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https://www.readbyqxmd.com/read/29777016/clinical-utility-of-electronic-alberta-stroke-program-early-computed-tomography-score-software-in-the-enchanted-trial-database
#1
Simon Nagel, Xia Wang, Cheryl Carcel, Thompson Robinson, Richard I Lindley, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke. METHODS: All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemic stroke who participated in the alteplase dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded...
May 18, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29776575/optimal-long-term-antithrombotic-treatment-of-patients-with-stable-coronary-artery-disease-and-atrial-fibrillation-oltat-registry
#2
Q Fischer, J L Georges, C Le Feuvre, A Sharma, N Hammoudi, E Berman, S Cohen, I Jolivet, J Silvain, G Helft
BACKGROUND: The optimal long-term antithrombotic treatment of patients with stable coronary artery disease (CAD) and atrial fibrillation (AF) is a challenge in daily practice. We sought to determine the prevalence of hemorrhagic complications and ischaemic events depending on antithrombotic strategy in patients with stable CAD and AF. METHODS: The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiovascular mortality, myocardial infarction and ischaemic stroke...
August 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29775142/aspirin-for-primary-prevention-of-stroke-in-traumatic-cerebrovascular-injury-association-with-increased-risk-of-transfusion
#3
Russell L Griffin, Stephanie R Falatko, Stella Aslibekyan, Virginia Strickland, Mark R Harrigan
OBJECTIVE Blunt traumatic extracranial carotid or vertebral artery injury (i.e., traumatic cerebrovascular injury [TCVI]) occurs in 1%-2% of all blunt trauma admissions, carries a 10% risk of thromboembolic ischemic stroke, and accounts for up to 9600 strokes annually in the US. Screening CT angiograms (CTAs) of patients with trauma has become ubiquitous in recent years, and patients with initially asymptomatic TCVI are commonly treated with antiplatelet agents to prevent stroke. Prophylaxis with antiplatelets is thought to be safer than anticoagulation, which carries a significant risk of hemorrhage in patients with trauma...
May 18, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29774601/the-impact-of-mitral-stenosis-on-outcomes-of-aortic-valve-stenosis-patient-undergoing-surgical-aortic-valve-replacement-or-transcatheter-aortic-valve-replacement
#4
Yasser Al-Khadra, Fahed Darmoch, Motaz Baibars, Amir Kaki, Zaher Fanari, M Chadi Alraies
BACKGROUND: The concomitant presence of mitral stenosis (MS) in the setting of symptomatic aortic stenosis represent a clinical challenge. Little is known regarding the outcome of mitral stenosis (MS) patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Therefore, we sought to study the outcome of MS patients undergoing aortic valve replacement (AVR). METHOD: Using weighted data from the National Inpatient Sample (NIS) database between 2011 and 2014, we identified patients who were diagnosed with MS...
May 17, 2018: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29774194/improper-use-of-thrombolytic-agents-in-acute-hemiparesis-following-misdiagnosis-of-acute-ischemic-stroke
#5
Min Chan Kim, Seok Won Kim
Objective: Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke. Methods: We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis...
April 2018: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/29773716/thrombectomy-6-24-hours-after-stroke-in-trial-ineligible-patients
#6
Shashvat M Desai, Marcelo Rocha, Bradley J Molyneaux, Matthew Starr, Cynthia L Kenmuir, Bradley A Gross, Brian Thomas Jankowitz, Tudor G Jovin, Ashutosh P Jadhav
BACKGROUND AND PURPOSE: The DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials. METHODS: A retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6-24 hour time window...
May 17, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29773497/indications-for-red-cell-transfusions-in-pediatric-patients
#7
REVIEW
Jill M Cholette, Suzie A Noronha, Jerard Seghatchian, Neil Blumberg
Red cell transfusions are amongst the most common therapeutic procedures in seriously ill children, particularly in the inpatient setting. This is despite the fact that there is no evidence base for most clinical settings, with the exception of patients with hemoglobinopathies, particularly thalassemia and sickle cell anemia. Obviously exsanguinating hemorrhage and life threatening anemia are urgent indications for which no other therapeutic approach is currently available. Most transfusions are, however, given prophylactically to prevent the complications of hypoxia or hemodynamic stability, based upon expert opinion and a faith in the oxygen carrying capacity and beneficial hemodynamic properties of transfused red cells...
May 10, 2018: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29772320/predictive-factors-of-silent-brain-infarcts-after-asymptomatic-carotid-endarteriectomy
#8
Rémy Pascot, Benjamin Parat, Yann Le Teurnier, Gilles Godet, Jean-Yves Gauvrit, Yann Gouëffic, Eric Steinmetz, Alain Cardon, Adrien Kaladji
BACKGROUND: The optimization of medical treatment regularly challenges the role of carotid surgery for asymptomatic patients. Current research seeks to determine which of these patients will benefit most from surgery. The goal of this study was to identify in a multi-center study, using MRI, the risk factors for postoperative silent cerebral ischemic lesions after carotid surgery for asymptomatic stenosis METHODS: The multicenter, retrospective study included patients with asymptomatic severe carotid stenosis suitable for surgical treatment and who did not have a history of cerebral ischemia...
May 14, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29770166/free-radical-damage-in-ischemia-reperfusion-injury-an-obstacle-in-acute-ischemic-stroke-after-revascularization-therapy
#9
REVIEW
Ming-Shuo Sun, Hang Jin, Xin Sun, Shuo Huang, Fu-Liang Zhang, Zhen-Ni Guo, Yi Yang
Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/29770118/neuroinflammation-as-a-target-for-intervention-in-subarachnoid-hemorrhage
#10
REVIEW
Airton Leonardo de Oliveira Manoel, R Loch Macdonald
Aneurysmal subarachnoid hemorrhage (SAH) is a sub-type of hemorrhagic stroke associated with the highest rates of mortality and long-term neurological disabilities. Despite the improvement in the management of SAH patients and the reduction in case fatality in the last decades, disability and mortality remain high in this population. Brain injury can occur immediately and in the first days after SAH. This early brain injury can be due to physical effects on the brain such as increased intracranial pressure, herniations, intracerebral, intraventricular hemorrhage, and hydrocephalus...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29769590/low-factor-xiii-levels-after-intravenous-thrombolysis-predict-short-term-mortality-in-ischemic-stroke-patients
#11
Edina Gabriella Székely, Katalin Réka Czuriga-Kovács, Zsuzsanna Bereczky, Éva Katona, Zoltán András Mezei, Attila Nagy, Noémi Klára Tóth, Ervin Berényi, László Muszbek, László Csiba, Zsuzsa Bagoly
In this observational study we investigated whether levels of factor XIII (FXIII) and its major polymorphisms affect the outcome of thrombolysis by recombinant tissue plasminogen activator (rtPA) in acute ischemic stroke (AIS) patients. Study cohort included 132 consecutive AIS patients undergoing i.v. thrombolysis within 4.5 h of symptom onset. Blood samples taken on admission, immediately after and 24 h after therapy were analyzed for FXIII activity and antigen levels. FXIII-A p.Val34Leu, p.Tyr204Phe, FXIII-B p...
May 16, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29768323/efficacy-and-risks-of-anticoagulation-for-cerebral-venous-thrombosis
#12
Weilin Xu, Liansheng Gao, Tao Li, Anwen Shao, Jianmin Zhang
BACKGROUND AND PURPOSE: Cerebral venous thrombosis (CVT) is a rare but life-threatening disease. Timely and proper treatments are the keys in saving patients' life and preventing from permanent neurological deficits. We performed this network meta-analysis to evaluate the role of anticoagulation in CVT, especially for the patients accompanied with hemorrhagic stroke. METHODS: PubMed, Embase, Web of Science, Cochrane Database, and Chinese Biomedical (CBM) databases were searched comprehensively to select eligible articles (up to 30 June 2017)...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29767602/excess-stroke-incidence-in-young-aboriginal-people-in-south-australia-pooled-results-from-two-population-based-studies
#13
Anna H Balabanski, Jonathan Newbury, James M Leyden, Hisatomi Arima, Craig S Anderson, Sally Castle, Jennifer Cranefield, Tracey Paterson, Amanda G Thrift, Judith Katzenellenbogen, Alex Brown, Timothy J Kleinig
Background Retrospective data indicate increased stroke incidence in Aboriginal/Torres Strait Islander (Indigenous) Australians, possibly with poorer outcomes. We present the first prospective population-based stroke incidence study in Indigenous Australians. Methods We pooled data from ASCEND and SEARCH, two prospective "ideal" South Australian stroke incidence studies, ASCEND conducted in urban Northwestern Adelaide (2009-2010) and SEARCH in five South Australian rural centers (2009-2011). We calculated age-standardized incidence for Aboriginal and non-Aboriginal people...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29766811/p2x7-receptor-associated-programmed-cell-death-in-the-pathophysiology-of-hemorrhagic-stroke
#14
Hengli Zhao, Yujie Chen, Hua Feng
Hemorrhagic stroke is a life-threatening disease characterized by a sudden rupture of cerebral blood vessels, and cell death is widely believed to occur after exposure to blood metabolites or subsequently damaged cells. Recently, programmed cell death, such as apoptosis, autophagy, necroptosis, pyroptosis, and ferroptosis, has been demonstrated to play crucial roles in the pathophysiology of stroke. However, the detailed mechanisms of these novel kinds of cell death are still unclear. The P2X7 receptor, previously known for its cytotoxic activity, is an ATP-gated, non-selective cation channel that belongs to the family of ionotropic P2X receptors...
May 15, 2018: Current Neuropharmacology
https://www.readbyqxmd.com/read/29766806/increased-serum-total-bile-acids-can-be-associated-with-a-small-hematoma-volume-and-decreased-clinical-severity-during-acute-intracerebral-hemorrhage
#15
Kaili Wang, Yu Zhang, Chongke Zhong, Jiaping Xu, Yanlin Zhang, Jijun Shi, Goudong Xiao, Xia Zhang, Huihui Liu, Zhichao Huang, Chun-Feng Liu, Shoujiang You, Yongjun Cao
BACKGROUND: The impact of total bile acids (TBA) level on clinical outcomes after acute intracerebral hemorrhage (ICH) is still not understood. OBJECTIVE: We investigated whether admission TBA level is associated with hematoma volume, stroke clinical severity, and 3-month outcomes in acute ICH patients. METHODS: A total of 335 ICH patients were prospectively enrolled. Patients were divided into four groups, according to the quartiles of serum TBA level at the time of admission...
May 15, 2018: Current Neurovascular Research
https://www.readbyqxmd.com/read/29766772/rivaroxaban-for-stroke-prevention-after-embolic-stroke-of-undetermined-source
#16
Robert G Hart, Mukul Sharma, Hardi Mundl, Scott E Kasner, Shrikant I Bangdiwala, Scott D Berkowitz, Balakumar Swaminathan, Pablo Lavados, Yongjun Wang, Yilong Wang, Antonio Davalos, Nikolay Shamalov, Robert Mikulik, Luis Cunha, Arne Lindgren, Antonio Arauz, Wilfried Lang, Anna Czlonkowska, Jens Eckstein, Rubens J Gagliardi, Pierre Amarenco, Sebastian F Ameriso, Turgut Tatlisumak, Roland Veltkamp, Graeme J Hankey, Danilo Toni, Daniel Bereczki, Shinichiro Uchiyama, George Ntaios, Byung-Woo Yoon, Raf Brouns, Matthias Endres, Keith W Muir, Natan Bornstein, Serefnur Ozturk, Martin J O'Donnell, Matthys M De Vries Basson, Guillaume Pare, Calin Pater, Bodo Kirsch, Patrick Sheridan, Gary Peters, Jeffrey I Weitz, W Frank Peacock, Ashkan Shoamanesh, Oscar R Benavente, Campbell Joyner, Ellison Themeles, Stuart J Connolly
Background Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. Methods We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766771/five-year-risk-of-stroke-after-tia-or-minor-ischemic-stroke
#17
Pierre Amarenco, Philippa C Lavallée, Linsay Monteiro Tavares, Julien Labreuche, Gregory W Albers, Halim Abboud, Sabrina Anticoli, Heinrich Audebert, Natan M Bornstein, Louis R Caplan, Manuel Correia, Geoffrey A Donnan, José M Ferro, Fernando Gongora-Rivera, Wolfgang Heide, Michael G Hennerici, Peter J Kelly, Michal Král, Hsiu-Fen Lin, Carlos Molina, Jong Moo Park, Francisco Purroy, Peter M Rothwell, Tomas Segura, David Školoudík, P Gabriel Steg, Pierre-Jean Touboul, Shinichiro Uchiyama, Éric Vicaut, Yongjun Wang, Lawrence K S Wong
Background After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events. Methods We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766770/mri-guided-thrombolysis-for-stroke-with-unknown-time-of-onset
#18
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766750/clopidogrel-and-aspirin-in-acute-ischemic-stroke-and-high-risk-tia
#19
S Claiborne Johnston, J Donald Easton, Mary Farrant, William Barsan, Robin A Conwit, Jordan J Elm, Anthony S Kim, Anne S Lindblad, Yuko Y Palesch
Background Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population. Methods In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29765398/epidemiology-of-intracranial-hemorrhage-associated-with-oral-anticoagulants-in-spain-trends-in-anticoagulation-complications-registry-the-tac-2-study
#20
Gustavo Zapata-Wainberg, Sonia Quintas, Álvaro Ximénez-Carrillo Rico, Jaime Masjuán Vallejo, Pere Cardona, Mar Castellanos Rodrigo, Lorena Benavente Fernández, Andrés García Pastor, José Egido, José Maciñeiras, Joaquín Serena, María Del Mar Freijo Guerrero, Francisco Moniche, José Vivancos
Objective: Patients receiving treatment with oral anticoagulants (OACs) are at risk of intracranial hemorrhage (ICH). In this study, we describe the epidemiological and clinical characteristics of patients receiving OACs who experience ICH and compare those receiving vitamin K antagonists (ICH-VKAs) with those receiving direct OACs (ICH-DOACs). Methods: We performed a national, multicenter, descriptive, observational, retrospective study of all adult patients receiving OACs who were admitted to the neurology department with ICH over a 1-year period...
April 2018: Interventional Neurology
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