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Ischemic stroke randomized

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https://www.readbyqxmd.com/read/29778671/international-study-of-comparative-health-effectiveness-with-medical-and-invasive-approaches-ischemia-trial-rationale-and-design
#1
David J Maron, Judith S Hochman, Sean M O'Brien, Harmony R Reynolds, William E Boden, Gregg W Stone, Sripal Bangalore, John A Spertus, Daniel B Mark, Karen P Alexander, Leslee Shaw, Jeffrey S Berger, T Bruce Ferguson, David O Williams, Robert A Harrington, Yves Rosenberg
BACKGROUND: Prior trials comparing a strategy of optimal medical therapy with or without revascularization have not shown that revascularization reduces cardiovascular events in patients with stable ischemic heart disease (SIHD). However, those trials only included participants in whom coronary anatomy was known prior to randomization and did not include sufficient numbers of participants with significant ischemia. It remains unknown whether a routine invasive approach offers incremental value over a conservative approach with catheterization reserved for failure of medical therapy in patients with moderate or severe ischemia...
April 21, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29777016/clinical-utility-of-electronic-alberta-stroke-program-early-computed-tomography-score-software-in-the-enchanted-trial-database
#2
Simon Nagel, Xia Wang, Cheryl Carcel, Thompson Robinson, Richard I Lindley, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke. METHODS: All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemic stroke who participated in the alteplase dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded...
May 18, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29773586/seafood-long-chain-n-3-polyunsaturated-fatty-acids-and-cardiovascular-disease-a-science-advisory-from-the-american-heart-association
#3
REVIEW
Eric B Rimm, Lawrence J Appel, Stephanie E Chiuve, Luc Djoussé, Mary B Engler, Penny M Kris-Etherton, Dariush Mozaffarian, David S Siscovick, Alice H Lichtenstein
Since the 2002 American Heart Association scientific statement "Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease," evidence from observational and experimental studies and from randomized controlled trials continues to emerge to further substantiate the beneficial effects of seafood long-chain n-3 polyunsaturated fatty acids and cardiovascular disease. A recent American Heart Association science advisory addressed the specific effect of n-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events...
May 17, 2018: Circulation
https://www.readbyqxmd.com/read/29773578/relationship-between-glycated-hemoglobin-and-stroke-risk-a-systematic-review-and-meta-analysis
#4
REVIEW
John Peter Mitsios, Elif Ilhan Ekinci, Gregory Peter Mitsios, Leonid Churilov, Vincent Thijs
BACKGROUND: Diabetes mellitus is a major risk factor for ischemic stroke. Rising hemoglobin A1c (HbA1c ) levels are associated with microvascular diabetes mellitus complication development; however, this relationship has not been established for stroke risk, a macrovascular complication. METHODS AND RESULTS: We conducted a systematic review and meta-analysis of observational cohort and nested case-control cohort studies assessing the association between rising HbA1c levels and stroke risk in adults (≥18 years old) with and without type 1 or type 2 diabetes mellitus...
May 17, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29768352/effectiveness-of-trevo-stent-retriever-in-acute-ischemic-stroke-comparison-with-solitaire-stent
#5
Ho Jun Yi, Dong Hoon Lee, Sang Uk Kim
Recently, mechanical thrombectomy with stent retriever has achieved faster and higher rates of recanalization for intracranial major vessel occlusion. However, comparative studies of the most widely used Solitaire and Trevo stents have been rarely published.The authors retrospectively reviewed a total of 200 patients who performed mechanical thrombectomy at our center during 4 years and divided patients into 2 groups: mechanical thrombectomy with Solitaire stent (Group 1: Solitaire) and mechanical thrombectomy with Trevo stent (Group 2: Trevo)...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29766772/rivaroxaban-for-stroke-prevention-after-embolic-stroke-of-undetermined-source
#6
Robert G Hart, Mukul Sharma, Hardi Mundl, Scott E Kasner, Shrikant I Bangdiwala, Scott D Berkowitz, Balakumar Swaminathan, Pablo Lavados, Yongjun Wang, Yilong Wang, Antonio Davalos, Nikolay Shamalov, Robert Mikulik, Luis Cunha, Arne Lindgren, Antonio Arauz, Wilfried Lang, Anna Czlonkowska, Jens Eckstein, Rubens J Gagliardi, Pierre Amarenco, Sebastian F Ameriso, Turgut Tatlisumak, Roland Veltkamp, Graeme J Hankey, Danilo Toni, Daniel Bereczki, Shinichiro Uchiyama, George Ntaios, Byung-Woo Yoon, Raf Brouns, Matthias Endres, Keith W Muir, Natan Bornstein, Serefnur Ozturk, Martin J O'Donnell, Matthys M De Vries Basson, Guillaume Pare, Calin Pater, Bodo Kirsch, Patrick Sheridan, Gary Peters, Jeffrey I Weitz, W Frank Peacock, Ashkan Shoamanesh, Oscar R Benavente, Campbell Joyner, Ellison Themeles, Stuart J Connolly
Background Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. Methods We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766770/mri-guided-thrombolysis-for-stroke-with-unknown-time-of-onset
#7
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766750/clopidogrel-and-aspirin-in-acute-ischemic-stroke-and-high-risk-tia
#8
S Claiborne Johnston, J Donald Easton, Mary Farrant, William Barsan, Robin A Conwit, Jordan J Elm, Anthony S Kim, Anne S Lindblad, Yuko Y Palesch
Background Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population. Methods In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29765412/neural-stem-cell-conditioned-medium-ameliorated-cerebral-ischemia-reperfusion-injury-in-rats
#9
HongNa Yang, Cuilan Wang, Hui Chen, Lan Li, Shuang Ma, Hao Wang, YaRu Fu, Tingyu Qu
Introduction: Our previous study suggested that NSC-CM (neural stem cell-conditioned medium) inhibited cell apoptosis in vitro . In addition, many studies have shown that neurotrophic factors and microparticles secreted into a conditioned medium by NSCs had neuroprotective effects. Thus, we hypothesized that NSC-CM had the capacity of protecting against cerebral I/R injury. Methods: Adult male Sprague-Dawley rats receiving middle cerebral artery occlusion surgery as an animal model of cerebral I/R injury were randomly assigned to two groups: the control group and NSC-CM-treated group...
2018: Stem Cells International
https://www.readbyqxmd.com/read/29765394/mechanical-thrombectomy-in-elderly-stroke-patients-with-mild-to-moderate-baseline-disability
#10
Diana E Slawski, Hisham Salahuddin, Julie Shawver, Cynthia L Kenmuir, Gretchen E Tietjen, Andrea Korsnack, Syed F Zaidi, Mouhammad A Jumaa
Background: The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Methods: Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29764706/atrial-fibrillation-and-ischemic-events-with-rivaroxaban-in-patients-with-stable-coronary-artery-disease-afire-protocol-for-a-multicenter-prospective-randomized-open-label-parallel-group-study
#11
Satoshi Yasuda, Koichi Kaikita, Hisao Ogawa, Masaharu Akao, Junya Ako, Tetsuya Matoba, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui
BACKGROUND: In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients...
May 2, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29762091/rapid-automated-quantification-of-cerebral-leukoaraiosis-on-ct-images-a-multicenter-validation-study
#12
Liang Chen, Anoma Lalani Carlton Jones, Grant Mair, Rajiv Patel, Anastasia Gontsarova, Jeban Ganesalingam, Nikhil Math, Angela Dawson, Basaam Aweid, David Cohen, Amrish Mehta, Joanna Wardlaw, Daniel Rueckert, Paul Bentley
Purpose To validate a random forest method for segmenting cerebral white matter lesions (WMLs) on computed tomographic (CT) images in a multicenter cohort of patients with acute ischemic stroke, by comparison with fluid-attenuated recovery (FLAIR) magnetic resonance (MR) images and expert consensus. Materials and Methods A retrospective sample of 1082 acute ischemic stroke cases was obtained that was composed of unselected patients who were treated with thrombolysis or who were undergoing contemporaneous MR imaging and CT, and a subset of International Stroke Thrombolysis-3 trial participants...
May 15, 2018: Radiology
https://www.readbyqxmd.com/read/29761573/using-fat-to-fight-disease-a-systematic-review-of-non-homologous-adipose-derived-stromal-stem-cell-therapies
#13
REVIEW
Marjorie E Bateman, Amy L Strong, Jeffrey M Gimble, Bruce A Bunnell
OBJECTIVE: The objective of this review is to describe the safety and efficacy of ASC and SVF in treating common diseases and the next steps in research that must occur prior to clinical use. EVIDENCE REVIEW: Pubmed, Ovid Medline, Embase, Web of Science, and the Cochrane Library were searched for articles about use of SVF or ASC for disease therapy published between 2012 and 2017. One meta-analysis, 2 randomized controlled trials, and 16 case series were included, representing 844 human patients...
May 15, 2018: Stem Cells
https://www.readbyqxmd.com/read/29760204/model-based-meta-analysis-to-evaluate-optimal-doses-of-direct-oral-factor-xa-inhibitors-in-atrial-fibrillation-patients
#14
Hideki Yoshioka, Hiromi Sato, Hiroto Hatakeyama, Akihiro Hisaka
The noninferiority of direct oral factor Xa (FXa) inhibitors (rivaroxaban, apixaban, and edoxaban) in treatment of atrial fibrillation were demonstrated compared with warfarin by several large clinical trials; however, subsequent meta-analyses reported a higher risk of major bleeding with rivaroxaban than with the other FXa inhibitors. In the present study, we first estimated the changes of prothrombin time (PT) in 5 randomized trials based on reported population pharmacokinetic and pharmacodynamic models and then carried out a model-based meta-analysis to obtain models describing the relationship between PT changes and the event rates of ischemic stroke/systemic embolism (SE) and of major bleeding...
May 22, 2018: Blood Advances
https://www.readbyqxmd.com/read/29758114/time-well-spent-in-recanalizing-complex-cerebrovascular-occlusions
#15
Perttu J Lindsberg
After publication of several randomized, controlled trials demonstrating the efficacy of mechanical thrombectomy (MT) following intravenous t-PA (IV t-PA) the current guidelines of acute management of cerebrovascular have been revised (1,2). In addition to IV t-PA within 4,5 hours applied in a wide spectrum of ischemic stroke subtypes, MT has been proven as the second therapeutic target in a longer time window in much more selected cases of large vessel occlusions (LVO). This article is protected by copyright...
May 14, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29756589/effect-of-combination-therapy-with-neuroprotective-and-vasoprotective-agents-on-cerebral-ischemia
#16
Jiping Yang, Bei Yang, Baoxin Xiu, Jinchong Qi, Huaijun Liu
Because most tested drugs are active against only one of the damaging processes associated with stroke, other mechanisms may cause cellular death. Thus, a combination of protective agents targeting different pathophysiological mechanisms may obtain better effects than a single agent. The major objective of this study was to investigate the effect of combination therapy with vascular endothelial growth factor (VEGF) and nerve growth factor (NGF) after controlled ischemic brain injury in rabbits. METHODS: Animals were randomly assigned to one of the following groups: sham group, saline-treated control group or NGF+VEGF-treated group...
May 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29754671/rationale-and-design-for-the-vascular-outcomes-study-of-asa-along-with-rivaroxaban-in-endovascular-or-surgical-limb-revascularization-for-peripheral-artery-disease-voyager-pad
#17
Warren H Capell, Marc P Bonaca, Mark R Nehler, Edmond Chen, John M Kittelson, Sonia S Anand, Scott D Berkowitz, Eike Sebastian Debus, Fabrizio Fanelli, Lloyd Haskell, Manesh R Patel, Rupert Bauersachs, William R Hiatt
BACKGROUND: Patients with peripheral artery disease (PAD) undergoing a lower-extremity revascularization are at heightened risk for ischemic cardiac and limb events. Although intensification of antithrombotic therapy after revascularization has demonstrated benefit in coronary disease populations, this approach has not been well studied or shown consistent benefit in PAD. Recent trial evidence demonstrated that a treatment strategy of rivaroxaban added to background antiplatelet therapy reduced ischemic risk in patients following recent acute coronary syndromes, as well as in patients with stable atherosclerotic vascular disease...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29752869/allogeneic-umbilical-cord-blood-infusion-for-adults-with-ischemic-stroke-clinical-outcomes-from-a-phase-1-safety-study
#18
Daniel T Laskowitz, Ellen R Bennett, Rebecca J Durham, John J Volpi, Jonathan R Wiese, Michael Frankel, Elizabeth Shpall, Jeffry M Wilson, Jesse Troy, Joanne Kurtzberg
Stroke is a major cause of death and long-term disability, affecting one in six people worldwide. The only currently available approved pharmacological treatment for ischemic stroke is tissue plasminogen activator; however, relatively few patients are eligible for this therapy. We hypothesized that intravenous (IV) infusion of banked unrelated allogeneic umbilical cord blood (UCB) would improve functional outcomes in patients with ischemic stroke. To investigate this, we conducted a phase 1 open-label trial to assess the safety and feasibility of a single IV infusion of non-human leukocyte antigen (HLA) matched, ABO matched, unrelated allogeneic UCB into adult stroke patients...
May 12, 2018: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/29752398/device-related-thrombus-after-left-atrial-appendage-closure-incidence-predictors-and-outcomes
#19
Srinivas R Dukkipati, Saibal Kar, David R Holmes, Shephal K Doshi, Vijendra Swarup, Douglas N Gibson, Brijeshwar Maini, Nicole T Gordon, Michael L Main, Vivek Y Reddy
Background -In patients with atrial fibrillation (AF), left atrial appendage closure (LAAC) with the Watchman device prevents thromboembolism from the LAA; however, thrombus may form on the left atrial face of the device, and then potentially embolize. Herein, we studied the incidence, predictors and clinical outcome of device-related thrombus (DRT) using a large series of clinical trial cohorts of patients undergoing Watchman implantation. Methods -We studied the device arms of 4 prospective FDA trials: PROTECT-AF (n=463); PREVAIL (n=269); CAP (n=566); CAP2 (n=578)...
May 11, 2018: Circulation
https://www.readbyqxmd.com/read/29748424/intravenous-recombinant-tissue-type-plasminogen-activator-influence-on-outcome-in-anterior-circulation-ischemic-stroke-treated-by-mechanical-thrombectomy
#20
Marc Ferrigno, Nicolas Bricout, Didier Leys, Laurent Estrade, Charlotte Cordonnier, Thomas Personnic, Maeva Kyheng, Hilde Henon
BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) improves functional outcome in patients with ischemic stroke related to proximal-vessel occlusion in the anterior circulation. Whether MT alone is as effective as IVT/MT remains controversial. We aimed at evaluating the influence of IVT in patients with large anterior circulation artery occlusion treated with MT. METHODS: We did a prospective observational cohort study in patients with stroke related to large anterior circulation artery occlusion treated by MT who were admitted to Lille University Hospital, Lille, France...
May 10, 2018: Stroke; a Journal of Cerebral Circulation
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