Latest & greatest articles for stroke

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Top results for stroke

1. Thrombectomy for Stroke in the Public Health Care System of Brazil. (Abstract)

Thrombectomy for Stroke in the Public Health Care System of Brazil. Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries.We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal (...) intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 1:1 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days.A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period

2020 NEJM

2. Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study. (Abstract)

Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study. Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown.To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA).Prospective cohort study comparing stroke or TIA recurrence in patients (...) with and without residual shunt after PFO closure.Single hospital center.1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic stroke who were undergoing percutaneous PFO closure were followed for up to 11 years.Residual shunt was evaluated by transthoracic echocardiography with saline contrast. Primary outcome was a composite of the first recurrent ischemic stroke or TIA after PFO closure.Compared with complete closure, the presence of residual shunt after PFO closure

2020 Annals of Internal Medicine

3. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. (Abstract)

Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. Earlier administration of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is associated with reduced mortality by the time of hospital discharge and better functional outcomes at 3 months. However, it remains unclear whether shorter door-to-needle times translate into better long-term outcomes.To examine whether shorter door-to-needle times (...) with intravenous tPA for acute ischemic stroke are associated with improved long-term outcomes.This retrospective cohort study included Medicare beneficiaries aged 65 years or older who were treated for acute ischemic stroke with intravenous tPA within 4.5 hours from the time they were last known to be well at Get With The Guidelines-Stroke participating hospitals between January 1, 2006, and December 31, 2016, with 1-year follow-up through December 31, 2017.Door-to-needle times for intravenous tPA.The primary

2020 JAMA

4. Antithrombotic Treatment of Embolic Stroke of Undetermined Source: RE-SPECT ESUS Elderly and Renally Impaired Subgroups Full Text available with Trip Pro

Antithrombotic Treatment of Embolic Stroke of Undetermined Source: RE-SPECT ESUS Elderly and Renally Impaired Subgroups Antithrombotic Treatment of Embolic Stroke of Undetermined Source: RE-SPECT ESUS Elderly and Renally Impaired Subgroups - PubMed This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. National Institutes of Health National (...) : Number of items displayed: Create RSS Cancel RSS Link Copy Actions Cite Share Permalink Copy Page navigation Stroke Actions . 2020 Jun;51(6):1758-1765. doi: 10.1161/STROKEAHA.119.028643. Epub 2020 May 14. Antithrombotic Treatment of Embolic Stroke of Undetermined Source: RE-SPECT ESUS Elderly and Renally Impaired Subgroups , , , , , , , , , , , , , , , , , , , , , , , Affiliations Expand Affiliations 1 From the Faculty of Medicine, Institute for Medical Informatics, Biometry and Epidemiology

2020 EvidenceUpdates

5. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. (Abstract)

Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. In acute ischemic stroke, there is uncertainty regarding the benefit and risk of administering intravenous alteplase before endovascular thrombectomy.We conducted a trial at 41 academic tertiary care centers in China to evaluate endovascular thrombectomy with or without intravenous alteplase in patients with acute ischemic stroke. Patients with acute ischemic stroke from large-vessel occlusion in the anterior (...) (adjusted common odds ratio, 1.07; 95% confidence interval, 0.81 to 1.40; P = 0.04 for noninferiority) but was associated with lower percentages of patients with successful reperfusion before thrombectomy (2.4% vs. 7.0%) and overall successful reperfusion (79.4% vs. 84.5%). Mortality at 90 days was 17.7% in the thrombectomy-alone group and 18.8% in the combination-therapy group.In Chinese patients with acute ischemic stroke from large-vessel occlusion, endovascular thrombectomy alone was noninferior

2020 NEJM

6. In older adults with acute ischemic stroke, the Clinical Frailty Scale predicted mortality at 28 days. (Abstract)

In older adults with acute ischemic stroke, the Clinical Frailty Scale predicted mortality at 28 days. Evans NR, Wall J, To B, et al. Clinical frailty independently predicts early mortality after ischaemic stroke. Age Ageing. 2020. [Epub ahead of print]. 31951248.

2020 Annals of Internal Medicine

7. In ischemic stroke with viable hypoperfused tissue, alteplase > 4.5 h after last seen well improves function. (Abstract)

In ischemic stroke with viable hypoperfused tissue, alteplase > 4.5 h after last seen well improves function. Tsivgoulis G, Katsanos AH, Malhotra K, et al. Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window. Neurology. 2020;94:e1241-8. 31892636.

2020 Annals of Internal Medicine

8. Covid-19: Stroke

, stroke patients are advised to protect themselves from contagion, given they are at increased risk for complications if they get COVID-19. Moreover, based on current information, it appears that elderly people with coronary heart disease or hypertension are more likely to present with more severe symptoms. People affected by infectious diseases as COVID-19 are also at increased risk of ischaemic and haemorrhagic cerebrovascular complications. For this reason, an increased number of strokes could (...) be forecast. However, an unexpected reduction of stroke patients in the emergency room throughout Europe has been observed. It is reasonable to assume that patients with acute mild stroke or TIA remain at home, because they are asked to stay at home, limit emergency room visits, and minimise travel. The patients may be prioritising avoiding contagion. Another issue is that stroke care organization and pathways within hospitals are currently adapted to cover the requirements of dealing with COVID-19

2020 European Academy of Neurology

9. Prevalence of dysphagia and economic burden of aspiration pneumonia in patients with stroke or head and neck cancer

Prevalence of dysphagia and economic burden of aspiration pneumonia in patients with stroke or head and neck cancer application/octet-stream

2020 Institute of Health Economics

10. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

found: AHI >5 in 70.4% (95% CI 62.1%–78.7%), AHI >20 in 39.5% (95% CI 31.6%–47.4%), and AHI >30 in 30.1% (95% CI 23.1%–37.0%) (Table S11). The meta-analysis by Seiler et al. [109] included a total of 89 studies where at least 10 patients were assessed, and full PSG or a portable device was used for diagnosis (Table S11). Fifty-four studies assessed patients 3 months after stroke. The distribution of stroke types was as follows: ischaemic stroke 5275, haemorrhagic stroke 302, TIA 405, unde?ned 1188 (...) cerebrovascular events. Does treatment of SDB have any impact on mortality and outcome after stroke? Whilst SDB and, in particular, OSA is common in stroke patients and associated with an increased risk of recurrent stroke and all-cause mortality, the impact of treating SDB on neurological recovery and cardio- vascular morbidity and mortality has only recently been explored. Results of the literature search. • The search revealed two updated systematic reviews with meta-analyses using CPAP or non-invasive

2020 European Academy of Neurology

11. Dabigatran Treatment of Acute Noncardioembolic Ischemic Stroke

Institute, Cumming School of Medicine, University of Calgary, AB, Canada (S.B.C., M.D.H.). 6 University of Montreal, QC, Canada (L.C.G). PMID: 32098609 DOI: Item in Clipboard Full-text links Cite Abstract Background and Purpose- Patients with transient ischemic attack (TIA) and minor ischemic stroke are at risk for early recurrent cerebral ischemia. Anticoagulants are associated with reduced recurrence but also increased hemorrhagic transformation (HT). The safety of the novel oral anticoagulant (...) dabigatran in acute stroke has not been evaluated. Methods- DATAS II (Dabigatran Treatment of Acute Stroke II) was a phase II prospective, randomized open label, blinded end point trial. Patients with noncardioembolic stroke/transient ischemic attack (National Institutes of Health Stroke Scale score, ≤9; infarct volume, ≤25 mL) were randomized to dabigatran or aspirin. Magnetic resonance imaging was performed before randomization and repeated at day 30. Imaging end points were ascertained centrally

2020 EvidenceUpdates

12. Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs Full Text available with Trip Pro

complications (18 fatal strokes, 68 non-fatal strokes, 11 fatal myocardial infarctions and 6 deaths from other causes) [Correction added on 20 April, after first online publication: the percentage value has been corrected to 2·8]. Of the 86 strokes, 67 (78 per cent) were ipsilateral, 17 (20 per cent) were contralateral and two (2 per cent) were vertebrobasilar. Forty-five strokes (52 per cent) were ischaemic, nine (10 per cent) haemorrhagic, and stroke subtype was not determined in 32 patients (37 per cent (...) Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 3 Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands. 4 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. 5 Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, Utrecht, the Netherlands. 6 Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands. 7

2020 EvidenceUpdates

13. Practice advisory update: Patent foramen ovale and secondary stroke prevention

in patients with cerebrovascular disease, and patent foramen ovale (PFO) and stroke; has received support from WL Gore and Associates for the REDUCE PFO closure study, from GlaxoSmithKline for a study of outcomes from proximal aortic surgeries, from Bayer for a study of rivaroxaban for secondary stroke prevention in patients with embolic stroke of undetermined source, from Mallinkrodt for a study of the impact of inhaled nitric oxide on cerebral perfusion, from Novartis for a study of BAF312 in patients (...) with intracerebral hemorrhage (ICH), from Biogen for a study of glibenclamide for cerebral edema following large hemispheric infarction; and received support from the National Institutes of Health (NIH) for work with the cardiothoracic surgery network, deferoxamine in ICH, neurologic outcomes in a renal insufficiency cohort; and has provided his expert opinion for medical-legal cases involving stroke. G. Gronseth serves as an associate editor for Neurology; has served as chief evidence-based medicine consultant

2020 American Academy of Neurology

14. Association of CHA2 DS2 -VASc Score with Stroke, Thromboembolism, and Death in Hip Fracture Patients

, Denmark. 3 Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark. PMID: 32294240 DOI: Item in Clipboard Full-text links Cite Abstract Objectives: Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic embolism (2 points), vascular (...) Registry. Measurements: We calculated incidence rates, cumulative incidences, and hazard ratios (HRs) with 95% confidence intervals (CIs) by CHA 2 DS 2 -VASc score, stratified on AF history. Results: The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA 2 DS 2 -VASc score, and it was 1.9% for patients with a score of 1 and 8.6% for patients with a score above 5 in the AF group. Corresponding incidences in the non-AF group were 1.6% and 7.6%. Compared

2020 EvidenceUpdates

15. Canadian Stroke Best Practice recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

on antiplatelet and anticoagulant use, 9 and Thrombosis Canada clinical guides. 8GUIDELINE E304 CMAJ | MARCH 23, 2020 | VOLUME 192 | ISSUE 12 of placebo reduced the number of serious vascular events by 36 (standard error [SE] 5) per 1000 per year in patients with a previ- ous myocardial infarction and also by 36 (SE 6) per 1000 per year in patients with a previous history of stroke or transient ischemic attack. In patients with peripheral arterial disease, treatment with ASA instead of placebo reduced (...) outcome were 0.96 (95% confidence interval [CI] 0.81–1.13) and 0.95 (95% CI 0.83–1.08), respectively. In the ASCEND trial, 4 the risk of the primary outcome (first serious vascular event [myocardial infarction, stroke, transient ischemic attack or cardiovascular death]) was significantly lower in the ASA group (8.5% v. 9.6%; relative risk [RR] 0.88, 95% CI 0.79–0.97). The results of these 3 trials were incorporated into 2 system- atic reviews, the results of which conflicted. 5,6 The use of ASA did

2020 CPG Infobase

16. Temporary Emergency Guidance to U.S. Stroke Centers During the COVID-19 Pandemic Full Text available with Trip Pro

Pandemic On Behalf of the AHA/ASA Stroke Council Leadership and On Behalf of the AHA/ASA Stroke Council Leadership Originally published 1 Apr 2020 Stroke. ;0:null Abstract During this unprecedented time of extraordinary stress on the US healthcare system, the AHA/ASA Stroke Council—as individuals in our localities and together as an entity at the national level—acknowledge the mounting concern regarding optimal stroke care during the COVID-19 pandemic among vascular neurologists and those clinicians (...) Temporary Emergency Guidance to U.S. Stroke Centers During the COVID-19 Pandemic Temporary Emergency Guidance to US Stroke Centers During the COVID-19 Pandemic | Stroke Search Search Hello Guest! Login to your account Email Password Keep me logged in Search Search 2020 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Free Access article Share on Jump to Free Access article Temporary Emergency Guidance to US Stroke Centers During the COVID-19

2020 American Heart Association

17. Computerised speech and language therapy can help people with aphasia find words following a stroke. (Abstract)

Computerised speech and language therapy can help people with aphasia find words following a stroke. The studyPalmer R, Dimairo M, Cooper C, et al. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial. Lancet Neurol 2019;18:821-33.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/21/01 (...) ) and the Tavistock Trust for Aphasia.To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000864/after-a-stroke-computerised-speech-and-language-therapy-can-help-people-find-words.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

2020 BMJ

18. Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. (Abstract)

Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. Nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, is a neuroprotectant that is effective in preclinical stroke models of ischaemia-reperfusion. In this trial, we assessed the efficacy and safety of nerinetide in human ischaemia-reperfusion that occurs with rapid endovascular thrombectomy in patients who had (...) an acute ischaemic stroke.For this multicentre, double-blind, randomised, placebo-controlled study done in 48 acute care hospitals in eight countries, we enrolled patients with acute ischaemic stroke due to large vessel occlusion within a 12 h treatment window. Eligible patients were aged 18 years or older with a disabling ischaemic stroke at the time of randomisation, had been functioning independently in the community before the stroke, had an Alberta Stroke Program Early CT Score (ASPECTS) greater

2020 Lancet

19. Continual Long-Term Physiotherapy After Stroke

are eligible to receive continual long-term community-based physiotherapy have already received 12 weeks of physiotherapy after being diagnosed with stroke. We excluded people who were admitted to hospital for transient ischemic attack, as it is characterized as a minor and nondisabling type of stroke, 16 and focused on people who were admitted for either ischemic or (intracerebral or subarachnoid) hemorrhagic stroke. Budget Impact Analysis March 2020 Ontario Health Technology Assessment Series; Vol. 20 (...) and long-term medical attention. There are different types of stroke. The two major classifications are ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when an artery in the brain is blocked. Hemorrhagic stroke occurs when a blood vessel in the brain breaks open, interrupting blood flow in the brain. 1 Clinical Need and Target Population In Canada, approximately 62,000 people suffer a stroke annually, and about 405,000 are living with the consequences of a stroke. 2 This number

2020 Health Quality Ontario

20. Canadian Stroke Best Practice recommendations: rehabilitation, recovery, and community participation following stroke. Part one: rehabilitation and recovery following stroke; 6th edition update 2019

be costly, or forgo super- vised therapy and potentially not meet their rehabilita- tion and recovery potential. The 2019 update of the Canadian Stroke Best Practice Recommendations (CSBPR): Rehabilitation and Recovery following Stroke module is a comprehen- sive summary of current evidence-based recommenda- tions, focusing primarily on the management of people who have already had a moderately or severely dis- abling stroke. People with milder stroke or transient ischemic attack may not require (...) for select patients with acute stroke (for instance, people with more mild strokesor transient ischemic attack) butcautionisadvised, andclinical judgmentshouldbeused(Evidence Level C). (iv) Once deemed to be medically and neurologically stable, patients should receive a recommended three hours perdayof directtask-specific therapy, five days aweek, delivered by the interdisciplinary stroke team (Evidence Level C); more therapy results in better outcomes (Evidence Level A). (v) Individualized

2020 CPG Infobase