29 octubre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Diagnostic Accuracy of Transcranial Doppler for Brain Death Confirmation: Systematic Review and Meta-Analysis

J.J. Chang, G. Tsivgoulis, A.H. Katsanos, M.D. Malkoff and A.V. Alexandrov

BACKGROUND AND PURPOSE: Transcranial Doppler is a useful ancillary test for brain death confirmation because it is safe, noninvasive, and done at the bedside. Transcranial Doppler confirms brain death by evaluating cerebral circulatory arrest. Case series studies have generally reported good correlations between transcranial Doppler confirmation of cerebral circulatory arrest and clinical confirmation of brain death. The purpose of this study is to evaluate the utility of transcranial Doppler as an ancillary test in brain death confirmation.

08 octubre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. In Vitro Evaluation of Intra-Aneurysmal, Flow-Diverter-Induced Thrombus Formation: A Feasibility Study

K. Gester, I. Lüchtefeld, M. Büsen, S.J. Sonntag, T. Linde, U. Steinseifer and G. Cattaneo

BACKGROUND AND PURPOSE: Intracranial aneurysm treatment by flow diverters aims at triggering intra-aneurysmal thrombosis. By combining in vitro blood experiments with particle imaging velocimetry measurements, we investigated the time-resolved thrombus formation triggered by flow diverters.

22 octubre 2015

AMERICAN JOURNAL OF NEURORADIOLOGY. Preclinical Testing of a Novel Thin Film Nitinol Flow-Diversion Stent in a Rabbit Elastase Aneurysm Model

Y. Ding, D. Dai, D.F. Kallmes, D. Schroeder, C.P. Kealey, V. Gupta, A.D. Johnson and R. Kadirvel

BACKGROUND AND PURPOSE: Thin film nitinol can be processed to produce a thin microporous sheet with a low percentage of metal coverage (<20%) and high pore attenuation (∼70 pores/mm2) for flow diversion. We present in vivo results from the treatment of experimental rabbit aneurysms by using a thin film nitinol–based flow-diversion device.

14 abril 2016

STROKE. Clinical Sciences. Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke

Sarah Song, MD, MPH; Gregg C. Fonarow, MD; DaiWai M. Olson, PhD, RN; Li Liang, PhD; Phillip J. Schulte, PhD; Adrian F. Hernandez, MD, MS; Eric D. Peterson, MD, MPH; Mathew J. Reeves, PhD; Eric E. Smith, MD, MPH; Lee H. Schwamm, MD; Jeffrey L. Saver, MD

Background and Purpose: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. Although studies have suggested improved processes of care in GWTG-Stroke–participating hospitals, it is not known whether this improved care translates into improved clinical outcomes compared with nonparticipating hospitals.

12 abril 2016

STROKE. Clinical Sciences. Risk Reduction of Cerebral Stroke After Stereotactic Radiosurgery for Small Unruptured Brain Arteriovenous Malformations

Shunya Hanakita, MD, PhD; Masahiro Shin, MD, PhD; Tomoyuki Koga, MD, PhD; Hiroshi Igaki, MD, PhD; Nobuhito Saito, MD, PhD

Background and Purpose: A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) indicated the superiority of medical management in reducing the risks for strokes and other neurological deficits over observation alone. The aim of our study was to verify the rationale for stereotactic radiosurgery (SRS) for small unruptured arteriovenous malformation.

24 marzo 2015

STROKE. Clinical Sciences. Longitudinal Relationship Between Cerebral Small-Vessel Disease and Cerebral Blood Flow. The Second Manifestations of Arterial Disease-Magnetic Resonance Study

Pieternella H. van der Veen, MD, PhD; Majon Muller, MD, PhD; Koen L. Vincken, PhD; Jeroen Hendrikse, MD, PhD; Willem P.T.M. Mali, MD, PhD; Yolanda van der Graaf, MD, PhD; Mirjam I. Geerlings, PhD; on behalf of the SMART Study Group

Background and Purpose: Cerebral small-vessel disease and cerebral blood flow (CBF) are interrelated. However, the direction of the relationship is unknown, and longitudinal studies are scarce. We investigated the longitudinal relationship between CBF and white matter hyperintensities (WMHs) and lacunes, as representatives of cerebral small-vessel disease, in patients with manifest arterial disease.

07 abril 2015

STROKE. Emerging Therapy Critiques. Endovascular Treatment for Ischemic Strokes With Large Vessel Occlusion. Proven Therapy and Bright Future

Amrou Sarraj, MD; Rishi Gupta, MD, MBA

Intravenous tissue-type plasminogen activator (tPA) has been the mainstay and only therapy with proven clinical benefit in patients with acute ischemic stroke for the nearly 20 years.1 Patients harboring a large vessel occlusions (LVOs) seemed to be recalcitrant to intravenous thrombolysis that portended a poor neurological recovery.2 Catheter-based treatments offered a promise of higher recanalization rates and better outcomes.

11 febrero 2016

STROKE. Clinical Sciences. Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms

Wenjun Ji, MD*; Aihua Liu, MD*; Xianli Lv, MD; Huibin Kang, MS; Liqian Sun, MD; Youxiang Li, MD; Xinjian Yang, MD; Chuhan Jiang, MD; Zhongxue Wu, MD

Background and Purpose: Procedure-related neurological complications are common after endovascular treatment of unruptured intracranial aneurysms. We aimed to develop a score to quantify individual patient risk.

15 marzo 2016

STROKE. Clinical Sciences. Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke

Jaime Gonzalez-Valcarcel, MD; Leila Sissani, BS; Julien Labreuche, BS; Marie-Germaine Bousser, MD; Angel Chamorro, MD; Marc Fisher, MD; Ian Ford, MD; Kim M. Fox, MD; Michael G. Hennerici, MD; Heinrich P. Mattle, MD; Peter M. Rothwell, MD; Philippe Gabriel Steg, MD; Eric Vicaut, MD; Pierre Amarenco, MD, for the PERFORM Investigators

Background and Purpose: The presumed safety of paracetamol in high–cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial.

15 marzo 2016

STROKE. Clinical Sciences. Does Diffusion Lesion Volume Above 70 mL Preclude Favorable Outcome Despite Post-Thrombolysis Recanalization?

Marie Tisserand, PhD; Guillaume Turc, PhD; Sylvain Charron, PhD; Laurence Legrand, MD; Myriam Edjlali, MD; Pierre Seners, MD; Pauline Roca, PhD; Stéphanie Lion; Olivier Naggara, PhD; Jean-Louis Mas, MD; Jean-François Méder, PhD; Jean-Claude Baron, ScD; Catherine Oppenheim, PhD

Background and Purpose: Whether to withhold recanalization treatment when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is unsettled. Our aim was to assess the impact of recanalization on outcome in patients with baseline DWI lesion ≥70 mL (DWI≥70 mL) treated ≤4.5 hours from onset. We hypothesized that recanalization is beneficial in a sizeable fraction of these patients and that this is associated with a larger DWI lesion reversal.

21 enero 2016

STROKE. Clinical Sciences. Safety of Pregnancy After Cerebral Venous Thrombosis. A Systematic Review

Diana Aguiar de Sousa, MD, MSc; Patrícia Canhão, MD, PhD; José M. Ferro, MD, PhD

Background and Purpose: Pregnancy and puerperium are associated with an increased risk of venous thrombotic events (VTEs), including cerebral venous thrombosis (CVT). We aimed to systematically review, in pregnant woman with previous CVT, (1) the risk of recurrence of CVT or other VTE; (2) the result of pregnancy; and (3) the association of antithrombotic prophylaxis with these outcomes.

17 febrero 2016

STROKE. Clinical Sciences. Safety and Efficacy of Solitaire Stent Thrombectomy. Individual Patient Data Meta-Analysis of Randomized Trials

Bruce C.V. Campbell, MBBS, PhD*; Michael D. Hill, MD, MSc*; Marta Rubiera, MD*; Bijoy K. Menon, MD, MSc*; Andrew Demchuk, MD; Geoffrey A. Donnan, MD; Daniel Roy, MD; John Thornton, MD; Laura Dorado, MD, PhD; Alain Bonafe, MD; Elad I. Levy, MD; Hans-Christoph Diener, MD, PhD; María Hernández-Pérez, MD; Vitor Mendes Pereira, MD; Jordi Blasco, MD; Helena Quesada, MD; Jeremy Rempel, MD; Reza Jahan, MD; Stephen M. Davis, MD; Bruce C. Stouch, PhD; Peter J. Mitchell, MBBS†; Tudor G. Jovin, MD†; Jeffrey L. Saver, MD†; Mayank Goyal, MD†

Background and Purpose: Recent positive randomized trials of endovascular therapy for ischemic stroke used predominantly stent retrievers. We pooled data to investigate the efficacy and safety of stent thrombectomy using the Solitaire device in anterior circulation ischemic stroke.

11 febrero 2015

STROKE. Clinical Sciences. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Use, Temporal Trends, and Outcomes

Kevin N. Sheth, MD; Eric E. Smith, MD, MPH; Maria V. Grau-Sepulveda, MD, MPH; Dawn Kleindorfer, MD; Gregg C. Fonarow, MD; Lee H. Schwamm, MD

Background and Purpose: Interhospital transfer after use of intravenous tissue-type plasminogen activator (tPA) in acute stroke (drip and ship) is increasingly frequent. Small studies have suggested that drip and ship tPA is safe and increases rates of tPA use; however, little is known about real-world practice patterns. We sought to evaluate temporal trends in drip and ship tPA use and to compare the patient and hospital characteristics with that of conventional (front door) thrombolysis.

15 enero 2015

STROKE. Clinical Sciences. Outcome in Patients Previously on Antithrombotic Therapy in the SAMMPRIS Trial. Subgroup Analysis

Helmi L. Lutsep, MD; Stanley L. Barnwell, MD, PhD; Darren T. Larsen, RN; Michael J. Lynn, MS; Mindy Hong, MSPH; Tanya N. Turan, MD; Colin P. Derdeyn, MD; David Fiorella, MD, PhD; L. Scott Janis, PhD; Marc I. Chimowitz, MB, ChB; for the SAMMPRIS Investigators

Background and Purpose: Stenting has been used as a rescue therapy in patients with intracranial arterial stenosis and a transient ischemic attack or stroke when on antithrombotic therapy (AT). We determined whether the stenting versus aggressive medical therapy for intracranial arterial stenosis (SAMMPRIS) trial supported this approach by comparing the treatments within subgroups of patients whose qualifying event (QE) occurred on versus off of AT.

05 febrero 2015

STROKE. Clinical Sciences. Diagnostic Procedures, Treatments, and Outcomes in Stroke Patients Admitted to Different Types of Hospitals

Kjell Asplund, MD; Maria Sukhova, MSc; Per Wester, MD; Birgitta Stegmayr, PhD; on behalf of the Riksstroke Collaboration

Background and Purpose: In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance.