12 marzo 2016

THE LANCET. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial

Nicolai Tegn, MD, Prof Michael Abdelnoor, PhD, Lars Aaberge, MD, Knut Endresen, MD, Prof Pål Smith, MD, Prof Svend Aakhus, MD, Erik Gjertsen, MD, Ola Dahl-Hofseth, MD, Prof Anette Hylen Ranhoff, MD, Prof Lars Gullestad, MD, Dr Bjørn Bendz, MD for the After Eighty study investigators

Background: Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy.

23 febrero 2016

STROKE. Clinical Sciences. Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth. A Systematic Review and Meta-Analysis

Daan Backes, MD; Gabriel J.E. Rinkel, MD, FRCPE; Kamil G. Laban, MD; Ale Algra, MD, PhD; Mervyn D.I. Vergouwen, MD, PhD

Background and Purpose: Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient- and aneurysm-specific risk factors for aneurysm growth.

25 febrero 2016

STROKE. Clinical Sciences. Cerebrovascular Disease. in Rheumatic Diseases A Systematic Review and Meta-Analysis

Stewart J. Wiseman, BSc; Stuart H. Ralston, FRCP; Joanna M. Wardlaw, FRCR

Background and Purpose: Some rheumatic diseases are associated with stroke. Less is known about associations with stroke subtypes or stroke risk by age. We quantified the association between stroke, its subtypes, and rheumatic diseases and identified when stroke risk is greatest.

03 marzo 2016

STROKE. Clinical Sciences. Stroke and Embolic Events in Hypertrophic Cardiomyopathy. Risk Stratification in Patients Without Atrial Fibrillation

Shintaro Haruki, MD, PhD; Yuichiro Minami, MD, PhD; Nobuhisa Hagiwara, MD, PhD

Background and Purpose: Stroke and systemic embolic events are known to occur as complications of hypertrophic cardiomyopathy (HCM), and these complications are more common in patients with accompanying atrial fibrillation (AF). The diagnosis of AF is sometimes difficult, however, and it is possible that subclinical asymptomatic paroxysmal episodes or a first episode of AF in patients without previously documented AF may lead to embolic events. We investigated the prevalence of embolic events in patients with HCM and evaluated risk factors for these events in patients without documented AF.

23 febrero 2016

STROKE. Brief Report. Early Endovascular Treatment in Intravenous Tissue Plasminogen Activator–Ineligible Patients

Letícia C. Rebello, MD; Diogo C. Haussen, MD; Jonathan A. Grossberg, MD; Samir Belagaje, MD; Andrey Lima, MD; Aaron Anderson, MD; Michael R. Frankel, MD; Raul G. Nogueira, MD

Background and Purpose: Intravenous tissue-type plasminogen activator (tPA) treatment in acute stroke has many exclusion criteria. We aimed to assess the safety and efficacy of endovascular therapy (ET) in intravenous (IV) tPA-ineligible patients.

01 marzo 2016

STROKE. Brief Report. Safety of Endovascular Thrombectomy in Patients Receiving Non–Vitamin K Antagonist Oral Anticoagulants

Jan C. Purrucker, MD; Marcel Wolf, MD; Kirsten Haas, PhD; Timolaos Rizos, MD; Shujah Khan; Rainer Dziewas, MD; Christoph Kleinschnitz, MD; Andreas Binder, MD; Klaus Gröschel, MD; Michael G. Hennerici, MD; Kyriakos Lobotesis, MD; Sven Poli, MD; Günter Seidel, MD; Tobias Neumann-Haefelin, MD; Peter A. Ringleb, MD; Peter U. Heuschmann, MD; Roland Veltkamp, MD

Background and Purpose: Prospective data on the safety of endovascular thrombectomy in acute stroke patients on non–vitamin K antagonist oral anticoagulants are lacking.

23 febrero 2016

STROKE. Clinical Sciences. Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke. A Matched-Pairs Analysis

Anne Broeg-Morvay, MD*; Pasquale Mordasini, MD, MSc*; Corrado Bernasconi, MD, PhD; Monika Bühlmann, MD; Frauke Pult, MD; Marcel Arnold, MD; Gerhard Schroth, MD; Simon Jung, MD; Heinrich P. Mattle, MD; Jan Gralla, MD, MSc*; Urs Fischer, MD, MSc*

Background and Purpose: Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear.

25 febrero 2016

STROKE. Clinical Sciences. Association Between Time From Stroke Onset and Fluid-Attenuated Inversion Recovery Lesion Intensity Is Modified by Status of Collateral Circulation

Anke Wouters, MD; Patrick Dupont, PhD; Soren Christensen, PhD; Bo Norrving, MD; Rico Laage, PhD; Götz Thomalla, PhD; Greg Albers, MD; Vincent Thijs, MD; Robin Lemmens, MD

Background and Purpose: In patients with acute stroke, the intensity of a fluid-attenuated inversion recovery (FLAIR) lesion in the region of diffusion restriction is associated with time from symptom onset. We hypothesized that collateral status as assessed by the hypoperfusion intensity ratio could modify the association between time from stroke onset and FLAIR lesion intensity.

08 marzo 2016

STROKE. Clinical Sciences. Association Between Time to Reperfusion and Outcome Is Primarily Driven by the Time From Imaging to Reperfusion

Marc Ribo, MD; Carlos A. Molina, MD; Erik Cobo, PhD; Neus Cerdà, PhD; Alejandro Tomasello, MD; Helena Quesada, MD; Maria Angeles De Miquel, MD; Mónica Millan, MD; Carlos Castaño, MD; Xabier Urra, MD; Luis Sanroman, MD, PhD; Antoni Dàvalos, MD; Tudor Jovin, MD, for the REVASCAT Trial Investigators*

Background and Purpose: A progressive decline in the odds of favorable outcome as time to reperfusion increases is well known. However, the impact of specific workflow intervals is not clear.

17 febrero 2016

STROKE. Clinical Sciences. Inflammatory Markers and Outcomes After Lacunar Stroke. Levels of Inflammatory Markers in Treatment of Stroke Study

Amelia K. Boehme, PhD, MSPH; Leslie A. McClure, PhD; Yu Zhang, MS; Jorge M. Luna, MS; Oscar H. Del Brutto, MD; Oscar R. Benavente, MD; Mitchell S.V. Elkind, MD, MS

Background and Purpose: We hypothesized that concentrations of interleukin 6 (IL-6), serum amyloid A, tumor necrosis factor-α receptor 1, CD40 ligand, and monocyte chemoattractant protein 1 would predict recurrent ischemic stroke and major vascular events after recent lacunar stroke.

02 febrero 2016

STROKE. Clinical Sciences. Documentation of Improved Outcomes for Intracranial Aneurysm Management Over a 15-Year Interval

Michelle H. Chua, BS; Christoph J. Griessenauer, MD; Christopher J. Stapleton, MD; Lucy He, MD; Ajith J. Thomas, MD; Christopher S. Ogilvy, MD

Background and Purpose: Despite rapid advancements in intracranial aneurysm management, there is no evidence as of yet that this has translated into improvement in overall prognosis.

17 febrero 2016

STROKE. Clinical Sciences. Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

Maxim Mokin, MD, PhD; Ashish Sonig, MD, MS; Sananthan Sivakanthan, BS; Zeguang Ren, MD, PhD; Lucas Elijovich, MD; Adam Arthur, MD, MPH; Nitin Goyal, MD; Peter Kan, MD, MPH; Edward Duckworth, MD; Erol Veznedaroglu, MD; Mandy J. Binning, MD; Kenneth M. Liebman, MD; Vikas Rao, MD; Raymond D. Turner IV, MD; Aquilla S. Turk, DO; Blaise W. Baxter, MD; Guilherme Dabus, MD; Italo Linfante, MD; Kenneth V. Snyder, MD, PhD; Elad I. Levy, MD, MBA; Adnan H. Siddiqui, MD, PhD

Background and Purpose: Patients with posterior circulation strokes have been excluded from recent randomized endovascular stroke trials. We reviewed the recent multicenter experience with endovascular treatment of posterior circulation strokes to identify the clinical, radiographic, and procedural predictors of successful recanalization and good neurological outcomes.

26 enero 2016

STROKE. Clinical Sciences. Cortical Venous Filling on Dynamic Computed Tomographic Angiography. A Novel Predictor of Clinical Outcome in Patients With Acute Middle Cerebral Artery Stroke

Ido R. van den Wijngaard, MD; Marieke J.H. Wermer, MD, PhD; Jelis Boiten, MD, PhD; Ale Algra, MD, PhD; Ghislaine Holswilder, MSc; Frederick J.A. Meijer, MD, PhD; Diederik W.J. Dippel, MD, PhD; Birgitta K. Velthuis, MD, PhD; Charles B.L.M. Majoie, MD, PhD; Marianne A.A. van Walderveen, MD, PhD

Background and Purpose: Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome.

14 enero 2016

STROKE. Clinical Sciences. Thrombus Length Estimation on Delayed Gadolinium–Enhanced T1

Shenqiang Yan, MD; Qingmeng Chen, MM; Mengjun Xu, MD; Jianzhong Sun, MB; David S. Liebeskind, MD; Min Lou, MD, PhD

Background and Purpose: Previous studies revealed a close relationship between thrombus length and recanalization rate after intravenous thrombolysis (IVT). As a novel approach, we prospectively adjusted the order of sequence acquisition to obtain delayed gadolinium–enhanced T1 (dGE-T1) and thereby assess thrombus length on dGE-T1 to evaluate its predictive value for recanalization after IVT.

28 enero 2016

STROKE. Clinical Sciences. Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke

Olvert A. Berkhemer, MD*; Ivo G.H. Jansen, MD*; Debbie Beumer, MD; Puck S.S. Fransen, MD; Lucie A. van den Berg, MD; Albert J. Yoo, MD; Hester F. Lingsma, PhD; Marieke E.S. Sprengers, MD, PhD; Sjoerd F.M. Jenniskens, MD, PhD; Geert J. Lycklama à Nijeholt, MD, PhD; Marianne A.A. van Walderveen, MD, PhD; René van den Berg, MD, PhD; Joseph C.J. Bot, MD, PhD; Ludo F.M. Beenen, MD; Anna M.M. Boers, MSc; Cornelis H. Slump, PhD; Yvo B.W.E.M. Roos, MD, PhD*; Robert J. van Oostenbrugge, MD, PhD*; Diederik W.J. Dippel, MD, PhD*; Aad van der Lugt, MD, PhD*; Wim H. van Zwam, MD, PhD*; Henk A. Marquering, PhD*; Charles B.L.M. Majoie, MD, PhD*, on behalf of the MR CLEAN Investigators

Background and Purpose: Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).