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Ischaemic stroke

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https://www.readbyqxmd.com/read/28812226/in-light-of-recently-published-clinical-trials-and-their-implication-for-clinical-practice-does-a-large-catchment-area-acute-hospital-require-24%C3%A2-hour-ct-neck-and-head-angiography-and-or-neuro-interventional-services-in-the-setting-of-acute-ischaemic-stroke
#1
REVIEW
J Halpin, C Peters, J O'Brien, T Scanlon, M Shelly, N Cunningham, L Hickey
BACKGROUND: Recently published clinical trials have resulted in a significant change in the guidelines used to manage patients suffering an acute ischaemic stroke. New neuro-interventional techniques have revolutionised stroke outcomes. Currently, such services are only available in two specialist centres. AIMS: We attempted to evaluate the need for the provision of routine computed tomography (CT) angiography and neuro-interventional services at a university teaching hospital in Limerick...
August 15, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28809046/platelet-transfusion-to-reverse-antiplatelet-therapy-before-decompressive-surgery-in-patients-with-intracranial-haemorrhage
#2
M Baschin, S Selleng, J-P Zeden, A Westphal, T Kohlmann, H W Schroeder, A Greinacher, T Thiele
BACKGROUND: Platelet concentrates (PC) are transfused to improve primary haemostasis before urgent neurosurgery in patients with intracranial haemorrhage (ICH) receiving antiplatelet therapy (APT). It is unresolved, whether PCs increase the risk for major cardio- and cerebrovascular adverse events. We evaluated a standardized transfusion regimen to reverse APT in patients with ICH who required decompressive neurosurgery. METHODS: Analysed were consecutive patients between 2012 and 2014...
August 14, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28808783/post-stroke-seizures-are-clinically-underestimated
#3
Carla Bentes, Hugo Martins, Ana Rita Peralta, Carlos Casimiro, Carlos Morgado, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho E Melo, Teresa Paiva, José M Ferro
Cerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment...
August 14, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28803441/thermoregulation-disorders-of-central-origin-how-to-diagnose-and-treat
#4
Marta Zawadzka, Marta Szmuda, Maria Mazurkiewicz-Bełdzińska
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28802808/novel-oral-anticoagulants-in-direct-current-cardioversion-for-atrial-fibrillation
#5
Giuseppe Femia, Taufik Fetahovic, Pratap Shetty, Astin Lee
BACKGROUND: For some patients with atrial fibrillation, direct current cardioversion (DCCV) is one strategy that can be used to establish sinus rhythm but appropriate anticoagulation is mandatory to prevent thromboembolic events. Historically, patients were anticoagulated with warfarin with bridging with unfractionated or low molecular weight heparin, however, recently novel oral anticoagulants (NOACs), apixaban, dabigatran and rivaroxaban have become more popular. Despite the increase in use, real world data on safety and efficacy is limited...
July 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28800868/nor-test-ing-tenecteplase-in-acute-ischaemic-stroke
#6
Craig S Anderson
No abstract text is available yet for this article.
August 8, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28798779/one-swallow-does-not-a-summer-make-but-many-swallows-do-accumulating-clinical-evidence-for-nearly-eliminated-peri-procedural-and-30-day-complications-with-mesh-covered-stents-transforms-the-carotid-revascularisation-field
#7
REVIEW
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28797662/amputation-rates-mortality-and-pre-operative-comorbidities-in-patients-revascularised-for-intermittent-claudication-or-critical-limb-ischaemia-a-population-based-study
#8
E Baubeta Fridh, M Andersson, M Thuresson, B Sigvant, B Kragsterman, S Johansson, P Hasvold, M Falkenberg, J Nordanstig
OBJECTIVES: The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). METHODS: This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records...
August 7, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28797196/the-improve-guidelines-ischaemia-models-procedural-refinements-of-in-vivo-experiments
#9
Nathalie Percie du Sert, Alessio Alfieri, Stuart M Allan, Hilary Vo Carswell, Graeme A Deuchar, Tracy D Farr, Paul Flecknell, Lindsay Gallagher, Claire L Gibson, Michael J Haley, Malcolm R Macleod, Barry W McColl, Christopher McCabe, Anna Morancho, Lawrence Df Moon, Michael J O'Neill, Isabel Pérez de Puig, Anna Planas, C Ian Ragan, Anna Rosell, Lisa A Roy, Kathryn O Ryder, Alba Simats, Emily S Sena, Brad A Sutherland, Mark D Tricklebank, Rebecca C Trueman, Lucy Whitfield, Raymond Wong, I Mhairi Macrae
Most in vivo models of ischaemic stroke target the middle cerebral artery and a spectrum of stroke severities, from mild to substantial, can be achieved. This review describes opportunities to improve the in vivo modelling of ischaemic stroke and animal welfare. It provides a number of recommendations to minimise the level of severity in the most common rodent models of middle cerebral artery occlusion, while sustaining or improving the scientific outcomes. The recommendations cover basic requirements pre-surgery, selecting the most appropriate anaesthetic and analgesic regimen, as well as intraoperative and post-operative care...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28790536/comparison-of-results-classical-and-eversion-carotid-endarterectomy
#10
Muhamed Djedovic, Emir Mujanovic, Amel Hadzimehmedagic, Dragan Totic, Haris Vukas, Haris Vranic
INTRODUCTION: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications...
April 2017: Medical Archives
https://www.readbyqxmd.com/read/28783201/validation-of-the-dapt-score-in-patients-randomized-to-6-or-12-months-clopidogrel-after-predominantly-second-generation-drug-eluting-stents
#11
Yukinori Harada, Jonathan Michel, Raphaela Lohaus, Katharina Mayer, Roberto Emmer, Anna Lena Lahmann, Roisin Colleran, Daniele Giacoppo, Annabelle Wolk, Jurrien M Ten Berg, Franz-Josef Neumann, Yaling Han, Tom Adriaenssens, Ralph Tölg, Melchior Seyfarth, Michael Maeng, Bernhard Zrenner, Claudius Jacobshagen, Jochen Wöhrle, Sebastian Kufner, Tanja Morath, Tareq Ibrahim, Isabell Bernlochner, Marcus Fischer, Heribert Schunkert, Karl-Ludwig Laugwitz, Julinda Mehilli, Robert A Byrne, Adnan Kastrati, Stefanie Schulz-Schüpke
The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups...
July 27, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28782913/screening-with-doppler-ultrasound-for-carotid-artery-stenosis-in-patients-with-stroke-or-transient-ischaemic-attack
#12
Tatiana Kristensen, Peter Hovind, Helle K Iversen, Ulrik B Andersen
INTRODUCTION: Carotid endarterectomy of symptomatic internal carotid artery stenosis in patients with stroke or transient ischaemic attack reduces the risk of recurrent stroke, particularly if performed within 2 weeks from the first event. We evaluated the efficiency of a screening programme based on Doppler ultrasound in patients hospitalized with stroke or transient ischaemic attack in the stroke centre at Rigshospitalet, Glostrup, Denmark, concerning timeliness of referral to the vascular surgeon and performance of carotid endarterectomy according to national recommendations...
August 7, 2017: Clinical Physiology and Functional Imaging
https://www.readbyqxmd.com/read/28782109/low-vs-high-haemoglobin-trigger-for-transfusion-in-vascular-surgery-protocol-for-a-randomised-trial
#13
A Møller, H B Nielsen, J Wetterslev, O B Pedersen, D Hellemann, S Shahidi
BACKGROUND: In patients with cardiovascular disease, guidelines for administration of red blood cells (RBC) are mainly based on studies outside the vascular surgical setting with the recommendation to use a haemoglobin (hb) trigger-level lower than by guidelines from The European Society for Vascular Surgery. Restricting RBC transfusion may affect blood O2 transport with a risk for development of tissue ischaemia and postoperative complications. METHODS: In a single-centre, open-label, assessor blinded trial, 58 vascular surgical patients (> 40 years of age) awaiting open surgery of the infrarenal aorta or infrainguinal arterial bypass surgery undergo a web-based randomisation to one of two groups: perioperative RBC transfusion triggered by hb < 8 g/dl or hb < 9...
September 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28781064/cardiovascular-mortality-and-morbidity-in-patients-with-type-2-diabetes-following-initiation-of-sodium-glucose-co-transporter-2-inhibitors-versus-other-glucose-lowering-drugs-cvd-real-nordic-a-multinational-observational-analysis
#14
Kåre I Birkeland, Marit E Jørgensen, Bendix Carstensen, Frederik Persson, Hanne L Gulseth, Marcus Thuresson, Peter Fenici, David Nathanson, Thomas Nyström, Jan W Eriksson, Johan Bodegård, Anna Norhammar
BACKGROUND: In patients with type 2 diabetes and a high cardiovascular risk profile, the sodium-glucose co-transporter-2 (SGLT2) inhibitors empagliflozin and canagliflozin have been shown to lower cardiovascular morbidity and mortality. Using real-world data from clinical practice, we aimed to compare cardiovascular mortality and morbidity in new users of SGLT2 inhibitors versus new users of other glucose-lowering drugs, in a population with a broad cardiovascular risk profile. METHODS: CVD-REAL Nordic was an observational analysis of individual patient-level data from the Prescribed Drug Registers, Cause of Death Registers, and National Patient Registers in Denmark, Norway, and Sweden...
August 3, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28780550/improving-discharge-care-the-potential-of-a-new-organisational-intervention-to-improve-discharge-after-hospitalisation-for-acute-stroke-a-controlled-before-after-pilot-study
#15
Dominique A Cadilhac, Nadine E Andrew, Enna Stroil Salama, Kelvin Hill, Sandy Middleton, Eleanor Horton, Ian Meade, Sarah Kuhle, Mark R Nelson, Rohan Grimley
OBJECTIVE: Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before-after observational study design. SETTING: Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes...
August 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28780236/tenecteplase-versus-alteplase-for-management-of-acute-ischaemic-stroke-nor-test-a-phase-3-randomised-open-label-blinded-endpoint-trial
#16
Nicola Logallo, Vojtech Novotny, Jörg Assmus, Christopher E Kvistad, Lars Alteheld, Ole Morten Rønning, Bente Thommessen, Karl-Friedrich Amthor, Hege Ihle-Hansen, Martin Kurz, Håkon Tobro, Kamaljit Kaur, Magdalena Stankiewicz, Maria Carlsson, Åse Morsund, Titto Idicula, Anne Hege Aamodt, Christian Lund, Halvor Næss, Ulrike Waje-Andreassen, Lars Thomassen
BACKGROUND: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. METHODS: This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway...
August 2, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28779954/paraoxonase-1-pon1-and-stroke-the-dilemma-of-the-genetic-variation
#17
REVIEW
Amir Tajbakhsh, Mehdi Rezaee, Mahdi Rivandi, Faranak Forouzanfar, Fahimeh Afzaljavan, Alireza Pasdar
Ischaemic stroke, which is mostly caused by atherosclerosis, is one of the most widely causes of mortality and morbidity. One of the most important enzymatic activities of paraoxonase-1 (PON1) in association with high-density lipoprotein (HDL) is the prevention of low-density lipoprotein (LDL) oxidation, which gives it an anti-atherogenic activity. PON1 expression and activity is influenced by various factors; the most important of which is genetic polymorphism, mainly single nucleotide polymorphisms (SNPs)...
August 2, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28770324/impact-of-metformin-on-cardiovascular-disease-a-meta-analysis-of-randomised-trials-among-people-with-type-2-diabetes
#18
REVIEW
Simon J Griffin, James K Leaver, Greg J Irving
AIMS/HYPOTHESIS: Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Yet previous systematic reviews have raised doubts about its effectiveness in reducing risk of cardiovascular disease, the most costly complication of type 2 diabetes. We aimed to systematically identify and pool randomised trials reporting cardiovascular outcomes in which the effect of metformin was 'isolated' through comparison to diet, lifestyle or placebo. METHODS: We performed an electronic literature search of MEDLINE, EMBASE and the Cochrane Library...
August 2, 2017: Diabetologia
https://www.readbyqxmd.com/read/28760698/assessment-of-behavioural-deficits-following-ischaemic-stroke-in-the-marmoset
#19
REVIEW
Rozenn Le Gal, Myriam Bernaudin, Jérôme Toutain, Omar Touzani
Stroke is a common and devastating disease worldwide. Over the last two decades, many therapeutic approaches to ameliorate ischaemic stroke have been promising in animal studies but failed when transferred to the clinical situation. One of the possible explanations for these failures is the widespread use of animal models of cerebral ischemia that do not mimic the pathology encountered in the clinic. Accordingly, many expert committees recommended the integration of higher order species such as non-human primates in pre-clinical stroke studies...
July 29, 2017: Behavioural Brain Research
https://www.readbyqxmd.com/read/28759944/impact-of-health-utility-after-thrombotic-complications-following-total-hip-and-knee-arthroplasty
#20
Bikram Karmakar
BACKGROUND: Medical complications and preexisting conditions frequently place the surgeon in the unenviable position of choosing between the serious and potentially life-threatening effects of thrombosis, or the issue of bleeding and surgical site complications. The aim of this research was to determine if health utility could be a consideration before choosing to therapeutically anticoagulate in the hip and knee arthroplasty patient. METHODS: The quantitative risks and effectiveness of treatment options for venous thromboembolism, atrial fibrillation, acute coronary syndromes, ischaemic stroke and mechanical heart valves were evaluated from previously published data...
July 31, 2017: ANZ Journal of Surgery
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