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JOURNAL ARTICLE
Benjamin Hotter, Ivana Galinovic, Claudia Kunze, Peter Brunecker, Gerhard J Jungehulsing, Arno Villringer, Matthias Endres, Kersten Villringer, Jochen B Fiebach
Transient ischemic attack (TIA) is defined as focal neurological deficit caused by ischemia resolving within 24 hours. In a secondary analysis of a large monocentric cohort of 446 TIA patients, we explored the frequency and determinants of diffusion-weighted imaging (DWI) lesions on high-resolution magnetic resonance imaging. Overall, 240 (54%) of all TIA patients presented with DWI lesions. These patients had higher National Institute of Health Stroke Scale and ABCD2 scores and presented more frequently with vessel occlusion and perfusion deficits, but had similar functional outcome at 3 months...
September 2019: Annals of Neurology
#2
JOURNAL ARTICLE
Ramazan Jabbarli, Daniela Pierscianek, Roland Rölz, Marvin Darkwah Oppong, Klaus Kaier, Mukesch Shah, Christian Taschner, Christoph Mönninghoff, Horst Urbach, Jürgen Beck, Ulrich Sure, Michael Forsting
OBJECTIVE: Delayed cerebral ischemia (DCI) is strongly associated with poor outcome after subarachnoid hemorrhage (SAH). Cerebral vasospasm is a major contributor to DCI and requires special attention. To evaluate the effect of vasospasm management on SAH outcome, we performed a pooled analysis of 2 observational SAH cohorts. MATERIALS: Data from 2 institutional databases with consecutive patients with SAH treated between 2005 and 2012 were pooled. The effect of 2 institutional standards of conservative and endovascular vasospasm treatment (EVT) on the rates of DCI (new cerebral infarcts not visible on the post-treatment imaging) and unfavorable outcome (modified Rankin Scale score >2) at 6 months follow-up was analyzed...
July 30, 2019: Neurology
#3
RANDOMIZED CONTROLLED TRIAL
Craig S Anderson, Yining Huang, Richard I Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Qiang Li, Laurent Billot, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Alice C Durham, Pablo M Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Federico Silva, Lili Song, Nguyen H Thang, Joanna M Wardlaw, Ji-Guang Wang, Xia Wang, Mark Woodward, John Chalmers, Thompson G Robinson
BACKGROUND: Systolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intravenous alteplase in patients with acute ischaemic stroke, but the target systolic blood pressure for optimal outcome is uncertain. We assessed intensive blood pressure lowering compared with guideline-recommended blood pressure lowering in patients treated with alteplase for acute ischaemic stroke. METHODS: We did an international, partial-factorial, open-label, blinded-endpoint trial of thrombolysis-eligible patients (age ≥18 years) with acute ischaemic stroke and systolic blood pressure 150 mm Hg or more, who were screened at 110 sites in 15 countries...
March 2, 2019: Lancet
#4
REVIEW
Thomas Beez, Christopher Munoz-Bendix, Hans-Jakob Steiger, Kerim Beseoglu
Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique aiming to open the "closed box" represented by the non-expandable skull in cases of refractory intracranial hypertension. It is a valuable modality in the armamentarium to treat patients with malignant stroke: the life-saving effect has been proven for both supratentorial and infratentorial DC in virtually all age groups...
June 7, 2019: Critical Care: the Official Journal of the Critical Care Forum
#5
EDITORIAL
Bruce C V Campbell
No abstract text is available yet for this article.
August 2019: Stroke; a Journal of Cerebral Circulation
#6
REVIEW
Rocco J Cannistraro, Mohammed Badi, Benjamin H Eidelman, Dennis W Dickson, Erik H Middlebrooks, James F Meschia
CNS small vessel disease (CSVD) causes 25% of strokes and contributes to 45% of dementia cases. Prevalence increases with age, affecting about 5% of people aged 50 years to almost 100% of people older than 90 years. Known causes and risk factors include age, hypertension, branch atheromatous disease, cerebral amyloid angiopathy, radiation exposure, immune-mediated vasculitides, certain infections, and several genetic diseases. CSVD can be asymptomatic; however, depending on location, lesions can cause mild cognitive dysfunction, dementia, mood disorders, motor and gait dysfunction, and urinary incontinence...
June 11, 2019: Neurology
#7
COMMENT
Hanne Christensen
No abstract text is available yet for this article.
July 2019: Lancet Neurology
#8
RANDOMIZED CONTROLLED TRIAL
Henry Ma, Bruce C V Campbell, Mark W Parsons, Leonid Churilov, Christopher R Levi, Chung Hsu, Timothy J Kleinig, Tissa Wijeratne, Sami Curtze, Helen M Dewey, Ferdinand Miteff, Chon-Haw Tsai, Jiunn-Tay Lee, Thanh G Phan, Neil Mahant, Mu-Chien Sun, Martin Krause, Jonathan Sturm, Rohan Grimley, Chih-Hung Chen, Chaur-Jong Hu, Andrew A Wong, Deborah Field, Yu Sun, P Alan Barber, Arman Sabet, Jim Jannes, Jiann-Shing Jeng, Benjamin Clissold, Romesh Markus, Ching-Huang Lin, Li-Ming Lien, Christopher F Bladin, Søren Christensen, Nawaf Yassi, Gagan Sharma, Andrew Bivard, Patricia M Desmond, Bernard Yan, Peter J Mitchell, Vincent Thijs, Leeanne Carey, Atte Meretoja, Stephen M Davis, Geoffrey A Donnan
BACKGROUND: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging. METHODS: We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging...
May 9, 2019: New England Journal of Medicine
#9
REVIEW
Sophie S Wang, Yang Yang, Julia Velz, Emanuela Keller, Andreas R Luft, Luca Regli, Marian C Neidert, Oliver Bozinov
Among spontaneous intracranial haemorrhages, primary non-traumatic brainstem haemorrhages are associated with the highest mortality rate. Patients classically present with rapid neurological deterioration. Previous studies have found that the severity of initial neurological symptoms and hydrocephalus are predictors of poor outcomes. In addition, radiological parameters aim to classify brainstem haematomas according to volume, extension and impact on prognosis. However, previous studies have failed to agree on a differentiated radiological classification for outcome and functional recovery...
March 25, 2019: Swiss Medical Weekly
#10
COMPARATIVE STUDY
David J Seiffge, Maurizio Paciaroni, Duncan Wilson, Masatoshi Koga, Kosmas Macha, Manuel Cappellari, Sabine Schaedelin, Clare Shakeshaft, Masahito Takagi, Georgios Tsivgoulis, Bruno Bonetti, Bernd Kallmünzer, Shoji Arihiro, Andrea Alberti, Alexandros A Polymeris, Gareth Ambler, Sohei Yoshimura, Michele Venti, Leo H Bonati, Keith W Muir, Hiroshi Yamagami, Sebastian Thilemann, Riccardo Altavilla, Nils Peters, Manabu Inoue, Tobias Bobinger, Giancarlo Agnelli, Martin M Brown, Shoichiro Sato, Monica Acciarresi, Hans Rolf Jager, Paolo Bovi, Stefan Schwab, Philippe Lyrer, Valeria Caso, Kazunori Toyoda, David J Werring, Stefan T Engelter, Gian Marco De Marchis
OBJECTIVE: We compared outcomes after treatment with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and a recent cerebral ischemia. METHODS: We conducted an individual patient data analysis of seven prospective cohort studies. We included patients with AF and a recent cerebral ischemia (<3 months before starting oral anticoagulation) and a minimum follow-up of 3 months. We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed-effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs)...
June 2019: Annals of Neurology
#11
RANDOMIZED CONTROLLED TRIAL
Bruce C V Campbell, Peter J Mitchell, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Richard J Dowling, Bernard Yan, Steven J Bush, Helen M Dewey, Vincent Thijs, Rebecca Scroop, Marion Simpson, Mark Brooks, Hamed Asadi, Teddy Y Wu, Darshan G Shah, Tissa Wijeratne, Timothy Ang, Ferdinand Miteff, Christopher R Levi, Edrich Rodrigues, Henry Zhao, Patrick Salvaris, Carlos Garcia-Esperon, Peter Bailey, Henry Rice, Laetitia de Villiers, Helen Brown, Kendal Redmond, David Leggett, John N Fink, Wayne Collecutt, Andrew A Wong, Claire Muller, Alan Coulthard, Ken Mitchell, John Clouston, Kate Mahady, Deborah Field, Henry Ma, Thanh G Phan, Winston Chong, Ronil V Chandra, Lee-Anne Slater, Martin Krause, Timothy J Harrington, Kenneth C Faulder, Brendan S Steinfort, Christopher F Bladin, Gagan Sharma, Patricia M Desmond, Mark W Parsons, Geoffrey A Donnan, Stephen M Davis
BACKGROUND: Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion. METHODS: We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery and who were eligible to undergo thrombectomy to receive tenecteplase (at a dose of 0...
April 26, 2018: New England Journal of Medicine
#12
COMMENT
Brian Silver, Marcel Arnold
No abstract text is available yet for this article.
December 2018: Stroke; a Journal of Cerebral Circulation
#13
REVIEW
Jeffrey R Vitt, Michael Trillanes, J Claude Hemphill
Ischemic stroke is a common neurologic condition and can lead to significant long term disability and death. Observational studies have demonstrated worse outcomes in patients presenting with the extremes of blood pressure as well as with hemodynamic variability. Despite these associations, optimal hemodynamic management in the immediate period of ischemic stroke remains an unresolved issue, particularly in the modern era of revascularization therapies. While guidelines exist for BP thresholds during and after thrombolytic therapy, there is substantially less data to guide management during mechanical thrombectomy...
2019: Frontiers in Neurology
#14
JOURNAL ARTICLE
Simon Nagel, Mehdi Bouslama, Lars U Krause, Clemens Küpper, Mirko Messer, Martina Petersen, Stephan Lowens, Moritz Herzberg, Peter A Ringleb, Markus A Möhlenbruch, Steffen Tiedt, Fabricio O Lima, Diogo C Haussen, Wade S Smith, Michael H Lev, Raul G Nogueira
Background and Purpose- We aimed to describe the safety and efficacy of immediate mechanical thrombectomy (MT) in patients with large vessel occlusions and low National Institutes of Health Stroke Scale (NIHSS) versus best medical management. Methods- Patients from prospectively collected databases of 6 international comprehensive stroke centers with large vessel occlusions (distal intracranial internal carotid, middle cerebral artery-M1 and M2 segments, or basilar artery with or without tandem occlusions) and NIHSS 0 to 5 were identified and divided into 2 groups for analysis: immediate MT or initial best medical management which included rescue MT after neurological deterioration (best medical management-MT)...
October 2018: Stroke; a Journal of Cerebral Circulation
#15
JOURNAL ARTICLE
Hammad Rahman, Safi U Khan, Fahad Nasir, Tehseen Hammad, Michael A Meyer, Edo Kaluski
Background and Purpose- The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy. Methods- Ten randomized controlled trials (15 434 patients) were selected using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (inception June 2018) comparing A+C with aspirin monotherapy in patients with transient ischemic attack or IS...
April 2019: Stroke; a Journal of Cerebral Circulation
#16
EDITORIAL
Wolfgang G Kunz, Mohammed A Almekhlafi, Mayank Goyal
No abstract text is available yet for this article.
July 2018: Stroke; a Journal of Cerebral Circulation
#17
REVIEW
A Y X Yu, S B Coutts
No abstract text is available yet for this article.
July 2018: Stroke; a Journal of Cerebral Circulation
#18
JOURNAL ARTICLE
L Ding, B Peng
BACKGROUND AND PURPOSE: There is a lack of age-specific evidence regarding the efficacy and safety of dual antiplatelet therapy (DAPT). A systematic review and meta-analysis was conducted for dual versus mono antiplatelet therapy in elderly patients with ischaemic stroke (IS) or transient ischaemic attack (TIA). METHODS: PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Risk ratios (RRs) for the outcomes of stroke recurrence, major bleeding and intracranial bleeding were calculated based on the DerSimonian and Laird random effects model...
October 2018: European Journal of Neurology
#19
RANDOMIZED CONTROLLED TRIAL
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...
August 16, 2018: New England Journal of Medicine
#20
JOURNAL ARTICLE
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...
June 2018: Stroke; a Journal of Cerebral Circulation
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