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Acute stroke

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https://www.readbyqxmd.com/read/27922911/meta-analysis-of-comparison-of-the-newer-p2y12-inhibitors-oral-preparation-or-intravenous-to-clopidogrel-in-patients-with-acute-coronary-syndrome
#1
Lu Zhang, Jun Lu, Weihua Dong, Huiping Tian, Weiyi Feng, Haisheng You, Hairong He, Jing Ma, Yalin Dong
AIMS: New P2Y12 adenosine diphosphate receptor antagonist that has been used in the treatment of acute coronary syndrome (ACS) with mixed results. This systematic review analyzed and compared the evidence from large, clinical trials regarding the efficacy of clopidogrel relative to that of cangrelor, prasugrel, and ticagrelor in reducing the incidence of cardiovascular events in patients with ACS. METHODS AND RESULTS: This analysis of the findings for comparing newer P2Y12 inhibitors with clopidogrel of 13 clinical trials involving a total of 87,985 patients with ACS ...
November 29, 2016: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#2
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
December 5, 2016: Medical Care
https://www.readbyqxmd.com/read/27922879/the-changes-in-pulse-pressure-variation-or-stroke-volume-variation-after-a-tidal-volume-challenge-reliably-predict-fluid-responsiveness-during-low-tidal-volume-ventilation
#3
Sheila Nainan Myatra, Natesh R Prabu, Jigeeshu Vasishtha Divatia, Xavier Monnet, Atul Prabhakar Kulkarni, Jean-Louis Teboul
OBJECTIVES: Stroke volume variation and pulse pressure variation do not reliably predict fluid responsiveness during low tidal volume ventilation. We hypothesized that with transient increase in tidal volume from 6 to 8 mL/kg predicted body weight, that is, "tidal volume challenge," the changes in pulse pressure variation and stroke volume variation will predict fluid responsiveness. DESIGN: Prospective, single-arm study. SETTING: Medical-surgical ICU in a university hospital...
December 5, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27922251/endovascular-prevention-and-treatment-of-stroke-related-to-extracranial-carotid-artery-disease
#4
Leonardo Rangel-Castilla, Gary B Rajah, Hakeem J Shakir, Jason M Davies, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, L N Hopkins
Acute ischemic stroke (AIS) is the leading cause of premature mortality and morbidity worldwide for both men and women. Extracranial carotid artery stenosis/occlusion is responsible for approximately 11.5%% of ischemic strokes, whereas extracranial large vessel disease comprises roughly 16.6% of ischemic strokes. Carotid artery disease has been the source of significant debate among neurovascular and cardiovascular specialists, as well as vascular surgeons, as to the best method of revascularization, surgical reconstruction versus endovascular recanalization...
December 6, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27921203/treatment-of-uncomplicated-type-b-aortic-dissection
#5
REVIEW
Hitoshi Matsuda
Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter >40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3-6 months after onset...
December 5, 2016: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27920715/intra-arterial-mechanical-thrombectomy-an-effective-treatment-for-ischemic-stroke-caused-by-endocarditis
#6
Olafur Sveinsson, Lars Herrman, Staffan Holmin
Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27920714/idarucizumab-as-antidote-to-intracerebral-hemorrhage-under-treatment-with-dabigatran
#7
Valentin Held, Philipp Eisele, Christoph C Eschenfelder, Kristina Szabo
BACKGROUND AND PURPOSE: Non-vitamin K anticoagulants (NOAC) such as dabigatran have become important therapeutic options for the prevention of stroke. Until recently, there were only nonspecific agents to reverse their anticoagulant effects in a case of emergency. Idarucizumab, an antibody fragment targeting dabigatran, is the first specific antidote for a NOAC to be approved, but real-world experience is limited. METHODS: We report two cases of patients on dabigatran with acute intracerebral hemorrhage who received idarucizumab...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27920364/an-optimal-wilcoxon-mann-whitney-test-of-mortality-and-a-continuous-outcome
#8
Roland A Matsouaka, Aneesh B Singhal, Rebecca A Betensky
We consider a two-group randomized clinical trial, where mortality affects the assessment of a follow-up continuous outcome. Using the worst-rank composite endpoint, we develop a weighted Wilcoxon-Mann-Whitney test statistic to analyze the data. We determine the optimal weights for the Wilcoxon-Mann-Whitney test statistic that maximize its power. We derive a formula for its power and demonstrate its accuracy in simulations. Finally, we apply the method to data from an acute ischemic stroke clinical trial of normobaric oxygen therapy...
December 5, 2016: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/27920287/teaching-neuroimages-hemigeographic-tongue-following-an-acute-ischemic-stroke
#9
Gregory Youngnam Chang, Montserrat G Delgado, Sergio Calleja
No abstract text is available yet for this article.
December 6, 2016: Neurology
https://www.readbyqxmd.com/read/27919794/diagnostic-utility-of-contrast-enhanced-3d-t1-weighted-imaging-in-acute-cerebral-infarction-associated-with-graves-disease
#10
Yasufumi Gon, Manabu Sakaguchi, Naoki Oyama, Hideki Mochizuki
Graves disease is rarely complicated with cerebrovascular steno-occlusive diseases. Previous studies have suggested several hypotheses for this occurrence, including excess thyroid hormone, which stimulates the sympathetic nervous system, which in turn causes an abnormal hemodynamic response with consequent atherosclerotic changes, and antithyroid antibodies cause local vascular inflammation in patients with Graves disease. However, radiological findings of vasculitis in patients with Graves disease and cerebral infarction remain less known...
December 2, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27919793/inter-rater-reliability-for-thrombolysis-in-cerebral-infarction-with-tici-2c-category
#11
Ondrej Volny, Petra Cimflova, Viktor Szeder
BACKGROUND AND PURPOSE: Thrombolysis in cerebral infarction (TICI) with 2b/3 (>50% of occluded territory/complete reperfusion) has been regarded as a successful angiographic outcome. To account for near-perfect angiographic results, the category TICI 2c (near-complete reperfusion) has been introduced. As the degree of inter-rater reliability for TICI with 2c category remains poorly studied, we strived to evaluate the agreement among stroke-treating specialists. METHODS: All consecutive patients, who underwent stent-retriever thrombectomy for acute ischemic stroke in the period between January 2014 and April 2016 at the Department of Neurointerventional Radiology, were analyzed...
December 2, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27919293/perioperative-statin-therapy-in-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#12
Alessandro Putzu, Bruno Capelli, Alessandro Belletti, Tiziano Cassina, Enrico Ferrari, Michele Gallo, Gabriele Casso, Giovanni Landoni
BACKGROUND: Several studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients. METHODS: Electronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery...
December 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27919055/associations-with-health-related-quality-of-life-after-intracerebral-haemorrhage-pooled-analysis-of-interact-studies
#13
Candice Delcourt, Danni Zheng, Xiaoying Chen, Maree Hackett, Hisatomi Arima, Jun Hata, Emma Heeley, Rustam Al-Shahi Salman, Mark Woodward, Yining Huang, Thompson Robinson, Pablo M Lavados, Richard I Lindley, Christian Stapf, Leo Davies, John Chalmers, Craig S Anderson, Shoichiro Sato
BACKGROUND AND PURPOSE: Limited data exist on health-related quality of life (HRQoL) after intracerebral haemorrhage (ICH). We aimed to determine baseline factors associated with HRQoL among participants of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). METHODS: The INTERACT studies were randomised controlled trials of early intensive blood pressure (BP) lowering in patients with ICH (<6 hours) and elevated systolic BP (150-220 mm Hg)...
October 21, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27918088/cerebrolysin-for-acute-ischaemic-stroke
#14
REVIEW
Liliya Eugenevna Ziganshina, Tatyana Abakumova, Ludivine Vernay
BACKGROUND: Cerebrolysin is a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue, which has potential neuroprotective and neurotrophic properties. It is widely used in the treatment of acute ischaemic stroke in Russia, Eastern Europe, China, and other Asian and post-Soviet countries. OBJECTIVES: To assess the benefits and risks of cerebrolysin for treating acute ischaemic stroke. SEARCH METHODS: In May 2016 we searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, Web of Science Core Collection, with Science Citation Index, LILACS, OpenGrey, and a number of Russian Databases...
December 5, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27917948/association-of-cortical-vein-filling-with-clot-location-and-clinical-outcomes-in-acute-ischaemic-stroke-patients
#15
Sonu Bhaskar, Andrew Bivard, Peter Stanwell, John R Attia, Mark Parsons, Michael Nilsson, Christopher Levi
Delay in cortical vein filling during the late-venous phase (delayed-LCVF) is characterized by opacification of cerebral veins despite contrast clearance from contralateral veins on dynamic computed tomography angiography (dCTA) in acute ischemic stroke (AIS) patients. The aim of the study was to investigate the associations of delayed-LCVF with clot location, reperfusion status at 24 hours, and 90-days functional outcome in AIS patients who received reperfusion therapy. A prospective cohort of AIS patients treated with intravenous thrombolysis was studied...
December 5, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27917937/vessel-wall-differences-between-middle-cerebral-artery-and-basilar-artery-plaques-on-magnetic-resonance-imaging
#16
Peng-Peng Niu, Yao Yu, Hong-Wei Zhou, Yang Liu, Yun Luo, Zhen-Ni Guo, Hang Jin, Yi Yang
A recent study showed that posterior circulation plaques have a greater capacity for positive remodeling in a non-Asian population. We aimed to investigate if the features of plaques in the middle cerebral artery (MCA) were different from those in the basilar artery (BA) in a northern Chinese population. We retrospectively analysed the records of 71 consecutive patients with acute ischemic stroke. All patients had at least one MCA or BA plaque with early or mild (<50% stenosis) atherosclerosis identified using vessel wall magnetic resonance imaging...
December 5, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27917312/a-4d-ct-digital-phantom-of-an-individual-human-brain-for-perfusion-analysis
#17
Rashindra Manniesing, Christoph Brune, Bram van Ginneken, Mathias Prokop
Brain perfusion is of key importance to assess brain function. Modern CT scanners can acquire perfusion maps of the cerebral parenchyma in vivo at submillimeter resolution. These perfusion maps give insights into the hemodynamics of the cerebral parenchyma and are critical for example for treatment decisions in acute stroke. However, the relations between acquisition parameters, tissue attenuation curves, and perfusion values are still poorly understood and cannot be unraveled by studies involving humans because of ethical concerns...
2016: PeerJ
https://www.readbyqxmd.com/read/27917298/lambl-s-excrescences-a-case-report-and-review-of-the-literature
#18
Haroon Kamran, Nirav Patel, Gagandeep Singh, Venu Pasricha, Moro Salifu, Samy I McFarlane
Lambl's excrescences are filamentous extensions of cardiac valves, mostly asymptomatic but rarely associated with catastrophic thromboembolic events such as acute ischemic stroke and acute coronary syndromes. Numerous case reports cited in the literature have addressed various spectrum of presentation of these syndromes and their outcomes based on therapies used. We encountered such a patient from our own experience who presented with an acute ischemic stroke with no other identifiable cause other than the Lambl's excrescences...
2016: Clinical Case Reports and Reviews
https://www.readbyqxmd.com/read/27916623/multiple-beneficial-effects-of-melanocortin-mc4-receptor-agonists-in-experimental-neurodegenerative-disorders-therapeutic-perspectives
#19
REVIEW
Daniela Giuliani, Alessandra Ottani, Laura Neri, Davide Zaffe, Paolo Grieco, Jerzy Jochem, Gian Maria Cavallini, Anna Catania, Salvatore Guarini
Melanocortin peptides induce neuroprotection in acute and chronic experimental neurodegenerative conditions. Melanocortins likewise counteract systemic responses to brain injuries. Furthermore, they promote neurogenesis by activating critical signaling pathways. Melanocortin-induced long-lasting improvement in synaptic activity and neurological performance, including learning and memory, sensory-motor orientation and coordinated limb use, has been consistently observed in experimental models of acute and chronic neurodegeneration...
December 1, 2016: Progress in Neurobiology
https://www.readbyqxmd.com/read/27916259/cyp-genetic-variants-cyp-metabolite-levels-and-neurologic-deterioration-in-acute-ischemic-stroke-in-chinese-population
#20
Xingyang Yi, Jing Lin, Chun Wang, Qiang Zhou
BACKGROUND: The mechanisms of neurologic deterioration (ND) are not fully understood. The aim of the present study was to evaluate the relationship between CYP genetic variants and CYP metabolite levels with ND in acute ischemic stroke patients. METHODS: Eleven single nucleotide polymorphisms (SNPs) of seven CYP genes were genotyped in 396 patients with acute ischemic stroke. The CYP plasma metabolite levels (20-hydroxyeicosatetraenoic acid [HETE], total epoxyeicosatrienoic acids [EETs], and dihydroxyeicosatrienoic acids [DiHETEs]) were also assessed...
December 1, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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