05 mayo 2015

STROKE. Obesity Increases Stroke Risk in Young Adults. Opportunity for Prevention

Walter N. Kernan, MD; Jennifer L. Dearborn, MD, MPH

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.

07 mayo 2015

STROKE. Clinical Sciences. Is Blood Pressure Control for Stroke Prevention the Correct Goal?

George Howard, DrPH; Maciej Banach, MD, PhD; Mary Cushman, MD; David C. Goff, MD, PhD; Virginia J. Howard, PhD; Daniel T. Lackland, DrPH; Jim McVay, DrPA; James F. Meschia, MD; Paul Muntner, PhD; Suzanne Oparil, MD; Melanie Rightmyer, DNP; Herman A. Taylor, MD

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.

07 mayo 2015

STROKE. Clinical Sciences. Common NOTCH3 Variants and Cerebral Small-Vessel Disease

Loes C.A. Rutten-Jacobs, PhD*; Matthew Traylor, PhD*; Poneh Adib-Samii, MBBS; Vincent Thijs, MD; Cathie Sudlow, MD; Peter M. Rothwell, MD; Giorgio Boncoraglio, MD; Martin Dichgans, MD; Steve Bevan, PhD; James Meschia, MD; Christopher Levi, MD; Natalia S. Rost, MD; Jonathan Rosand, MD; Ahamad Hassan, MRCP; Hugh S. Markus, MD

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.

13 mayo 2014

STROKE. Clinical Sciences. Drivers of Costs Associated With Reperfusion Therapy in Acute Stroke

Kit N. Simpson, DrPH; Annie N. Simpson, PhD; Patrick D. Mauldin, PhD; Michael D. Hill, MD; Sharon D. Yeatts, PhD; Judith A. Spilker, BSN; Lydia D. Foster, MS; Pooja Khatri, MD; Renee Martin, PhD; Edward C. Jauch, MD; Dawn Kleindorfer, MD; Yuko Y. Palesch, PhD; Joseph P. Broderick, MD; for the IMS III Investigators

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.

29 abril 2014

STROKE. Clinical Sciences. Intravenous Thrombolysis of Basilar Artery Occlusion. Thrombus Length Versus Recanalization Success

Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO; Tiina Sairanen, MD, PhD, MSc (Stroke Med); Heli Silvennoinen, MD, PhD; Oili Salonen, MD, PhD; Perttu J. Lindsberg, MD, PhD, FESO

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.

01 mayo 2014

STROKE. Clinical Sciences. Long-Term Outcome of 106 Consecutive Pediatric Ruptured Brain Arteriovenous Malformations After Combined Treatment

Thomas Blauwblomme, MD; Marie Bourgeois, MD; Philippe Meyer, MD; Stéphanie Puget, MD, PhD; Federico Di Rocco, MD, PhD; Nathalie Boddaert, MD, PhD; Michel Zerah, MD, PhD; Francis Brunelle, MD, PhD; Christian Sainte Rose, MD, PhD; Olivier Naggara, MD, PhD

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.

17 abril 2014

STROKE. The Art of Estimating Outcomes and Treating Patients With Stroke in the 21st Century

Gustavo Saposnik, MD, MSc, FRCPC

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).

05 junio 2014

STROKE. Clinical Sciences. Cognitive Deterioration in Bilateral Asymptomatic Severe Carotid Stenosis

Laura Buratti, MD; Clotilde Balucani, MD; Giovanna Viticchi, MD; Lorenzo Falsetti, MD; Claudia Altamura, MD; Emma Avitabile, MD; Leandro Provinciali, MD; Fabrizio Vernieri, MD; Mauro Silvestrini, MD

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.

29 mayo 2014

STROKE. Clinical Sciences. Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy

David S. Liebeskind, MD; Reza Jahan, MD; Raul G. Nogueira, MD; Osama O. Zaidat, MD; Jeffrey L. Saver, MD; for the SWIFT Investigators

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.

15 mayo 2014

STROKE. Clinical Sciences. Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Bijoy K. Menon, MD; Mohammed A. Almekhlafi, MD, MSc; Vitor Mendes Pereira, MD, MSc; Jan Gralla, MD; Alain Bonafe, MD; Antoni Davalos, MD; Rene Chapot, MD; Mayank Goyal, MD; on behalf of the STAR Study Investigators

Background and Purpose: We report on workflow and process-based performance measures and their effect on clinical outcome in Solitaire FR Thrombectomy for Acute Revascularization (STAR), a multicenter, prospective, single-arm study of Solitaire FR thrombectomy in large vessel anterior circulation stroke patients.

22 mayo 2014

STROKE. Clinical Sciences. Capillary Index Score in the Interventional Management of Stroke Trials I and II

Firas Al-Ali, MD; Thomas A. Tomsick, MD; John J. Connors III, MD; James M. Gebel, MD; John J. Elias, PhD; Georges Z. Markarian, MD; Zein Al-Ali; Joseph P. Broderick, MD

Background and Purpose: The Capillary Index Score (CIS) is a simple angiography-based scale for assessing viable tissue in the ischemic territory. We retrospectively applied it to Interventional Management of Stroke (IMS) trials I and II to evaluate the predictive value for good outcomes.

12 junio 2014

STROKE. Clinical Sciences. Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy

Manabu Inoue, MD, PhD*; Jean-Marc Olivot, MD, PhD*; Julien Labreuche, BST; Michael Mlynash, MD, MS; Waimea Tai, MD; Jean-François Albucher, MD; Elena Meseguer, MD; Pierre Amarenco, MD; Mikael Mazighi, MD, PhD

Background and Purpose: In acute ischemic stroke patients treated by intravenous thrombolysis, a diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an independent factor of functional outcomes. Our aim was to assess the impact of pretreatment DWI-ASPECTS on outcomes after endovascular therapy, with a specific emphasis on recanalization.

29 mayo 2014

STROKE. Clinical Sciences. Predictors of Functional Dependence Despite Successful Revascularization in Large-Vessel Occlusion Strokes

Zhong-Song Shi, MD; David S. Liebeskind, MD; Bin Xiang, PhD; Sijian Grace Ge, MS; Lei Feng, MD; Gregory W. Albers, MD; Ronald Budzik, MD; Thomas Devlin, MD; Rishi Gupta, MD; Olav Jansen, MD; Tudor G. Jovin, MD; Monika Killer-Oberpfalzer, MD; Helmi L. Lutsep, MD; Juan Macho, MD; Raul G. Nogueira, MD; Marilyn Rymer, MD; Wade S. Smith, MD; Nils Wahlgren, MD; Gary R. Duckwiler, MD; for the Multi MERCI, TREVO, and TREVO 2 Investigators

Background and Purpose: High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy.

01 junio 2015

NEUROSURGERY. Long-term Outcomes of the International Randomized Clinical Trial of Stenting Versus Endarterectomy for Symptomatic Carotid Artery Stenosis

Starke, Robert M. MD; Komotar, Ricardo J. MD; Ahmad, Faiz MD; Connolly, E. Sander MD

Atherosclerotic stenosis of the internal carotid artery accounts for 10% to 15% of all strokes. For symptomatic patients with significant extracranial carotid stenosis, prior trials have found better outcomes after carotid endarterectomy (CEA) compared with best medical therapy.1-5 Numerous studies have assessed endovascular treatment (angioplasty with or without stenting) as an alternative to CEA.6-10 More recently, randomized trials comparing stenting with CEA for symptomatic carotid stenosis found that stenting was associated with a higher risk of stroke but lower rates of myocardial infarction, access site hematoma, and cranial nerve palsy.

01 junio 2015

NEUROSURGERY. Clinical Features and Prognosis of Intracranial Artery Dissection

Sikkema, Tineke MD*; Uyttenboogaart, Maarten MD, PhD*; van Dijk, J. Marc C. MD, PhD‡; Groen, Rob J.M. MD, PhD‡; Metzemaekers, Jan D.M. MD, PhD‡; Eshghi, Omid MD§; Mazuri, Aryan MD§; Bakker, Nicolaas A. MD, PhD‡; Luijckx, Gert-Jan MD, PhD*

BACKGROUND: Intracranial artery dissections (IADs) are an important cause of stroke or subarachnoid hemorrhage (SAH). Outcome of IAD in the anterior circulation or presentation without SAH is rarely investigated and might be different.