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Stroke

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13 papers 0 to 25 followers
https://www.readbyqxmd.com/read/27733029/direct-thrombus-imaging-in-stroke
#1
REVIEW
Jongseong Kim, Jung E Park, Matthias Nahrendorf, Dong-Eog Kim
There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity...
September 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27960192/transcranial-doppler
#2
REVIEW
Vijay K Sharma, Ka Sing Wong, Andrei V Alexandrov
Transcranial Doppler ultrasonography (TCD) is the only diagnostic modality that provides a reliable evaluation of intracranial blood flow patterns in real-time. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings. TCD criteria for intracranial stenosis have been validated against various forms of angiographic studies and serve as reliable tools for screening, diagnostic as well as follow up purposes...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27960183/antithrombotic-therapy
#3
REVIEW
Sun U Kwon, Jong S Kim
Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the mainstay of therapy in these patients. Several studies have found anticoagulation (warfarin) to increase the risk of bleeding events and have an efficacy no better than that of aspirin. Therefore, anticoagulants are not widely used unless patients develop recurrent ischemic symptoms despite receiving antiplatelet therapy. Because ICAS progression is not uncommon and the risk of stroke recurrence is high when aspirin monotherapy is used, dual antiplatelet agents may be needed at least in the early disease stage...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27960181/stroke-mechanisms
#4
REVIEW
Ka Sing Wong, Louis R Caplan, Jong S Kim
Recent advances in neuroimaging technologies, such as diffusion weighted magnetic resonance imaging (MRI), perfusion weighted computed tomography (CT)/MRI, MR/CT angiography and Doppler ultrasonography allow us to determine the mechanisms of stroke and transient ischemic attack. In addition, high-resolution vessel wall MRI is nowadays increasingly used to understand the stroke mechanism in patients with intracranial atherosclerosis. Artery to artery embolism, hypoperfusion and the combination of the two are the important stroke mechanisms in patients with extracranial atherosclerosis...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27960179/angioplasty-and-stenting
#5
REVIEW
Thomas W Leung, Ashley M Wabnitz, Zhongrong Miao, Marc I Chimowitz
The high rate of recurrent strokes in patients with intracranial atherosclerotic disease (ICAS) despite medical therapy prompted intracranial angioplasty and/or stenting an adjunctive treatment option. The minute calibers of cerebral arteries, the relative paucity of supporting medial and adventitia layers, the presence of end-anastomosing perforator branches, and the vascular tortuosity from groin to head all demand specialized operative skills and dedicated tools. Since the stroke mechanism of ICAS is diverse, patient selection for endovascular treatment requires a sound understanding of the underlying pathophysiology...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27960164/clinical-stroke-syndromes
#6
REVIEW
Jong S Kim, Louis R Caplan
The main mechanism of stroke in patients who have extracranial atherosclerosis is artery to artery embolism, occasionally associated with hemodynamic disturbances. Although these mechanisms are also important in patients with intracranial atherosclerosis, branch occlusion and in-situ thrombotic occlusion play a relatively more important role in these patients. Accordingly, clinical stroke syndromes differ between extracranial atherosclerosis and intracranial atherosclerosis. In anterior circulation, middle cerebral artery atherosclerosis frequently produces subcortical infarction by way of branch occlusion...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27643898/stroke-new-developments-and-their-application-in-clinical-practice
#7
Peter J Kelly, Eoin Kavanagh, Sean Murphy
Significant advances have been made in recent years in primary stroke prevention, improved stroke outcomes in high-income populations, emergency stroke therapy, and stroke prevention. In this article, we review recent trends in stroke epidemiology, improvements in delivery of intravenous thrombolysis (via stroke system-wide approaches, application of 'Lean Principles' to improve workflow processes, and re-evaluation of exclusion criteria), recent stroke thrombectomy trials, and new developments in stroke prevention, with emphasis on risk prediction in transient ischemic attack, choice and timing of anticoagulation therapy for secondary stroke prevention, and emerging concepts in risk stratification for management of symptomatic carotid stenosis...
August 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27347228/stroke-prevention-in-atrial-fibrillation-and-valvular-heart-disease
#8
Saad Ahmad, Heath Wilt
There is a clinically staggering burden of disease stemming from cerebrovascular events, of which a majority are ischemic in nature and many are precipitated by atrial fibrillation (AF). AF can occur in isolation or in association with myocardial or structural heart disease. In the latter case, and when considering health at an international level, congenital and acquired valve-related diseases are frequent contributors to the current pandemic of AF and its clinical impact. Guidelines crafted by the American Heart Association, American College of Cardiology, European Society of Cardiology and Heart Rhythm Society underscore the use of vitamin K antagonists (VKAs) among patients with valvular heart disease, particularly in the presence of concomitant AF, to reduce the risk of ischemic stroke of cardioembolic origin; however, the non-VKAs, also referred to as direct, target-specific or new oral anticoagulants (NOACs), have not been actively studied in this particular population...
2016: Open Cardiovascular Medicine Journal
https://www.readbyqxmd.com/read/27282861/neuroimaging-wisely
#9
REVIEW
J Buethe, J Nazarian, K Kalisz, M Wintermark
Diagnostic imaging is the most rapidly growing physician service in the Medicare and privately insured population. The growing share of medical costs devoted to imaging procedures has led to increasing concerns among the key federal agencies and private payers. In an attempt to educate health care providers, patients, and families on the importance of making optimal clinical decisions, the American Board of Internal Medicine Foundation organized the Choosing Wisely initiative with strong collaboration from specialty societies representing nearly all medical disciplines...
December 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27283277/the-mechanism-of-and-preventive-therapy-for-stroke-in-patients-with-atrial-fibrillation
#10
REVIEW
Young-Hoon Kim, Seung-Young Roh
Atrial fibrillation is a major cardiac cause of stroke, and a pathogenesis involving thrombus formation in patients with atrial fibrillation is well established. A strategy for rhythm control that involves catheter ablation and anticoagulation therapy is evolving. A strategy for rhythm control that restores and maintains sinus rhythm should reduce the risk of ischemic stroke that is associated with atrial fibrillation; however, this is yet to be proven in large-scale randomized controlled trials. This paper reviews the emerging role of rhythm control therapy for atrial fibrillation to prevent stroke...
May 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27283276/how-and-when-to-screen-for-atrial-fibrillation-after-stroke-insights-from-insertable-cardiac-monitoring-devices
#11
REVIEW
Francesca Bridge, Vincent Thijs
The introduction of insertable cardiac monitoring devices has dramatically altered our understanding of the role of intermittent atrial fibrillation in cryptogenic stroke. In this narrative review we discuss the incidence, timing and relationship between atrial fibrillation and cryptogenic stroke, how to select patients for monitoring and the value and limitations of different monitoring strategies. We also discuss the role of empirical anticoagulation, and atrial fibrillation burden as a means of tailoring anticoagulation in patients at high risk of bleeding...
May 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27260938/resuming-anticoagulant-therapy-after-intracerebral-bleeding
#12
REVIEW
Cecilia Becattini, Agnese Sembolini, Maurizio Paciaroni
The clinical benefit of resuming anticoagulant treatment after an anticoagulants-associated intracranial hemorrhage (ICH) is debated. No randomized trial has been conducted on this particular clinical issue. The risk of ICH recurrence from resuming anticoagulant therapy is expected to be higher after index lobar than deep ICH and in patients with not amendable risk factors for ICH. Retrospective studies have recently shown improved survival with resumption of treatment after index anticoagulants-associated ICH...
September 2016: Vascular Pharmacology
https://www.readbyqxmd.com/read/27071644/posterior-circulation-cerebrovascular-syndromes-diagnosis-and-management
#13
REVIEW
Ursula G Schulz, Urs Fischer
One in five strokes affects the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist...
January 2017: Journal of Neurology, Neurosurgery, and Psychiatry
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