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Ischaemic stroke

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https://www.readbyqxmd.com/read/28229893/safety-and-efficacy-of-natalizumab-in-patients-with-acute-ischaemic-stroke-action-a-randomised-placebo-controlled-double-blind-phase-2-trial
#1
Jacob Elkins, Roland Veltkamp, Joan Montaner, S Claiborne Johnston, Aneesh B Singhal, Kyra Becker, Maarten G Lansberg, Weihua Tang, Ih Chang, Kumar Muralidharan, Sarah Gheuens, Lahar Mehta, Mitchell S V Elkind
BACKGROUND: In animal models of acute ischaemic stroke, blocking of the leukocyte-endothelium adhesion by antagonism of α4 integrin reduces infarct volumes and improves outcomes. We assessed the effect of one dose of natalizumab, an antibody against the leukocyte adhesion molecule α4 integrin, in patients with acute ischaemic stroke. METHODS: In this double-blind, phase 2 study, patients with acute ischaemic stroke (aged 18-85 years) from 30 US and European clinical sites were randomly assigned (1:1) to 300 mg intravenous natalizumab or placebo with stratification by treatment window and baseline infarct size...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28229882/can-natalizumab-be-beneficial-in-acute-ischaemic-stroke
#2
Turgut Tatlisumak
No abstract text is available yet for this article.
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28228467/gender-differences-in-clinical-presentation-and-1-year-outcomes-in-atrial-fibrillation
#3
Renate B Schnabel, Ladislav Pecen, Francisco M Ojeda, Markus Lucerna, Nargiz Rzayeva, Stefan Blankenberg, Harald Darius, Dipak Kotecha, Raffaele De Caterina, Paulus Kirchhof
OBJECTIVES: Our objective was to examine gender differences in clinical presentation, management and prognosis of atrial fibrillation (AF) in a contemporary cohort. METHODS: In 6412 patients, 39.7% women, of the PREvention oF thromboembolic events - European Registry in Atrial Fibrillation, we examined gender differences in symptoms, risk factors, therapies and 1-year incidence of adverse outcomes. RESULTS: Men with AF were on average younger than women (mean±SD: 70...
February 22, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28224695/distal-hyperintense-vessel-sign-is-associated-with-neurological-deterioration-in-acute-ischaemic-stroke
#4
K-W Nam, H-M Kwon, S-W Park, J-S Lim, M-K Han, Y-S Lee
BACKGROUND AND PURPOSE: The aim was to evaluate the relationship between distal hyperintense vessel sign (HVS) and early neurological deterioration (END) in acute ischaemic stroke with large vessel steno-occlusion. METHODS: Acute ischaemic stroke patients with symptomatic severe steno-occlusion in the middle cerebral artery or internal carotid artery were recruited within 24 h from symptom onset. Stroke outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) score at the time of admission and at 72 h and 7 days...
February 22, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28224399/can-neuroimaging-differentiate-pfo-and-af-related-cardioembolic-stroke-from-the-other-embolic-sources-clinical-radiological-correlation-on-a-retrospective-study
#5
Alessandro Stecco, Martina Quagliozzi, Eleonora Soligo, Andrea Naldi, Alessia Cassarà, Lorenzo Coppo, Roberta Rosso, Angelo Sante Bongo, Paola Amatuzzo, Francesco Buemi, Elena Guenzi, Alessandro Carriero
PURPOSE: The aim of this retrospective study was to map the specific ischemic lesion patterns of distribution in patent foramen ovale-related stroke (PFO-stroke) and atrial fibrillation-related stroke (AF-stroke) in patients with idiopatic ischemic stroke. MATERIALS AND METHODS: 750 ischaemic strokes were screened on basis of diagnostic imaging and tests: patients with known causes were excluded. 171 patients with unknown cause were selected and divided in two groups: AF-stroke (43 patients) and PFO-stroke (128 patients)...
February 21, 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/28222778/sample-size-considerations-for-trials-using-cerebral-white-matter-hyperintensity-progression-as-an-intermediate-outcome-at-1%C3%A2-year-after-mild-stroke-results-of-a-prospective-cohort-study
#6
Francesca M Chappell, Maria Del Carmen Valdés Hernández, Stephen D Makin, Kirsten Shuler, Eleni Sakka, Martin S Dennis, Paul A Armitage, Susana Muñoz Maniega, Joanna M Wardlaw
BACKGROUND: White matter hyperintensities (WMHs) are commonly seen on in brain imaging and are associated with stroke and cognitive decline. Therefore, they may provide a relevant intermediate outcome in clinical trials. WMH can be measured as a volume or visually on the Fazekas scale. We investigated predictors of WMH progression and design of efficient studies using WMH volume and Fazekas score as an intermediate outcome. METHODS: We prospectively recruited 264 patients with mild ischaemic stroke and measured WMH volume, Fazekas score, age and cardiovascular risk factors at baseline and 1 year...
February 21, 2017: Trials
https://www.readbyqxmd.com/read/28220472/renal-denervation-for-resistant-hypertension
#7
REVIEW
Giuseppe Coppolino, Anna Pisano, Laura Rivoli, Davide Bolignano
BACKGROUND: Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications, or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, renal sympathetic ablation (renal denervation) has been recently proposed as a possible therapeutic alternative to treat this condition...
February 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28218546/renal-artery-revascularization-by-using-the-riolan-anastomosis-as-feeding-vessel-in-a-patient-with-abdominal-aortic-coarctation-due-to-fibromuscular-dysplasia
#8
Christina Salmoukas, Stefan Ruemke, Jan Hinrich Bräsen, Axel Haverich, Omke Enno Teebken
Fibromuscular dysplasia is a non-inflammatory, non-atherosclerotic vascular disease, occurring predominantly in younger females. A histologically heterogeneous group of fibroplasia without an inflammatory component causes arterial narrowing. It affects mostly one or both renal arteries, cervicocranial or visceral arteries, leading to hypertension, renal failure/renal infarction or stroke/transient ischaemic attack. We present the case of a young female patient with abdominal aortic coarctation, history of acute renal failure, and critical hypertension due to pseudo-occlusion of both renal arteries...
February 20, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28213758/influence-of-a-combined-ct-c-arm-system-on-periprocedural-workflow-and-procedure-times-in-mechanical-thrombectomy
#9
Johannes Pfaff, Silvia Schönenberger, Christian Herweh, Mirko Pham, Simon Nagel, Peter Arthur Ringleb, Sabine Heiland, Martin Bendszus, Markus Alfred Möhlenbruch
OBJECTIVE: To achieve the fastest possible workflow in ischaemic stroke, we developed a CT/C-arm system, which allows imaging and endovascular treatment on the same patient table. METHODS: This prospective, monocentric trial was conducted between October 2014 and August 2016. Patients received stroke imaging and mechanical thrombectomy under general anaesthesia (GA) or conscious sedation (CS) using our combined setup comprising a CT-scanner and a mobile C-arm X-ray device...
February 17, 2017: European Radiology
https://www.readbyqxmd.com/read/28211060/shifting-gears-an-inpatient-medical-record-audit-and-post-discharge-survey-of-return-to-driving-following-stroke-transient-ischaemic-attack
#10
Janet Frith, Helen Warren-Forward, Isobel Hubbard, Carole James
BACKGROUND/AIM: In Australia, all stroke survivors should not drive for four weeks and transient ischaemic attack (TIA) survivors should not drive for two weeks. This study investigates the provision of return-to-driving education in the acute hospital setting and the use of this education by a cohort of Australian patients who have experienced a mild stroke or TIA and who are discharged directly home from their acute hospital admission. METHODS: A medical record audit was conducted of stroke patients discharged home from a regional hospital in Australia...
February 16, 2017: Australian Occupational Therapy Journal
https://www.readbyqxmd.com/read/28205339/doing-it-hard-in-the-bush-aligning-what-gets-measured-with-what-matters
#11
Malcolm I McDonald, Kenny D Lawson
What gets measured gets managed. Funding of health services is substantially determined by operational activity and specific outcome indicators. In day-to-day clinical decision-making, surrogate markers, such as glycosylated haemoglobin and blood pressure, are commonly used to modify risks of 'hard' outcomes that include kidney failure, ischaemic cardiac events, stroke and all-cause mortality. In many settings, surrogates are all we have to go on. As a consequence, current health funding models heavily rely on surrogate-based key performance indicators [KPIs]...
February 16, 2017: Australian Journal of Rural Health
https://www.readbyqxmd.com/read/28205318/risk-of-major-bleeding-and-stroke-associated-with-the-use-of-vkas-noacs-and-aspirin-in-patients-with-atrial-fibrillation-a-cohort-study
#12
Emilie Gieling, Hendrika A van den Ham, Hein van Onzenoort, Jacqueline Bos, Cornelis Kramers, Anthonius de Boer, Frank de Vries, Andrea M Burden
INTRODUCTION: Non-vitamin K antagonist oral anticoagulants (NOACs) are now available for the prevention of stroke in patients with atrial fibrillation (AF) as an alternative to vitamin K antagonists (VKA) and aspirin. The comparative effectiveness and safety in daily practice of these different drug classes is still unclear. The objective of this study was to evaluate the risk of major bleeding and stroke in AF patients using NOACs, VKAs or aspirin. METHODS: A retrospective cohort study was conducted among AF patients using the UK Clinical Practice Research Datalink (March 2008-October 2014)...
February 16, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28196949/referral-pathways-for-patients-with-tia-avoiding-hospital-admission-a-scoping-review
#13
Bridie Angela Evans, Khalid Ali, Jenna Bulger, Gary A Ford, Matthew Jones, Chris Moore, Alison Porter, Alan David Pryce, Tom Quinn, Anne C Seagrove, Helen Snooks, Shirley Whitman, Nigel Rees
OBJECTIVE: To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. DESIGN: Scoping review. DATA SOURCES: PubMed, CINAHL Web of Science, Scopus. STUDY SELECTION: Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. DATA EXTRACTION: We screened studies for eligibility and extracted data from relevant studies...
February 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/28188243/effectiveness-and-safety-of-reduced-dose-non-vitamin-k-antagonist-oral-anticoagulants-and-warfarin-in-patients-with-atrial-fibrillation-propensity-weighted-nationwide-cohort-study
#14
Peter Brønnum Nielsen, Flemming Skjøth, Mette Søgaard, Jette Nordstrøm Kjældgaard, Gregory Y H Lip, Torben Bjerregaard Larsen
Objective To examine clinical effectiveness and safety of apixaban 2.5 mg, dabigatran 110 mg, and rivaroxaban 15 mg compared with warfarin among patients with atrial fibrillation who had not previously taken an oral anticoagulant.Design Propensity weighted (inverse probability of treatment weighted) nationwide cohort study.Setting Individual linked data from three nationwide registries in Denmark.Participants Patients with non-valvular atrial fibrillation filling a first prescription for an oral anticoagulant from August 2011 to February 2016...
February 10, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28187920/holter-electrocardiogram-monitoring-in-patients-with-acute-ischaemic-stroke-find-afrandomised-an-open-label-randomised-controlled-trial
#15
Rolf Wachter, Klaus Gröschel, Götz Gelbrich, Gerhard F Hamann, Pawel Kermer, Jan Liman, Joachim Seegers, Katrin Wasser, Anna Schulte, Falko Jürries, Anna Messerschmid, Nico Behnke, Sonja Gröschel, Timo Uphaus, Anne Grings, Tugba Ibis, Sven Klimpe, Michaela Wagner-Heck, Magdalena Arnold, Evgeny Protsenko, Peter U Heuschmann, David Conen, Mark Weber-Krüger
BACKGROUND: Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. METHODS: Find-AFRANDOMISED is an open-label randomised study done at four centres in Germany...
February 8, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28186939/cardiac-diagnostic-work-up-for-atrial-fibrillation-after-transient-ischaemic-attacks-in-england-and-wales-results-from-a-cross-sectional-survey
#16
Olivia Geraghty, Eleni Korompoki, Filippos T Filippidis, Anthony Rudd, Roland Veltkamp
OBJECTIVES: Transient ischaemic attacks (TIAs) are an important precursor of stroke. Atrial fibrillation (AF) is among the most dangerous aetiologies shared between TIAs and strokes. Detection of AF after TIAs is essential for the initiation of oral anticoagulants. We aimed to identify variations in the use of cardiac investigations used to detect AF and cardiac pathology in patients with TIA in the UK. SETTING: All TIA clinical leads in England and Wales received an invitation by email to participate in an online survey in February 2015...
November 10, 2016: BMJ Open
https://www.readbyqxmd.com/read/28185801/lived-experience-of-having-a-child-with-stroke-a%C3%A2-qualitative-study
#17
Syrine Soufi, Stéphane Chabrier, Laurent Bertoletti, Silvy Laporte, Stéphane Darteyre
OBJECTIVE: To assess the lived experience of parents whose child has suffered a stroke. METHODS: A qualitative study model was chosen, comprising in-depth interviews with parents separately or altogether. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed verbatim and analysed using constant comparison and content analysis. Participant checking was performed. Thirteen families of children aged 1 month to 17 years, having suffered ischaemic or haemorrhagic arterial stroke within one to five years, were recruited...
January 25, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/28178406/haemorrhagic-transformation-after-ischaemic-stroke-in-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants
#18
Jan C Purrucker, Kirsten Haas, Marcel Wolf, Timolaos Rizos, Shujah Khan, Peter Kraft, Sven Poli, Rainer Dziewas, Johannes Meyne, Frederick Palm, Sebastian Jander, Markus Möhlenbruch, Peter U Heuschmann, Roland Veltkamp
BACKGROUND AND PURPOSE: To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28176973/changes-in-ischaemic-ecg-abnormalities-and-subsequent-risk-of-cardiovascular-disease
#19
Takeshi Sawai, Hironori Imano, Isao Muraki, Mina Hayama-Terada, Yuji Shimizu, Renzhe Cui, Akihiko Kitamura, Masahiko Kiyama, Takeo Okada, Tetsuya Ohira, Kazumasa Yamagishi, Mitsumasa Umesawa, Tomoko Sankai, Hiroyasu Iso
OBJECTIVE: The prognostic importance of changes in ischaemic ECG abnormalities over time (especially ST-T abnormalities) among Asians has not been fully investigated. We examined the associations between changes in ischaemic abnormalities upon serial ECG (improvement, persistence, deterioration) and cardiovascular disease (CVD) risk. METHODS: A prospective study cohort was conducted with 9374 men and women aged 40-69 years in four communities. Participants had multiple ECGs at study entry and during the next 10 years, and were followed up for a median period of 23...
2017: Heart Asia
https://www.readbyqxmd.com/read/28173711/association-between-patency-of-the-circle-of-willis-and-diabetes-mellitus-in-patients-with-cerebral-ischaemic-stroke
#20
Ying Chi, Zu-Neng Lu
Objective To examine patency of the cerebral anterior and posterior communicating arteries in patients with ischaemic stroke with or without diabetes mellitus. Methods This retrospective study included patients with acute ischaemic stroke treated between July 2011 and May 2016. Cerebral infarction was evaluated by magnetic resonance imaging. Anterior and posterior communicating-artery patency was determined using magnetic resonance angiography. Vessels were defined as patent or occluded. Results Out of 1 406 patients, incidence of vertebral basilar artery brain infarction and posterior cerebral artery brain infarction were significantly higher in patients with diabetes versus those without diabetes (35...
January 1, 2017: Journal of International Medical Research
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