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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
David J Seiffge, Christopher Traenka, Alexandros Polymeris, Lisa Hert, Nils Peters, Philippe Lyrer, Stefan T Engelter, Leo H Bonati, Gian Marco De Marchis
OBJECTIVE: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. METHODS: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs)...
September 30, 2016: Neurology
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Fernando Godinho Zampieri, David Turkel-Parrella, Abhijit Duggal, Thomas R Marotta, R Loch Macdonald, Simon Abrahamson
Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding...
September 18, 2016: Critical Care: the Official Journal of the Critical Care Forum
Thorsten R Doeppner, Jens R Pehlke, Britta Kaltwasser, Jana Schlechter, Ertugrul Kilic, Mathias Bähr, Dirk M Hermann
Cerebral ischemia stimulates N-methyl-d-aspartate receptors (NMDARs) resulting in increased calcium concentration and excitotoxicity. Yet, deactivation of NMDAR failed in clinical studies due to poor preclinical study designs or toxicity of NMDAR antagonists. Acamprosate is an indirect NMDAR antagonist used for patients with chronic alcohol dependence. We herein analyzed the therapeutic potential of acamprosate on brain injury, neurologic recovery and their underlying mechanisms. Mice were exposed to cerebral ischemia, treated with intraperitoneal injections of acamprosate or saline (controls), and allowed to survive until 3 months...
December 2015: Journal of Cerebral Blood Flow and Metabolism
Ángel Chamorro, Ulrich Dirnagl, Xabier Urra, Anna M Planas
Treatments for acute ischaemic stroke continue to evolve after the superior value of endovascular thrombectomy was confirmed over systemic thrombolysis. Unfortunately, numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischaemic stroke, making the search for new treatments imperative. Increased awareness of the relevance of rigorous preclinical testing, and appropriate selection of study participants, might overcome the barriers to progress in stroke research. Relevant areas of interest include the search for safe and effective treatment strategies that combine neuroprotection reperfusion, better use of advanced brain imaging for patient selection, and wider implementation of prehospital conducted clinical trials...
July 2016: Lancet Neurology
Line Melgaard, Anders Gorst-Rasmussen, Lars Hvilsted Rasmussen, Gregory Y H Lip, Torben Bjerregaard Larsen
BACKGROUND: Stroke and mortality risk among heart failure patients previously diagnosed with different manifestations of vascular disease is poorly described. We conducted an observational study to evaluate the stroke and mortality risk among heart failure patients without diagnosed atrial fibrillation and with peripheral artery disease (PAD) or prior myocardial infarction (MI). METHODS: Population-based cohort study of patients diagnosed with incident heart failure during 2000-2012 and without atrial fibrillation, identified by record linkage between nationwide registries in Denmark...
2016: PloS One
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
J P Klaas
No abstract text is available yet for this article.
June 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Hans-Christoph Diener, Magdy H Selim, Carlos A Molina, Steven M Greenberg
No abstract text is available yet for this article.
March 2016: Stroke; a Journal of Cerebral Circulation
Steven Karceski
No abstract text is available yet for this article.
November 24, 2015: Neurology
K D Kurz, G Ringstad, A Odland, R Advani, E Farbu, M W Kurz
Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used...
January 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
K-O Lövblad, V M Pereira
No abstract text is available yet for this article.
November 2015: AJNR. American Journal of Neuroradiology
Gregory W Albers, Rüdiger von Kummer, Thomas Truelsen, Jens-Kristian S Jensen, Gabriela M Ravn, Bjørn A Grønning, Hugues Chabriat, Ku-Chou Chang, Antonio E Davalos, Gary A Ford, James Grotta, Markku Kaste, Lee H Schwamm, Ashfaq Shuaib
BACKGROUND: Current treatment of ischaemic stroke with thrombolytic therapy is restricted to 3-4·5 h after symptom onset. We aimed to assess the safety and efficacy of desmoteplase, a fibrin-dependent plasminogen activator, given between 3 h and 9 h after symptom onset in patients with occlusion or high-grade stenosis in major cerebral arteries. METHODS: In a prospective, double-blind, multicentre, parallel-group, randomised trial, we enrolled patients from 77 hospitals in 17 countries who had ischaemic stroke and occlusion or high-grade stenosis in major cerebral arteries...
June 2015: Lancet Neurology
Azmil H Abdul-Rahim, Ana-Cristina Perez, Rachael L Fulton, Pardeep S Jhund, Roberto Latini, Gianni Tognoni, John Wikstrand, John Kjekshus, Gregory Y H Lip, Aldo P Maggioni, Luigi Tavazzi, Kennedy R Lees, John J V McMurray
BACKGROUND: Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). METHODS AND RESULTS: We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4...
April 28, 2015: Circulation
Christian J Hoffmann, Ulrike Harms, Andre Rex, Frank Szulzewsky, Susanne A Wolf, Ulrike Grittner, Gisela Lättig-Tünnemann, Michael Sendtner, Helmut Kettenmann, Ulrich Dirnagl, Matthias Endres, Christoph Harms
BACKGROUND: Poststroke angiogenesis contributes to long-term recovery after stroke. Signal transducer and activator of transcription-3 (Stat3) is a key regulator for various inflammatory signals and angiogenesis. It was the aim of this study to determine its function in poststroke outcome. METHODS AND RESULTS: We generated a tamoxifen-inducible and endothelial-specific Stat3 knockout mouse model by crossbreeding Stat3(floxed/KO) and Tie2-Cre(ERT2) mice. Cerebral ischemia was induced by 30 minutes of middle cerebral artery occlusion...
May 19, 2015: Circulation
Jin-Man Jung, Jungsoon Choi, Mi-Yeon Eun, Woo-Keun Seo, Kyung-Hee Cho, Sungwook Yu, Kyungmi Oh, Soonwoong Hong, Kwang-Yeol Park
OBJECTIVE: To investigate whether prestroke antiplatelet agent (PA) use was associated with initial stroke severity. METHODS: This was a retrospective, case-control study based on data from a prospectively collected hospital-based stroke registry (Korea University Stroke Registry). A total of 3,025 patients who were admitted with a diagnosis of first-ever ischemic stroke within 5 days of symptom onset were included. Stroke severity was measured with the NIH Stroke Scale (NIHSS)...
March 17, 2015: Neurology
Leo H Bonati, Joanna Dobson, Roland L Featherstone, Jörg Ederle, H Bart van der Worp, Gert J de Borst, Willem P Th M Mali, Jonathan D Beard, Trevor Cleveland, Stefan T Engelter, Philippe A Lyrer, Gary A Ford, Paul J Dorman, Martin M Brown
BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax...
February 7, 2015: Lancet
Argye E Hillis
No abstract text is available yet for this article.
December 2014: Lancet Neurology
Walter N Kernan, Bruce Ovbiagele, Henry R Black, Dawn M Bravata, Marc I Chimowitz, Michael D Ezekowitz, Margaret C Fang, Marc Fisher, Karen L Furie, Donald V Heck, S Claiborne Clay Johnston, Scott E Kasner, Steven J Kittner, Pamela H Mitchell, Michael W Rich, DeJuran Richardson, Lee H Schwamm, John A Wilson
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy...
July 2014: Stroke; a Journal of Cerebral Circulation
Meng Lee, Jeffrey L Saver, Keun-Sik Hong, Neal M Rao, Yi-Ling Wu, Bruce Ovbiagele
BACKGROUND: Dual-antiplatelet regimens for prevention of recurrent stroke promote antithrombotic effects but may increase the risk for hemorrhage. PURPOSE: To qualitatively and quantitatively examine the risk for recurrent stroke and intracranial hemorrhage (ICH) linked to long-term dual- and single-antiplatelet therapy among patients with ischemic stroke and transient ischemic attack. DATA SOURCES: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials through March 2013 without language restrictions...
October 1, 2013: Annals of Internal Medicine
A H Abdul-Rahim, R L Fulton, B Frank, T Tatlisumak, M Paciaroni, V Caso, H-C Diener, K R Lees
BACKGROUND AND PURPOSE: Ischaemic stroke patients with atrial fibrillation (AF) are at risk of early recurrent stroke (RS). However, antithrombotics commenced at the acute stage may exacerbate haemorrhagic transformation, provoking symptomatic intracerebral haemorrhage (SICH). The relevance of antithrombotics on the patterns and outcome of the cohort was investigated. METHODS: A non-randomized cohort analysis was conducted using data obtained from VISTA (Virtual International Stroke Trials Archive)...
July 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
2014-10-26 08:41:56
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