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guidelines in early managment of acute ischemic stroke

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https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#1
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28723732/role-of-anesthesia-in-endovascular-stroke-therapy
#2
Arthur Wang, Apolonia E Abramowicz
PURPOSE OF REVIEW: Recent randomized clinical trials have demonstrated strong efficacy of endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions; in the USA alone, tens of thousands of patients annually may benefit. The impact of the type of anesthesia used during mechanical thrombectomy on patient outcomes remains controversial. This review discusses the current literature on the effects of anesthesia type on patient outcome following endovascular stroke therapy...
July 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28592775/blood-pressure-management-for-stroke-prevention-and-in-acute-stroke
#3
REVIEW
Keun-Sik Hong
Elevated blood pressure (BP) is the leading modifiable risk factor for stroke and the benefit of BP lowering therapy on the stroke risk reduction is well established. The optimal BP target for preventing stroke and other vascular events have been controversial, but the evidences from epidemiological studies and randomized controlled trials (RCTs) support intensive BP lowering for greater vascular protection, particularly for stroke prevention. For secondary stroke prevention, the evidence of intensive BP lowering benefit is limited since only a single RCT for patients with lacunar infarctions was conducted and most data were driven by exploratory analyses...
May 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28588423/dysphagia-screening-after-acute-stroke-a-quality-improvement-project-using-criteria-based-clinical-audit
#4
Jorun Sivertsen, Birgitte Graverholt, Birgitte Espehaug
BACKGROUND: Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28168953/stroke-disclosing-primary-aldosteronism-report-on-three-cases-and-review-of-the-literature
#5
REVIEW
Amina Nasri, Malek Mansour, Zeineb Brahem, Amel Kacem, Ahmed Abou Hassan, Hager Derbali, Meriem Messelmani, Jamel Zaouali, Ridha Mrissa
OBJECTIVES: There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas. MATERIALS AND METHODS: We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke...
February 2017: Annales D'endocrinologie
https://www.readbyqxmd.com/read/28157821/blood-pressure-control-for-acute-severe-ischemic-and-hemorrhagic-stroke
#6
Julian Bösel
PURPOSE OF REVIEW: Severe ischemic or hemorrhagic stroke is a devastating cerebrovascular disease often demanding critical care. Optimal management of blood pressure (BP) in the acute phase is controversial. The purpose of this review is to display insights from recent studies on BP control in both conditions. RECENT FINDINGS: BP control in acute ischemic stroke has recently been investigated with regard to endovascular recanalizing therapies. Decreases from baseline BP and hypotension during the intervention have been found detrimental...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28000127/intensive-care-unit-admission-for-patients-in-the-interact2-ich-blood-pressure-treatment-trial-characteristics-predictors-and-outcomes
#7
Katja E Wartenberg, Xia Wang, Paula Muñoz-Venturelli, Alejandro A Rabinstein, Pablo M Lavados, Craig S Anderson, Thompson Robinson
BACKGROUND: Wide variation exists in criteria for accessing intensive care unit (ICU) facilities for managing patients with critical illnesses such as acute intracerebral hemorrhage (ICH). We aimed to determine the predictors of admission, length of stay, and outcome for ICU among participants of the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of 2839 ICH patients (<6 h) and elevated systolic blood pressure (SBP) allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) BP-lowering treatment...
December 20, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27617425/endovascular-therapy-for-acute-ischemic-stroke-with-occlusion-of-the-middle-cerebral-artery-m2-segment
#8
MULTICENTER STUDY
Amrou Sarraj, Navdeep Sangha, Muhammad Shazam Hussain, Dolora Wisco, Nirav Vora, Lucas Elijovich, Nitin Goyal, Michael Abraham, Manoj Mittal, Lei Feng, Abel Wu, Vallabh Janardhan, Suman Nalluri, Albert J Yoo, Megan George, Randall Edgell, Rutvij J Shah, Clark Sitton, Emilio Supsupin, Suhas Bajgur, M Carter Denny, Peng R Chen, Mark Dannenbaum, Sheryl Martin-Schild, Sean I Savitz, Rishi Gupta
Importance: Randomized clinical trials have shown the superiority of endovascular therapy (EVT) compared with best medical management for acute ischemic strokes with large vessel occlusion (LVO) in the anterior circulation. However, of 1287 patients enrolled in 5 trials, 94 with isolated second (M2) segment occlusions were randomized and 51 of these received EVT, thereby limiting evidence for treating isolated M2 segment occlusions as reflected in American Heart Association guidelines...
November 1, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27521435/stroke-outcomes-with-use-of-antithrombotics-within-24-hours-after-recanalization-treatment
#9
Han-Gil Jeong, Beom Joon Kim, Mi Hwa Yang, Moon-Ku Han, Hee-Joon Bae, Seung-Hoon Lee
OBJECTIVE: To compare clinical outcomes of patients who received early initiation (<24 hours) of antithrombotics with those who received standard management (antithrombotics administered ≥24 hours). METHODS: A total of 712 patients who had an acute ischemic stroke and underwent IV or endovascular (intra-arterial [IA]) recanalization between July 2007 and March 2015 were selected from a prospective clinical registry. Antithrombotics were initiated by an individual clinical decision...
September 6, 2016: Neurology
https://www.readbyqxmd.com/read/27366297/management-of-acute-hypertensive-response-in-patients-with-ischemic-stroke
#10
Ahmad AlSibai, Adnan I Qureshi
High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial...
July 2016: Neurohospitalist
https://www.readbyqxmd.com/read/27256836/recent-endovascular-stroke-trials-and-their-impact-on-stroke-systems-of-care
#11
REVIEW
Maxim Mokin, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, L Nelson Hopkins
Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 "positive" trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines...
June 7, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/26988891/blood-biomarkers-in-the-early-stage-of-cerebral-ischemia
#12
REVIEW
I Maestrini, A Ducroquet, S Moulin, D Leys, C Cordonnier, R Bordet
In ischemic stroke patients, blood-based biomarkers may be applied for the diagnosis of ischemic origin and subtype, prediction of outcomes and targeted treatment in selected patients. Knowledge of the pathophysiology of cerebral ischemia has led to the evaluation of proteins, neurotransmitters, nucleic acids and lipids as potential biomarkers. The present report focuses on the role of blood-based biomarkers in the early stage of ischemic stroke-within 72h of its onset-as gleaned from studies published in English in such patients...
March 2016: Revue Neurologique
https://www.readbyqxmd.com/read/26969238/preparing-for-a-pediatric-stroke-alert
#13
REVIEW
Timothy J Bernard, Neil R Friedman, Nicholas V Stence, William Jones, Rebecca Ichord, Catherine Amlie-Lefond, Michael M Dowling, Michael J Rivkin
BACKGROUND: Childhood arterial ischemic stroke is an important cause of morbidity and mortality in children. Hyperacute treatment strategies remain controversial and challenging, especially in the setting of increasingly proven medical and endovascular options in adults. Although national and international pediatric guidelines have given initial direction about acute therapy and management, pediatric centers have traditionally lacked the infrastructure to triage, diagnose, and treat childhood arterial ischemic stroke quickly...
March 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/26953574/selection-of-patients-and-anesthetic-types-for-endovascular-treatment-in-acute-ischemic-stroke-a-meta-analysis-of-randomized-controlled-trials
#14
Fubing Ouyang, Yicong Chen, Yuhui Zhao, Ge Dang, Jiahui Liang, Jinsheng Zeng
BACKGROUND: and Purpose Recent randomized controlled trials have demonstrated consistent effectiveness of endovascular treatment (EVT) for acute ischemic stroke, leading to update on stroke management guidelines. We conducted this meta-analysis to assess the efficacy and safety of EVT overall and in subgroups stratified by age, baseline stroke severity, brain imaging feature, and anesthetic type. METHODS: Published randomized controlled trials comparing EVT and standard medical care alone were evaluated...
2016: PloS One
https://www.readbyqxmd.com/read/26909816/blood-pressure-management-in-intracranial-hemorrhage-current-challenges-and-opportunities
#15
Cheryl Carcel, Shoichiro Sato, Craig S Anderson
Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group...
April 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/26866928/endovascular-management-of-acute-ischemic-strokes-with-tandem-occlusions
#16
Robert Fahed, Hocine Redjem, Raphaël Blanc, Julien Labreuche, Thomas Robert, Gabriele Ciccio, Didier Smadja, Stanislas Smajda, Michel Piotin
BACKGROUND: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. METHODS: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014...
2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/26670085/outcomes-of-argatroban-treatment-in-patients-with-atherothrombotic-stroke-observational-nationwide-study-in-japan
#17
Tomoki Wada, Hideo Yasunaga, Hiromasa Horiguchi, Takehiro Matsubara, Kiyohide Fushimi, Susumu Nakajima, Naoki Yahagi
BACKGROUND AND PURPOSE: Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke. METHODS: This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset...
February 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/26564181/-troponin-elevation-in-ischemic-stroke-patients
#18
C H Nolte, J F Scheitz, M Endres
Cerebrovascular and cardiovascular diseases are major causes of death and disability worldwide. Ischemic stroke is a frequent complication in cardiac diseases and, vice versa, cardiac complications commonly cause early clinical worsening and death after stroke. In the emergency setting, cardiac biomarkers (preferably troponin, cTn) are measured frequently in patients presenting with acute ischemic stroke. The measurement of cTn is recommended by the guidelines for early management of patients with acute ischemic stroke from the American Heart Association...
November 12, 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/26479737/length-of-stay-in-emergency-department-and-cerebral-intravenous-thrombolysis-in-community-hospitals
#19
Wiktor Szczuchniak, Grzegorz Kozera, Piotr Sobolewski, Waldemar Brola, Jacek Staszewski, Ulf Schminke, Walenty M Nyka
OBJECTIVES: Current guidelines for the early management of patients with acute ischemic stroke recommend completion of an evaluation within 60 min of the patient's arrival at the emergency department (ED) because prolongation of ED length of stay (LOS) may reduce the efficacy of acute stroke treatment. AIM: To evaluate the LOS in EDs at the community-based Polish stroke centers, to determine logistic, social, epidemiological, and clinical factors responsible for its prolongation, and to assess the association between increased LOS and the implementation of cerebral intravenous (IV) thrombolysis...
June 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/26386103/dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-after-ischemic-stroke-a-review-of-the-evidence
#20
REVIEW
Kyle A Davis, Marta A Miyares, Eric Dietrich
PURPOSE: The safety and efficacy of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in the setting of secondary stroke prevention are reviewed. SUMMARY: Antiplatelet therapy has been shown to reduce the risk of numerous vascular events, especially in the setting of secondary prevention. DAPT with aspirin and another antiplatelet agent such as clopidogrel, prasugrel, or ticagrelor has become the main stay of acute coronary syndrome (ACS) management...
October 1, 2015: American Journal of Health-system Pharmacy: AJHP
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