Latest & greatest articles for stroke

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Top results for stroke

61. Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. Full Text available with Trip Pro

Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. Transcatheter aortic valve replacement (TAVR) indications are expanding, leading to an increasing number of patients with bicuspid aortic stenosis undergoing TAVR. Pivotal randomized trials conducted to obtain US Food and Drug Administration approval excluded bicuspid anatomy.To compare the outcomes of TAVR with a balloon-expandable valve for bicuspid vs tricuspid aortic (...) stenosis.Registry-based prospective cohort study of patients undergoing TAVR at 552 US centers. Participants were enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies Registry from June 2015 to November 2018.TAVR for bicuspid vs tricuspid aortic stenosis.Primary outcomes were 30-day and 1-year mortality and stroke. Secondary outcomes included procedural complications, valve hemodynamics, and quality of life assessment.Of 81 822 consecutive

2019 JAMA

62. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Full Text available with Trip Pro

Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. To test the hypothesis that ticagrelor plus aspirin is safe and superior to clopidogrel plus aspirin for reducing high platelet reactivity at 90 days and stroke recurrence in patients with minor stroke or transient ischaemic attack, particularly in carriers of the CYP2C19 loss-of-function (...) atherosclerosis in the ticagrelor/aspirin group had a lower stroke recurrence at 90 days than those in the clopidogrel/aspirin group (6.0% v 13.1%; hazard ratio 0.45, 95% confidence interval 0.20 to 0.98; P=0.04). No difference was seen in the rates of major or minor haemorrhagic events between the ticagrelor/aspirin and clopidogrel/aspirin groups (4.8% v 3.5%; P=0.42).Patients with minor stroke or transient ischaemic attack who are treated with ticagrelor plus aspirin have a lower proportion of high platelet

2019 BMJ Controlled trial quality: predicted high

63. ACR–ASNR–SIR–SNIS Practice Parameter for the Performance of Endovascular Embolectomy and Revascularization in Acute Stroke

ischemic injury in a PRACTICE PARAMETER 3 Acute Stroke defined vascular distribution, or clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting >24 hours or until death, and other etiologies excluded. (Note: CNS infarction includes hemorrhagic infarctions (HI), types I and II; see “Hemorrhagic Infarction” [15-18].) Diagnostic catheter angiography – a minimally invasive procedure involving percutaneous catheterization of any of the arteries or veins (...) and/or recommendations regarding performance and reporting of the endovascular procedure and periprocedural care, and v) recommendations on quality control and performance improvement. Every year in the United States, an estimated 795,000 people suffer an ischemic stroke. It is estimated that at least approximately 10%, or nearly 80,000, of these strokes will be caused by an emergent large-vessel occlusion (ELVO) affecting the intracranial internal carotid artery, the proximal middle cerebral artery

2019 American Society of Neuroradiology

64. Therapeutic hypothermia for acute ischaemic stroke

haemorrhagic stroke. Current treatments 2.2 Patients suspected to be having an acute ischaemic stroke should have rapid assessment and early intervention with specialist care according to NICE's guideline on stroke and transient ischaemic attack in over 16s. Recanalisation strategies, such as thrombolysis, attempt to re-establish blood flow so that cells starved of oxygen can be rescued before they are irreversibly damaged. Effective stroke care also includes specialised supportive care and rehabilitation (...) Therapeutic hypothermia for acute ischaemic stroke Ther Therapeutic h apeutic hypothermia for acute ischaemic ypothermia for acute ischaemic strok stroke e Interventional procedures guidance Published: 29 May 2019 www.nice.org.uk/guidance/ipg647 Y Y our responsibility our responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully

2019 National Institute for Health and Clinical Excellence - Interventional Procedures

65. Interventions for visual field defects in people with stroke. (Abstract)

Interventions for visual field defects in people with stroke. Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (...) (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both.To determine the effects of interventions for people with visual field defects after stroke.We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision

2019 Cochrane

66. An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. (Abstract)

An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. Sphenopalatine ganglion stimulation increased cerebral collateral blood flow, stabilised the blood-brain barrier, and reduced infarct size, in preclinical models of acute ischaemic stroke, and showed potential benefit in a pilot randomised trial in humans. The pivotal ImpACT-24B (...) trial aimed to determine whether sphenopalatine ganglion stimulation 8-24 h after acute ischaemic stroke improved functional outcome.ImpACT-24B is a randomised, double-blind, sham-controlled, pivotal trial done at 73 centres in 18 countries. It included patients (men aged 40-80 years and women aged 40-85 years) with anterior-circulation acute ischaemic stroke, not undergoing reperfusion therapy. Enrolled patients were randomly assigned via web-based randomisation to receive active sphenopalatine

2019 Lancet Controlled trial quality: predicted high

67. Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality. Full Text available with Trip Pro

Revision, codes for ischemic stroke, intracerebral hemorrhage, and stroke not otherwise specified.Primary outcome was all-cause cumulative mortality in 30-day survivors at end of follow-up, stratified by age, sex, and stroke subtype, and compared with all-cause cumulative mortality in the general population.The study population included 15 527 patients with stroke (median age, 44 years [interquartile range, 38-47 years]; 53.3% women). At end of follow-up, a total of 3540 cumulative deaths had occurred (...) , including 1776 deaths within 30 days after stroke and 1764 deaths (23.2%) during a median duration of follow-up of 9.3 years (interquartile range, 5.9-13.1 years). The 15-year mortality in 30-day survivors was 17.0% (95% CI, 16.2%-17.9%). The standardized mortality rate compared with the general population was 5.1 (95% CI, 4.7-5.4) for ischemic stroke (observed mortality rate 12.0/1000 person-years [95% CI, 11.2-12.9/1000 person-years]; expected rate, 2.4/1000 person-years; excess rate, 9.6/1000 person

2019 JAMA

68. Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. Full Text available with Trip Pro

Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. To study trends in stroke mortality rates, event rates, and case fatality, and to explain the extent to which the reduction in stroke mortality rates was influenced by changes in stroke event rates or case fatality.Population based study.Person linked routine hospital and mortality data, England.795 869 adults aged 20 and older who were admitted to hospital with acute stroke (...) or died from stroke.Stroke mortality rates, stroke event rates (stroke admission or stroke death without admission), and case fatality within 30 days after stroke.Between 2001 and 2010 stroke mortality rates decreased by 55%, stroke event rates by 20%, and case fatality by 40%. The study population included 358 599 (45%) men and 437 270 (55%) women. Average annual change in mortality rate was -6.0% (95% confidence interval -6.2% to -5.8%) in men and -6.1% (-6.3% to -6.0%) in women, in stroke event

2019 BMJ

69. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. (Abstract)

Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. Stroke is one of the leading causes of disability worldwide and aphasia among survivors is common. Current speech and language therapy (SLT) strategies have only limited effectiveness in improving aphasia. A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability and hence (...) to improve aphasia.To assess the effects of tDCS for improving aphasia in people who have had a stroke.We searched the Cochrane Stroke Group Trials Register (June 2018), CENTRAL (Cochrane Library, June 2018), MEDLINE (1948 to June 2018), Embase (1980 to June 2018), CINAHL (1982 to June 2018), AMED (1985 to June 2018), Science Citation Index (1899 to June 2018), and seven additional databases. We also searched trial registers and reference lists, handsearched conference proceedings and contacted authors

2019 Cochrane

70. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial. Full Text available with Trip Pro

Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial. Loss of arm function is a common problem after stroke. Robot-assisted training might improve arm function and activities of daily living. We compared the clinical effectiveness of robot-assisted training using the MIT-Manus robotic gym with an enhanced upper limb therapy (EULT) programme based on repetitive functional task practice and with usual care.RATULS was a pragmatic, multicentre (...) , randomised controlled trial done at four UK centres. Stroke patients aged at least 18 years with moderate or severe upper limb functional limitation, between 1 week and 5 years after their first stroke, were randomly assigned (1:1:1) to receive robot-assisted training, EULT, or usual care. Robot-assisted training and EULT were provided for 45 min, three times per week for 12 weeks. Randomisation was internet-based using permuted block sequences. Treatment allocation was masked from outcome assessors

2019 Lancet Controlled trial quality: predicted high

71. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. Full Text available with Trip Pro

Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. Cryptogenic strokes constitute 20 to 30% of ischemic strokes, and most cryptogenic strokes are considered to be embolic and of undetermined source. An earlier randomized trial showed that rivaroxaban is no more effective than aspirin in preventing recurrent stroke after a presumed embolic stroke from an undetermined source. Whether dabigatran would be effective in preventing recurrent strokes after this type (...) follow-up of 19 months, recurrent strokes occurred in 177 patients (6.6%) in the dabigatran group (4.1% per year) and in 207 patients (7.7%) in the aspirin group (4.8% per year) (hazard ratio, 0.85; 95% confidence interval [CI], 0.69 to 1.03; P = 0.10). Ischemic strokes occurred in 172 patients (4.0% per year) and 203 patients (4.7% per year), respectively (hazard ratio, 0.84; 95% CI, 0.68 to 1.03). Major bleeding occurred in 77 patients (1.7% per year) in the dabigatran group and in 64 patients (1.4

2019 NEJM Controlled trial quality: predicted high

72. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. Full Text available with Trip Pro

Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging.We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had (...) ). Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group (adjusted risk ratio, 7.22; 95% CI, 0.97 to 53.5; P = 0.05). A secondary ordinal analysis of the distribution of scores on the modified Rankin scale did not show a significant between-group difference in functional improvement at 90 days.Among the patients in this trial who had ischemic stroke and salvageable brain tissue, the use of alteplase between 4.5 and 9.0 hours

2019 NEJM Controlled trial quality: predicted high

73. Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism: A Prospective Cohort Study. (Abstract)

with masked assessment of stroke outcomes. (ClinicalTrials.gov: NCT01216423).4 French hospital centers.361 consecutive patients with symptomatic acute PE from 13 November 2009 through 21 December 2015.Systematic contrast transthoracic echocardiography (TTE) and cerebral magnetic resonance imaging (MRI) within 7 days after enrollment.Recent symptomatic or silent ischemic stroke was diagnosed on the basis of clinical examination and cerebral MRI showing a hypersignal on the trace diffusion-weighted image (...) with reduction or pseudonormalization of apparent diffusion coefficient.Contrast TTE was conclusive in 324 of 361 patients and showed PFO in 43 patients (13%). The median age was 66 years (interquartile range, 54 to 77 years). In total, 51% of patients (145/284) had associated deep venous thrombosis, 91% (279/306) had cardiovascular risk factors, and 10% (16/151) presented with arrhythmia (no difference between PFO and non-PFO groups). Cerebral MRI was conclusive in 315 patients. Recent ischemic stroke

2019 Annals of Internal Medicine

74. Stem cell transplantation for ischemic stroke. Full Text available with Trip Pro

Stem cell transplantation for ischemic stroke. Stroke is a leading cause of morbidity and mortality worldwide, with very large healthcare and social costs, and a strong demand for alternative therapeutic approaches. Preclinical studies have shown that stem cells transplanted into the brain can lead to functional improvement. However, to date, evidence for the benefits of stem cell transplantation in people with ischemic stroke is lacking. This is the first update of the Cochrane review (...) published in 2010.To assess the efficacy and safety of stem cell transplantation compared with control in people with ischemic stroke.We searched the Cochrane Stroke Group Trials Register (last searched August 2018), CENTRAL (last searched August 2018), MEDLINE (1966 to August 2018), Embase (1980 to August 2018), and BIOSIS (1926 to August 2018). We handsearched potentially relevant conference proceedings, screened reference lists, and searched ongoing trials and research registers (last searched August

2019 Cochrane

75. Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial Full Text available with Trip Pro

Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture?Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.Fifty adults undergoing rehabilitation after stroke who were (...) ), and shoulder flexion 5 deg (95% CI -8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes.In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles.ACTRN12614001162606.Copyright © 2019 Australian Physiotherapy

2019 EvidenceUpdates

76. Caregivers' effects of augmented cognitive-behavioural therapy for post-stroke depressive symptoms in patients: secondary analyses to a randomized controlled trial (Abstract)

Caregivers' effects of augmented cognitive-behavioural therapy for post-stroke depressive symptoms in patients: secondary analyses to a randomized controlled trial To investigate the concomitant effects of two patient-directed interventions for post-stroke depressive symptoms on caregivers' well-being.Secondary analyses of the results of a randomized controlled trial.Fifty caregivers of stroke patients receiving outpatient rehabilitation.Stroke patients and their caregivers were randomly

2019 EvidenceUpdates

77. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA and and Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 38if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited (...) ) for people with acute stroke who meet all of the following criteria: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 17 of 38clinical deficits that suggest infarction in the territory of the middle cerebral artery, with a score above 15 on the NIHSS decreased level of consciousness, with a score of 1 or more on item 1a

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

78. Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack. (Abstract)

the accuracy of stroke recognition scales used in a prehospital or ER setting to identify stroke and transient Ischemic attack (TIA) in people suspected of stroke. The scales had to be applied to actual people and the results compared to a final diagnosis of stroke or TIA. We excluded studies that applied scales to patient records; enrolled only screen-positive participants and without complete 2 × 2 data.Two review authors independently conducted a two-stage screening of all publications identified (...) Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack. Rapid and accurate detection of stroke by paramedics or other emergency clinicians at the time of first contact is crucial for timely initiation of appropriate treatment. Several stroke recognition scales have been developed to support the initial triage. However, their accuracy remains uncertain and there is no agreement which of the scales perform better.To systematically identify

2019 Cochrane

79. Diagnostic evaluation of cryptogenic stroke

outcome evaluations to be completed this year. Dr. Dixon Yang is a 1st year resident at NYU Langone Health Peer reviewed by Matt Sanger, MD, neurology, NYU Langone Health Image courtesy of Wikimedia Commons References Sacco RL, Ellenberg JH, Mohr JP, et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol .1989;25(4):382-90. Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging (...) with her blood pressure well-controlled by a home medication. Computed tomography (CT) with angiography reveals signs of early acute ischemic changes in the right middle cerebral artery territory but no large vessel occlusion. She has no metabolic disturbances, an unremarkable complete blood count, and normal coagulation profile. She receives intravenous tissue plasminogen activator with improvement in symptoms and is admitted to the stroke unit. Further work up with 24-hour Holter monitor records

2019 Clinical Correlations

80. Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial Full Text available with Trip Pro

Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial Pulsed-wave ultrasound increases the exposure of an intracranial thrombus to alteplase (recombinant tissue plasminogen activator), potentially facilitating early reperfusion. We aimed to ascertain if a novel operator-independent transcranial ultrasound device delivering low-power high-frequency ultrasound could improve functional outcome in patients treated (...) with alteplase after acute ischaemic stroke.We did a multicentre, double-blind, phase 3, randomised controlled trial (CLOTBUST-ER) at 76 medical centres in 14 countries. We included patients with acute ischaemic stroke (National Institutes of Health Stroke Scale score ≥10) who received intravenous thrombolysis (alteplase bolus) within 3 h of symptom onset in North America and within 4·5 h of symptom onset in all other countries. Participants were randomly allocated (1:1) via an interactive web response

2019 EvidenceUpdates