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.

03 febrero 2015

STROKE. Clinical Sciences. How Sustained Is 24-Hour Diffusion-Weighted Imaging Lesion Reversal? Serial Magnetic Resonance Imaging in a Patient Cohort Thrombolyzed Within 4.5 Hours of Stroke Onset

Sebastien Soize, MD; Marie Tisserand, MD; Sylvain Charron, PhD*; Guillaume Turc, MD*; Wagih Ben Hassen, MD; Marc-Antoine Labeyrie, MD; Laurence Legrand, MD; Jean-Louis Mas, MD; Laurent Pierot, PhD; Jean-François Meder, PhD; Jean-Claude Baron, ScD; Catherine Oppenheim, PhD

Background and Purpose: Here, we assessed how sustained is reversal of the acute diffusion lesion (RAD) observed 24 hours after intravenous thrombolysis, and the relationships between RAD fate and early neurological improvement.

10 febrero 2015

STROKE. Clinical Sciences. Using Standard First-Pass Perfusion Computed Tomographic Data to Evaluate Collateral Flow in Acute Ischemic Stroke

Hui Chen, MD*; Bing Wu, MD, PhD*; Nan Liu, MD; Max Wintermark, MD; Zihua Su, PhD; Ying Li, MD; Jun Hu, MD, PhD; Yongwei Zhang, MD; Weiwei Zhang, MD, PhD; Guangming Zhu, MD, PhD

Background and Purpose: The study aims to determine whether volume transfer constant (Ktrans) maps calculated from first-pass perfusion computed tomographic data are a biomarker of cerebral collateral circulation and predict the clinical outcome in acute ischemic stroke caused by proximal arterial occlusion.

17 febrero 2015

STROKE. Early Mobilization After Stroke. Early Adoption but Limited Evidence

Julie Bernhardt, PhD; Coralie English, PhD; Liam Johnson, PhD; Toby B. Cumming, PhD

In the last decade, increasing attention has been paid to understanding the components of care that might contribute to the stroke unit effect. Early mobilization, in its many guises, is one component of care proposed to contribute to the survival and recovery benefits of stroke unit care.1 This topical review provides an overview of the current evidence, research, and practice recommendations for early mobilization after stroke.

01 abril 2016

JOURNAL OF NEUROSURGERY. Reversal of intraoperative arterial thrombosis with a fibrinolytic agent when treating large and giant partially thrombosed aneurysms of the middle cerebral artery

Shalva Eliava, MD, PhD, Yury Pilipenko, MD, PhD, Oleg Shekhtman, MD, PhD, and Anton Konovalov, MD

OBJECT: Thrombosis of the cerebral arteries is one of the complications of microsurgical operations for partially thrombosed intracranial aneurysms. The object of this study was to assess the frequency of intraoperative arterial thrombosis (IAT) during microsurgical treatment of large and giant partially thrombosed aneurysms of the middle cerebral artery (MCA) and also to assess the efficacy of the treatment of this complication.

23 febrero 2016

JOURNAL OF THE AMERICAN HEART ASSOCIATION. Stroke. Thrombolytic Recanalization of Carotid Arteries Is Highly Dependent on Degree of Stenosis, Despite Sonothrombolysis

Amelia J. Tomkins, PhD1,3; Rebecca J. Hood, BBiomedSci(Hons)1,3; Debbie Pepperall, DipPathTech1,3; Christopher L. Null, BS5; Christopher R. Levi, MBBS, BMedSci, FRACP2,3,4; Neil J. Spratt, FRACP, PhD*,1,3,4

Background: Stroke associated with acute carotid occlusion is associated with poor effectiveness of tissue plasminogen activator (tPA) thrombolysis and poor prognosis. Rupture of atherosclerotic plaques resulting in vascular occlusions may occur on plaques, causing variable stenosis. We hypothesized that degree of stenosis may affect recanalization rates with tPA. Ultrasound+tPA (sonothrombolysis) has been shown to improve recanalization for intracranial occlusions but has not been tested for carotid occlusion. Our primary aim was to determine thrombolytic recanalization rates in a model of occlusion with variable stenosis, with a secondary aim to investigate sonothrombolysis in this model.

01 abril 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Proximal Versus Distal Embolic Protection for Carotid Artery Stenting. A National Cardiovascular Data Registry Analysis

Jay Giri, MD, MPH∗; Sahil A. Parikh, MD†; Kevin F. Kennedy, MS‡; Ido Weinberg, MD§; Cameron Donaldson, MD§; Beau M. Hawkins, MD‖; Daniel J. McCormick, DO∗; Benjamin Jackson, MD¶; Ehrin J. Armstrong, MD, MSc#; Preethi Ramchand, MD∗∗; Christopher J. White, MD††; Michael R. Jaff, DO§; Kenneth Rosenfield, MD§; Robert W. Yeh, MD, MSc§

Objectives: The aim of this study was to compare the stroke/death rates between proximal embolic protection devices (P-EPDs) and distal filter embolic protection devices (F-EPDs) in elective carotid artery stenting (CAS).