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guidelines in early managment of acute ischemic stroke

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...
September 12, 2016: JAMA Neurology
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
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
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
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
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
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
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
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
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
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
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...
October 16, 2015: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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
M Kulla, M Friess, P D Schellinger, A Harth, O Busse, F Walcher, M Helm
BACKGROUND: The dataset "Emergency Department" of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) has been developed during several expert meetings. Its goal is an all-encompassing documentation of the early clinical treatment of patients in emergency departments. Using the example of the index disease acute ischemic stroke (stroke), the aim was to analyze how far this approach has been fulfilled. MATERIAL AND METHODS: In this study German, European and US American guidelines were used to analyze the extent of coverage of the datasets on current emergency department guidelines and recommendations from professional societies...
December 2015: Der Nervenarzt
William J Powers, Colin P Derdeyn, José Biller, Christopher S Coffey, Brian L Hoh, Edward C Jauch, Karen C Johnston, S Claiborne Johnston, Alexander A Khalessi, Chelsea S Kidwell, James F Meschia, Bruce Ovbiagele, Dileep R Yavagal
PURPOSE: The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. METHODS: This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations...
October 2015: Stroke; a Journal of Cerebral Circulation
Devin Harris, Christopher Hall, Kevin Lobay, Andrew McRae, Tanya Monroe, Jeffrey J Perry, Anthony Shearing, Gabe Wollam, Tom Goddard, Eddy Lang
The CAEP Stroke Practice Committee was convened in the spring of 2013 to revisit the 2001 policy statement on the use of thrombolytic therapy in acute ischemic stroke. The terms of reference of the panel were developed to include national representation from urban academic centres as well as community and rural centres from all regions of the country. Membership was determined by attracting recognized stroke leaders from across the country who agreed to volunteer their time towards the development of revised guidance on the topic...
March 2015: CJEM
Won Hyuk Chang, Yong-Il Shin, Sam-Gyu Lee, Gyung-Jae Oh, Young Shil Lim, Yun-Hee Kim
PURPOSE: The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. MATERIALS AND METHODS: This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records...
January 2015: Yonsei Medical Journal
Bernt Harald Helleberg, Hanne Ellekjær, Gitta Rohweder, Bent Indredavik
BACKGROUND: 10-40% of patients with acute ischemic stroke (AIS) suffer an early neurological deterioration (END), which may influence their long term prognosis. Multiple definitions of END exist, even in recently published papers. In the search for causes, various biochemical, clinical, and imaging markers have been found to be associated to END after AIS in some but not in other studies. The primary aim of this study is to assess the contribution of END to functional level at 3 months post stroke measured by modified Rankin Scale (mRS)...
2014: BMC Neurology
Alina Beliavsky, Jeffrey J Perry, Dar Dowlatshahi, Jason Wasserman, Marco L A Sivilotti, Jane Sutherland, Andrew Worster, Marcel Emond, Grant Stotts, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather E Murray, Ariane MacKey, Steve Verreault, George A Wells, Ian G Stiell, Mukul Sharma
BACKGROUND: Isolated dysarthria is an uncommon presentation of transient ischemic attack (TIA)/minor stroke and has a broad differential diagnosis. There is little information in the literature about how often this presentation is confirmed to be a TIA/stroke, and therefore there is debate about the risk of subsequent vascular events. Given the uncertain prognosis, it is unclear how to best manage patients presenting to the emergency department (ED) with isolated dysarthria. The objective of this study was to prospectively identify and follow a cohort of patients presenting to EDs with isolated dysarthria in order to explore their natural history and risk of recurrent cerebrovascular events...
May 2014: Cerebrovascular Diseases Extra
Nelson J Maldonado, Syed O Kazmi, Jose Ignacio Suarez
Acute ischemic stroke is the fourth leading cause of death and the leading cause of disability in the United States. Stroke is a medical emergency. The development of stroke systems of care has changed the way practitioners view and treat this devastating disease. Ample evidence has shown that patients presenting early and receiving intravenous thrombolytic therapy have the best chance for significant improvement in functional outcome, particularly if they are transported to specialized stroke centers. Early detection and management of medical and neurologic complications is key at preventing further brain damage in patients with acute ischemic stroke...
October 2014: Critical Care Clinics
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