International journal of stroke : official journal of the International Stroke Society
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Randomized Controlled Trial Comparative Study
PHANTOM-S: the prehospital acute neurological therapy and optimization of medical care in stroke patients - study.
Time from symptom onset to treatment is closely associated with the effectiveness of intravenous thrombolysis in acute ischemic stroke patients. Hospitals are encouraged to take every effort to shorten delay of treatment. Despite combined efforts to streamline procedures in hospitals to provide treatment as soon as possible, most patients receive tissue plasminogen activator with considerable delay and very few of them within 90 mins. Germany has an internationally acknowledged prehospital emergency care system with specially trained doctors on ambulances. We developed an ambulance equipped with a Computed Tomography (CT) scanner, point-of-care laboratory, teleradiological support, and an emergency-trained neurologist on board. In the Pre-Hospital Acute Neurological Therapy and Optimization of Medical care in Stroke Patients study, we aim at a reduction of the current alarm-to-needle time by prehospital use of tissue plasminogen activator in an ambulance. ⋯ Primary end point of the study is alarm-to-needle time. Secondary outcomes include thrombolysis treatment rates, modified Rankin scale after three-months, and alarm-to-imaging or alarm-to-laboratory time; safety aspects to be evaluated are mortality and rates of (symptomatic) intracerebral hemorrhage.
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Randomized Controlled Trial
The effectiveness of thrombolysis with intravenous alteplase for acute ischemic stroke in daily practice.
Thrombolysis with intravenous alteplase has been proven an effective treatment for patients with acute ischemic stroke in randomized clinical trials. In daily practice, the effect of thrombolysis may be less, and complications may occur more often. ⋯ Thrombolysis for ischemic stroke with intravenous alteplase is an effective treatment also in an unselected observational cohort of patients.
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Comparative Study
Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke.
Differences in risk factor profiles between patients with ischemic and hemorrhagic stroke may have an impact on subsequent mortality. ⋯ Patients with hemorrhagic stroke had a higher risk of dying within the first 30 days after stroke, but the risk of death was similar in the two groups after one-month. Hypertension was the only cardiovascular disease risk factor associated with an increased mortality rate for hemorrhagic stroke as compared to ischemic stroke.
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Collateral circulation and associated potential compensation in downstream perfusion have been recognized long before arterial occlusions were known to cause ischemic stroke. Arterial aspects and the venous capacity of collaterals to offset potentially devastating effects of blocking a cerebral artery have been studied in various animal species and even human populations with stroke, providing a framework for translational research. The time has come for collaterals to move from the periphery to a central position in stroke therapeutics, propelled by the momentum of imaging data and culminating in novel paradigms with respect to time, imaging approaches and treatment strategies. It is time for a concerted focus on collateral perfusion to harness potential therapeutic advances from acute stroke to chronic cerebrovascular disorders.
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We analyzed early diffusion-weighted magnetic resonance imaging of patients with acute basilar artery occlusion by applying different lesion scoring systems and determined their predictive value for favorable outcome. ⋯ In patients with acute basilar artery occlusion, posterior circulation Acute Stroke Prognosis Early CT Score of 8 or more points on early diffusion weighted imaging is an independent predictor for favorable outcome.