Background and Purpose: In 2010, Greater Manchester and London centralized acute stroke care into hyperacute units (Greater Manchester=3, London=8), with additional units providing ongoing specialist stroke care nearer patients’ homes. Greater Manchester patients presenting within 4 hours of symptom onset were eligible for hyperacute unit admission; all London patients were eligible. Research indicates that postcentralization, only London’s stroke mortality fell significantly more than elsewhere in England. This article attempts to explain this difference by analyzing how centralization affects provision of evidence-based clinical interventions.
Background and Purpose: We developed a new postdischarge system of care comprising a structured assessment covering longer-term problems experienced by patients with stroke and their carers, linked to evidence-based treatment algorithms and reference guides (the longer-term stroke care system of care) to address the poor longer-term recovery experienced by many patients with stroke.
Background and Purpose: Patients who survive intracerebral hemorrhage (ICH) often have compelling indications for anticoagulant and antiplatelet medication. This nationwide observational study aimed to determine the extent and predictors of antithrombotic treatment after ICH in Sweden.
Background and Purpose: This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion.
Background and Purpose: Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors.
The terms reperfusion and recanalization are sometimes erroneously used interchangeably when referring to outcomes of thrombolytic or endovascular therapies. Recanalization and reperfusion are neither discrete nor static measures and although achieving one often implies the other has also occurred. Arterial obstructions and perfusion deficits can both evolve independently over time, in the early hours not only after stroke onset but also after therapeutic interventions. Distinguishing reperfusion from recanalization can be challenging in the clinical arena because currently available noninvasive measurements from multimodal computed tomography or magnetic resonance imaging (MRI) have imperfect sensitivity and specificity.
A debate has been smoldering over the meaning of obesity in reducing the world burden of stroke. Like so many debates in medicine, it begins with disagreements about the interpretation of evidence, the meaning of statistical test results, and the role of bias. In one camp, are those who see that obesity is associated with increased risk for stroke and say that it as an important target for primary and secondary prevention. In the other, are those who agree that obesity increases stroke but say that it is more effective to treat the consequence of obesity that are responsible for stroke risk (ie, hypertension and dyslipidemia) than obesity itself.
Background and Purpose: Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension.
Background and Purpose: The most common monogenic cause of cerebral small-vessel disease is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, caused by NOTCH3 gene mutations. It has been hypothesized that more common variants in NOTCH3 may also contribute to the risk of sporadic small-vessel disease. Previously, 4 common variants (rs10404382, rs1043994, rs10423702, and rs1043997) were found to be associated with the presence of white matter hyperintensity in hypertensive community-dwelling elderly.
Background and Purpose: The Interventional Management of Stroke (IMS) III study tested the effect of intravenous tissue-type plasminogen activator (tPA) alone when compared with intravenous tPA followed by endovascular therapy and collected cost data to assess the economic implications of the 2 therapies. This report describes the factors affecting the costs of the initial hospitalization for acute stroke subjects from the United States.
Background and Purpose: In middle cerebral artery occlusion, probability of recanalization after intravenous tissue-type plasminogen activator thrombolysis (IVT) was reported to drop <1% for thrombi exceeding 8 mm. We aimed to evaluate the effect of thrombus length and location on success of recanalization after IVT in basilar artery occlusion.
Background and Purpose: Childhood intracerebral hemorrhage is mainly attributable to underlying brain arteriovenous malformations (bAVMs). Multimodal treatment options for bAVMs include microsurgery and embolization, allowing an immediate cure, and radiosurgery, entailing longer obliteration times. Follow-up data on pediatric ruptured bAVMs are scarce, making it difficult to assess the risk of subsequent intracerebral hemorrhage. Our aim was to assess the clinical and angiographic outcome and to analyze risk factors for rebleeding during and after combined treatment of pediatric bAVMs.
Clinicians, patients, and their families usually inquire about an expected outcome after an acute event, the response to thrombolysis, and endovascular therapy. Some clinicians use their past experience or weight risk factors known to influence stroke outcomes. These factors can be categorized as follows: (1) patient-level factors (eg, age, stroke severity, comorbid conditions), (2) physician-level factors (eg, specialty, years of experience), and (3) institutional-level factors (eg, Joint Commission on Accreditation of Healthcare Organizations affiliation, stroke center, annual volume of stroke admissions).
Background and Purpose: This study aimed to monitor cognitive performance during a 3-year period in subjects with bilateral asymptomatic severe internal carotid artery stenosis and to explore the role of cerebral hemodynamics and atherosclerotic disease in the development of cognitive dysfunction.
Background and Purpose: Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.
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