Holly A Shill, Matthew P Frosch, Tatiana Foroud, Gregor Kuhlenbäumer, Andrew Singleton, Claudia M Testa, Mark Hallett, Rodger Elble, Günther Deuschl
Essential tremor (ET) is a common cause of significant disability, but its etiologies and pathogenesis are poorly understood. Research has been hampered by the variable definition of ET and by non-standardized research approaches. The National Institute of Neurological Disorders and Stroke (USA) invited experts in ET and related fields to discuss current knowledge, controversies, and gaps in our understanding of ET and to develop recommendations for future research. Discussion focused on phenomenology and phenotypes, therapies and clinical trials, pathophysiology, pathology, and genetics...
October 4, 2016: Parkinsonism & related Disorders
Sarah A Moore, Ruth Da Silva, Madelaine Balaam, Lianne Brkic, Dan Jackson, Dan Jamieson, Thomas Ploetz, Helen Rodgers, Lisa Shaw, Frederike van Wijck, Christopher Price
BACKGROUND: Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities...
October 21, 2016: Trials
Mahnaz Ashoorkhani, Ali Bozorgi, Reza Majdzadeh, Hamed Hosseini, Ali Yoonessi, Ali Ramezankhani, Hassan Eftekhar
BACKGROUND: Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment...
October 21, 2016: Trials
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
Viraj Suvarna
Stroke prevention in atrial fibrillation (AF) has reached an exciting phase with a plethora of newer, potentially more efficacious and safer agents being introduced for physicians to select from. Dabigatran belongs to a class of anticoagulants called direct thrombin inhibitors, while rivaroxaban, apixaban, and edoxaban are direct Factor Xa inhibitors. Purely from a therapeutic endpoint perspective-based on the action of anticoagulants in reducing cardioembolic stroke-in clinical trials, one should look at whether a new anticoagulant in patients with AF prevents ischemic stroke...
October 2016: Journal of the Association of Physicians of India
T A Tomsick, J Carrozzella, L Foster, M D Hill, R von Kummer, M Goyal, A M Demchuk, P Khatri, Y Palesch, J P Broderick, S D Yeatts, D S Liebeskind
BACKGROUND AND PURPOSE: Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features. MATERIALS AND METHODS: Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0-2 end points at 90 days for endovascular therapy-treated M2 occlusions were analyzed...
October 20, 2016: AJNR. American Journal of Neuroradiology
Chang-Man An, Shin-Ok Jo
BACKGROUND AND OBJECTIVE: In general, adequate movement of the ankle joint is known to play an important role in functional activities. Stroke survivors frequently have limited range of motion of the ankle, leading to dysfunctional weight transfer toward the paretic lower limb during standing or gait. The purpose of this study was to investigate the effects of talocrural mobilization with movement (MWM) on ankle strength, dorsiflexion passive range of motion (DF-PROM), and weight-bearing ability on the paretic limb during standing or gait in stroke patients with limited ankle dorsiflexion...
October 17, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Sami Al Kasab, Michael J Lynn, Tanya N Turan, Colin P Derdeyn, David Fiorella, Bethany F Lane, L Scott Janis, Marc I Chimowitz
BACKGROUND: An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting <24 hours should be considered a stroke. We analyzed the impact of considering CITS as equivalent to stroke on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS: We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days...
October 17, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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
Gennaro Giustino, Roxana Mehran, Roland Veltkamp, Michela Faggioni, Usman Baber, George D Dangas
OBJECTIVES: The aim of this study was to investigate the efficacy and safety of intraprocedural embolic protection (EP) during transcatheter aortic valve replacement (TAVR). BACKGROUND: Randomized controlled trials (RCTs) investigating the efficacy of EP devices during TAVR were relatively underpowered. METHODS: A systematic review and study-level meta-analysis was performed of randomized controlled trials that tested the efficacy and safety of EP during TAVR...
October 24, 2016: JACC. Cardiovascular Interventions
A Muruganathan, Mangesh Tiwaskar
While the incidence and prevalence of stroke is gradually decreasing in the western world, a parallel increase is seen in the developing world. It is a matter of special concern to us as approximately 20-30% of stroke occur in people younger than 45 years in India. Indians are prone to higher stroke risk because of urbanization, diabetes, cigarette smoking and high incidence of hypertension. Unfortunately, there is an inadequate awareness about the risk of stroke with hypertension among general public. Hypertension is considered to be the most important risk factor for stroke, and all forms of hypertension are associated with an increased risk of both ischemic and haemorrhagic stroke...
September 2016: Journal of the Association of Physicians of India
Ling-Feng Zeng, Ye Cao, Lu Wang, Yun-Kai Dai, Ling Hu, Qi Wang, Li-Ting Zhu, Wen-Hu Bao, Yuan-Ping Zou, Yun-Bo Chen, Wei-Hua Xu, Wei-Xiong Liang, Ning-Sheng Wang
Current evidence demonstrated certain beneficial effects of medicinal herbs as an adjuvant therapy for post-stroke depression (PSD) in China; Chai-hu (Chinese Thorowax Root, Radix Bupleuri) is an example of a medicinal plant for Liver-Qi regulation (MPLR) in the treatment of PSD. Despite several narrative reports on the antidepressant properties of MPLR, it appears that there are no systematic reviews to summarize its outcome effects. Therefore, the aim of this review was to assess the effectiveness and safety of MPLR adjuvant therapy in patients with PSD...
October 20, 2016: Phytotherapy Research: PTR
Khader A Almhdawi, Virgil G Mathiowetz, Matthew White, Robert C delMas
There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension...
October 20, 2016: Occupational Therapy International
Michael B Boffa
PURPOSE OF REVIEW: Elevated plasma concentrations of lipoprotein(a) (Lp(a)) are an independent and causal risk factor for cardiovascular diseases including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis. This review summarizes the rationale for Lp(a) lowering and surveys relevant clinical trial data using a variety of agents capable of lowering Lp(a). RECENT FINDINGS: Contemporary guidelines and recommendations outline populations of patients who should be screened for elevated Lp(a) and who might benefit from Lp(a) lowering...
December 2016: Current Atherosclerosis Reports
B Li, L S Wang, C C Liu, C X Gu
Objective: To assess the clinical outcomes of totally endoscopic coronary artery bypass grafting (TECABG). Methods: A systematic review of studies reporting clinical outcomes of TECABG was performed. Twelve studies were included in the meta-analysis. R 3.2.3 was used to perform the statistical analysis. Results: Length of hospital stay of TACABG patients ranged from 3.3 to 8.6 days. The rate of recent conversion to thoracotomy was 0-28.1% (from perioperative period to 2 years after surgery); the rate of anastomotic bleeding was 1...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
M Luz Sánchez-Sánchez, Maria-Arántzazu Ruescas-Nicolau, José-Antonio Pérez-Miralles, Elena Marqués-Sulé, Gemma-Victoria Espí-López
BACKGROUND: In chronic stroke, feasible physical therapy (PT) programs are needed to promote function throughout life. OBJECTIVE: This randomized controlled pilot trial investigated the feasibility and effect of a PT program composed of strengthening exercises with elastic bands and bimanual functional training, with clearly defined doses based on the rate of perceived exertion (Borg scale), to counteract inactivity in chronic stroke. METHODS: Fifteen subjects > 6 month post-stroke were randomized to three-month of UE function training (UE group), or to lower extremity function training (LE group)...
October 19, 2016: Topics in Stroke Rehabilitation
Laura J Davidson, Charles J Davidson
Stroke leads to significant morbidity, disability, and mortality after TAVR. CKD and prior stroke are risk factors for stroke. Stratification of stroke risk would improve outcomes associated with TAVR. Ongoing prospective randomized trials on embolic protection and post implant anticoagulation are promising strategies to reduce stroke risk and new brain MRI lesions.
October 2016: Catheterization and Cardiovascular Interventions
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
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