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Ischemic stroke randomized

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https://www.readbyqxmd.com/read/28330015/contact-aspiration-versus-stent-retriever-front-line-for-recanalisation-in-acute-cerebral-infarction-the-aster-trial
#1
Bertrand Lapergue, Julien Labreuche, Michel Piotin
RATIONALE: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion (LVO). Favorable outcome is strongly associated with the successful reperfusion status. New techniques for MT such as contact aspiration (CA) seem promising to increase reperfusion status and clinical outcome in retrospective studies. We aim at ascertaining whether CA is more efficient than stent retriever as a front-line endovascular procedure...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28330012/mechanical-thrombectomy-for-minor-and-mild-stroke-patients-harboring-large-vessel-occlusion-in-the-anterior-circulation-a-multicenter-case-control-study
#2
Cyril Dargazanli, Caroline Arquizan, Arturo Consoli, Benjamin Gory, Omer Eker, Xavier Ayrignac, Jean-Pierre Decroix, Astrid Corlobé, Isabelle Mourand, Grégory Gascou, Mahmoud Charif, Julien Labreuche, Alain Duhamel, Paul-Emile Labeyrie, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Carlos Riquelme, Oguzhan Coskun, Jean-Philippe Desilles, Frédéric Bourdain, Roberto Riva, Mikael Obadia, Francis Turjman, Georges Rodesch, Pierre Labauge, Alain Bonafé, Mikael Mazighi, Vincent Costalat, Michel Piotin, Raphaël Blanc, Bertrand Lapergue
BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. There is no proven effectiveness of MT in the subgroup of minor stroke with LVO in the anterior circulation and data about mechanical thrombectomy (MT) in this subgroup of patients are sparse, with optimal management of these patients being yet not definitely addressed. The purpose of this case-control study was to evaluate MT in patients suffering from acute ischemic stroke (AIS) and LVO in the anterior circulation, presenting with minor to mild stroke symptoms (NIHSS<8)...
March 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28327054/effects-of-low-frequency-repetitive-transcranial-magnetic-stimulation-and-neuromuscular-electrical-stimulation-on-upper-extremity-motor-recovery-in-the-early-period-after-stroke-a-preliminary-study
#3
Aliye Tosun, Sabiha Türe, Ayhan Askin, Engin Ugur Yardimci, Secil Umit Demirdal, Tülay Kurt Incesu, Ozgur Tosun, Hikmet Kocyigit, Galip Akhan, Fazıl Mustafa Gelal
OBJECTIVE: To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on upper extremity motor function in patients with acute/subacute ischemic stroke. METHODS: Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT...
March 22, 2017: Topics in Stroke Rehabilitation
https://www.readbyqxmd.com/read/28318958/the-association-between-carotid-artery-atherosclerosis-and-silent-brain-infarction-a-systematic-review-and-meta-analysis
#4
Caitlin Finn, Ashley E Giambrone, Gino Gialdini, Diana Delgado, Hediyeh Baradaran, Hooman Kamel, Ajay Gupta
BACKGROUND: Carotid atherosclerosis is responsible for ~20% of ischemic strokes, but it is unclear whether carotid disease is associated with the presence of downstream silent brain infarction (SBI). We performed a systematic review and meta-analysis to study the relationship between SBI and 2 separate manifestations of carotid atherosclerosis, carotid intima-media thickening (IMT) and luminal stenosis. METHODS: Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database were searched with an additional search of references and citing articles of target studies...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28314578/anticoagulation-atrial-fibrillation-and-chronic-kidney%C3%A2-disease-whose-side%C3%A2-are-you-on
#5
Gunnar Henrik Heine, Vincent Brandenburg
Whether to initiate oral anticoagulant therapy in advanced chronic kidney disease patients with atrial fibrillation remains debatable. Although randomized trial data are lacking, observational studies yield controversial results. Keskar and colleagues analyzed data from a Canadian health care system and found that in elderly chronic kidney disease patients with atrial fibrillation, oral anticoagulant therapy did not prevent ischemic strokes, induced hemorrhages, but prolonged life. These paradoxical findings emphasize the dire need for an adequately powered randomized trial...
April 2017: Kidney International
https://www.readbyqxmd.com/read/28304200/advance-an-effective-and-feasible-technique-in-acute-stroke-treatment
#6
Erdem Gurkas, Cetin Kursad Akpinar, Emrah Aytac
Background and purpose Different techniques regarding efficient utilization of thrombectomy devices have been reported. Here, we described a novel technique named ADVANCE that is based on advancing a distal access catheter over the stent retriever. In this study, we aimed to report our initial results with this novel thrombectomy technique. Methods and results Sixty-seven consecutive acute anterior circulation ischemic stroke patients (35 male, 32 female) between January 2015 and January 2016 who were treated by mechanical thrombectomy were included in this prospective study...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28303440/the-efficacy-and-safety-of-high-dose-statins-in-acute-phase-of-ischemic-stroke-and-transient-ischemic-attack-a-systematic-review
#7
Jing-Xue Fang, Er-Qiang Wang, Wei Wang, Yang Liu, Gang Cheng
Inconsistent findings in the studies have been observed concerning the higher dose of statins use in the acute phase of ischemic stroke and transient ischemic attack (TIA). Therefore, we performed a systematic review to assess this issue. A computerized literature search in PubMed, Cochrane Library databases, and EMBASE for randomized controlled trials (RCTs) was conducted. The efficacy outcome indicators were National Institutes of Health Stroke Scale (NIHSS) score, infarct volume, and recurrence of stroke; the safety outcome indicators were intracranial hemorrhage events, cardiovascular and cerebrovascular events, and all-cause death...
March 16, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28302952/reduction-in-high-sensitivity-c-reactive-protein-levels-in-patients-with-ischemic-stroke-by-statin-treatment-hs-crp-sub-study-in-j-stars
#8
Kazuo Kitagawa, Naohisa Hosomi, Yoji Nagai, Tatsuo Kagimura, Toshiho Ohtsuki, Hideki Origasa, Kazuo Minematsu, Shinichiro Uchiyama, Masakazu Nakamura, Masayasu Matsumoto
AIMS: The pleiotropic effects of statins on recurrent stroke remain unclear. We investigated the effects of pravastatin on high-sensitivity C-reactive proteins (Hs-CRP) in ischemic stroke, and explored the impact of Hs-CRP on recurrent stroke and vascular events. METHODS: This randomized open-label trial was ancillary to the J-STARS trial. One thousand and ninety-five patients with non-cardiogenic ischemic stroke were assigned to the pravastatin (n=545) or control groups (n=550)...
March 7, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28301216/bioidentical-menopausal-hormone-therapy-registered-hormones-non-oral-estradiol%C3%A2-%C3%A2-%C3%A2-progesterone-are-optimal
#9
M L'Hermite
The many advantages of registered bioidentical sex hormones over registered, conventional, non-bioidentical menopausal hormone therapy (MHT) are considered. The transdermal route of estrogen administration avoids excess venous thromboembolic and ischemic stroke events. There is some indication that conjugated equine estrogens are more thrombogenic and most likely induce some hypertensive responses; estradiol might also be superior to conjugated equine estrogens (CEE) in terms of global cardiovascular health...
March 16, 2017: Climacteric: the Journal of the International Menopause Society
https://www.readbyqxmd.com/read/28298840/the-need-for-a-population-based-dose-optimization-study-for-recombinant-tissue-plasminogen-activator-in-acute-ischemic-stroke-a-study-from-a-tertiary-care-teaching-hospital-from-south-india
#10
Siju V Abraham, Fazil Thaha, S Vimal Krishnan, Athulya Shajan, Jayaraj Mymbilly Balakrishnan, Babu Urumese Palatty
CONTEXT: The guideline recommended dose of intravenous (i.v) recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke is 0.9 mg/kg in the European and American populations. In Asiatic population, some studies have shown that a lower dose of i.v rt-PA is equally efficacious. AIMS: To assess if there is a need for a dose optimization for i.v rt-PA study among Indians. SETTING AND DESIGN: A prospective, observational database of acute stroke cases that presented to a tertiary care institute over a period of 1 year was made...
January 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28297015/mortality-following-cardiovascular-and-bleeding-events-occurring-beyond-1-year-after-coronary-stenting-a-secondary-analysis-of-the-dual-antiplatelet-therapy-dapt-study
#11
Eric A Secemsky, Robert W Yeh, Dean J Kereiakes, Donald E Cutlip, David J Cohen, P Gabriel Steg, Christopher P Cannon, Patricia K Apruzzese, Ralph B D'Agostino, Joseph M Massaro, Laura Mauri
Importance: Early cardiovascular and bleeding events after coronary stenting are associated with high risk of morbidity and mortality. Objective: To assess the prognosis of cardiovascular and bleeding events occurring beyond 1 year after coronary stenting. Design, Setting, and Participants: This secondary analysis is derived from data from the Dual Antiplatelet Therapy (DAPT) Study, a multicenter trial involving 220 US and international clinical sites from 11 countries...
March 15, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28294373/rationale-and-design-of-reduce-it-reduction-of-cardiovascular-events-with-icosapent-ethyl-intervention-trial
#12
Deepak L Bhatt, Ph Gabriel Steg, Eliot A Brinton, Terry A Jacobson, Michael Miller, Jean-Claude Tardif, Steven B Ketchum, Ralph T Doyle, Sabina A Murphy, Paresh N Soni, Rene A Braeckman, Rebecca A Juliano, Christie M Ballantyne
Residual cardiovascular risk persists despite statins, yet outcome studies of lipid-targeted therapies beyond low-density lipoprotein cholesterol (LDL-C) have not demonstrated added benefit. Triglyceride elevation is an independent risk factor for cardiovascular events. High-dose eicosapentaenoic acid (EPA) reduces triglyceride-rich lipoproteins without raising LDL-C. Omega-3s have postulated pleiotropic cardioprotective benefits beyond triglyceride-lowering. To date, no large, multinational, randomized clinical trial has proved that lowering triglycerides on top of statin therapy improves cardiovascular outcomes...
March 15, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28291783/oesophageal-heat-exchangers-with-a-diameter-of-11mm-or-14-7mm-are-equally-effective-and-safe-for-targeted-temperature-management
#13
Daniel C Schroeder, Maria Guschlbauer, Alexandra C Maul, Daniel A Cremer, Ingrid Becker, David de la Puente Bethencourt, Peter Paal, Stephan A Padosch, Wolfgang A Wetsch, Thorsten Annecke, Bernd W Böttiger, Anja Sterner-Kock, Holger Herff
BACKGROUND: Targeted temperature management (TTM) is widely used in critical care settings for conditions including hepatic encephalopathy, hypoxic ischemic encephalopathy, meningitis, myocardial infarction, paediatric cardiac arrest, spinal cord injury, traumatic brain injury, ischemic stroke and sepsis. Furthermore, TTM is a key treatment for patients after out-of-hospital cardiac-arrest (OHCA). However, the optimal cooling method, which is quick, safe and cost-effective still remains controversial...
2017: PloS One
https://www.readbyqxmd.com/read/28291782/obesity-paradox-in-stroke-myth-or-reality-a-systematic-review
#14
Lisa Oesch, Turgut Tatlisumak, Marcel Arnold, Hakan Sarikaya
BACKGROUND AND PURPOSE: Both stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest a better prognosis in obese patients after stroke ("obesity paradox"). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search. METHODS: The reviewers searched MEDLINE from inception to December 2015...
2017: PloS One
https://www.readbyqxmd.com/read/28289241/symptomatic-patients-remain-at-substantial-risk-of-arterial-disease-complications-before-and-after-endarterectomy-or-stenting
#15
Cristina Hobeanu, Philippa C Lavallée, Peter M Rothwell, Leila Sissani, Gregory W Albers, Natan M Bornstein, Louis R Caplan, Geoffrey A Donnan, José M Ferro, Michael G Hennerici, Julien Labreuche, Carlos Molina, Philippe Gabriel Steg, Pierre-Jean Touboul, Shinichiro Uchiyama, Éric Vicaut, Lawrence K S Wong, Pierre Amarenco
BACKGROUND AND PURPOSE: After carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with transient ischemic attack or minor ischemic stroke, recurrent stroke risk falls to a low rate on modern medical treatment. METHODS: We used data from 4583 patients with recent transient ischemic attack or minor stroke enrolled in the TIAregistry.org to perform a nested case-control analysis to evaluate pre- and post-CEA/CAS risk. Cases were defined as patients with a CEA/CAS during the 1-year follow-up period...
March 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28289240/pais-2-paracetamol-acetaminophen-in-stroke-2-results-of-a-randomized-double-blind-placebo-controlled-clinical-trial
#16
Inger R de Ridder, Heleen M den Hertog, H Maarten A van Gemert, A H C M L Tobien Schreuder, Annemieke Ruitenberg, E Lisette Maasland, Ritu Saxena, Jordie H van Tuijl, Ben P W Jansen, Renske M Van den Berg-Vos, Frederique Vermeij, Peter J Koudstaal, L Jaap Kappelle, Ale Algra, H Bart van der Worp, Diederik W J Dippel
BACKGROUND AND PURPOSE: Subfebrile body temperature and fever in the first days after stroke are strongly associated with unfavorable outcome. A subgroup analysis of a previous trial suggested that early treatment with paracetamol may improve functional outcome in patients with acute stroke and a body temperature of ≥36.5°C. In the present trial, we aimed to confirm this finding. METHODS: PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2) was a multicenter, randomized, double-blind, placebo-controlled clinical trial...
March 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28285652/circulating-adiponectin-levels-in-relation-to-carotid-atherosclerotic-plaque-presence-ischemic-stroke-risk-and-mortality-a-systematic-review-and-meta-analyses
#17
Jessica Gorgui, Karina Gasbarrino, Marios K Georgakis, Maria A Karalexi, Bénédicte Nauche, Eleni Th Petridou, Stella S Daskalopoulou
BACKGROUND: Low circulating levels of adiponectin, an anti-inflammatory and vasculoprotective adipokine, are associated with obesity, type 2 diabetes, and atherosclerotic disease. Presence of unstable plaques in the carotid artery is a known etiological factor causing ischemic strokes. Herein, we systematically reviewed the association between circulating adiponectin and progression of carotid atherosclerotic disease, particularly evaluating the occurrence of (1) carotid atherosclerotic plaques, (2) ischemic stroke, and (3) mortality in subjects who suffered a previous ischemic stroke...
April 2017: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/28283600/hyperglycemia-predicts-poststroke-infections-in-acute-ischemic-stroke
#18
Thomas P Zonneveld, Paul J Nederkoorn, Willeke F Westendorp, Matthijs C Brouwer, Diederik van de Beek, Nyika D Kruyt
OBJECTIVE: To investigate whether admission hyperglycemia predicts poststroke infections and, if so, whether poststroke infections modify the effect of admission hyperglycemia on functional outcome in ischemic stroke. METHODS: We used data from acute ischemic stroke patients in the Preventive Antibiotics in Stroke Study (PASS), a multicenter randomized controlled trial (n = 2,550) investigating the effect of preventive antibiotics on functional outcome. Admission hyperglycemia was defined as blood glucose ≥7...
March 10, 2017: Neurology
https://www.readbyqxmd.com/read/28279642/low-intensity-400%C3%A2-mw-cm-2-500%C3%A2-khz-pulsed-transcranial-ultrasound-preconditioning-may-mitigate-focal-cerebral-ischemia-in-rats
#19
Hangdao Li, Junfeng Sun, Daqu Zhang, Daryl Omire-Mayor, Peter A Lewin, Shanbao Tong
BACKGROUND: Preconditioning methods, which could increase tolerance of brain to subsequent ischemic injuries with a small dose of non-injury stimuli, have gained attention. Capitalizing on noninvasiveness and safety of ultrasound modality, the pulsed transcranial ultrasound stimulation (pTUS) approach may provide a novel treatment for patients with high risk of stroke. OBJECTIVE: This study's goal was to investigate whether the risk of stroke could be minimized or eliminated by prior exposure to low-intensity, pulsed transcranial ultrasound stimulation (pTUS)...
February 27, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/28279371/carotid-plaque-lipid-content-and-fibrous-cap-status-predict-systemic-cv-outcomes-the-mri-substudy-in-aim-high
#20
Jie Sun, Xue-Qiao Zhao, Niranjan Balu, Moni B Neradilek, Daniel A Isquith, Kiyofumi Yamada, Gádor Cantón, John R Crouse, Todd J Anderson, John Huston, Kevin O'Brien, Daniel S Hippe, Nayak L Polissar, Chun Yuan, Thomas S Hatsukami
OBJECTIVES: The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. BACKGROUND: Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. METHODS: As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features...
March 2017: JACC. Cardiovascular Imaging
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