Stroke; a journal of cerebral circulation
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Multicenter Study
Multicenter accuracy and interobserver agreement of spot sign identification in acute intracerebral hemorrhage.
Rapid, accurate, and reliable identification of the computed tomography angiography spot sign is required to identify patients with intracerebral hemorrhage for trials of acute hemostatic therapy. We sought to assess the accuracy and interobserver agreement for spot sign identification. ⋯ Accuracy for spot identification is high with opportunity for improvement in spot interpretation sensitivity and interobserver agreement particularly through greater reliance on computed tomography angiography source data and awareness of limitations of multiplanar images. Further prospective study is needed.
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Randomized Controlled Trial
Time to brain imaging in acute stroke is improving: secondary analysis of the INSTINCT trial.
Patients with acute ischemic stroke benefit from rapid evaluation and treatment, and timely brain imaging is a necessary component. We determined the effect of a targeted behavioral intervention on door-to-imaging time (DIT) among patients with ischemic stroke treated with tissue-type plasminogen activator. Second, we examined the variation in DIT accounted for by patient-level and hospital-level factors. ⋯ Performance on DIT improved similarly in intervention and control hospitals, suggesting that nonintervention factors explain the improvement. Hospital-level factors explain a modest proportion of variation in DIT, but further research is needed to identify the hospital-level factors responsible.
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Randomized Controlled Trial
Remote ischemic perconditioning as an adjunct therapy to thrombolysis in patients with acute ischemic stroke: a randomized trial.
Remote ischemic preconditioning is neuroprotective in models of acute cerebral ischemia. We tested the effect of prehospital rPerC as an adjunct to treatment with intravenous alteplase in patients with acute ischemic stroke. ⋯ URL: http://www.clinicaltrials.gov. Unique identifier: NCT00975962.
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Arterial spin labeling (ASL) is a perfusion magnetic resonance imaging (MRI) technique that does not require contrast administration and thus may be more practical in hyperacute stroke than susceptibility-weighted bolus-tracking perfusion-weighted imaging (PWI). However, a threshold for ASL measurement of the ischemic penumbra needs to be determined. ⋯ ASL-DWI mismatch shows potential to identify salvageable tissue in hyperacute stroke.
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Randomized Controlled Trial
Subarachnoid extension of intracerebral hemorrhage and 90-day outcomes in INTERACT2.
The prognostic significance of subarachnoid extension of intracerebral hemorrhage was determined in the INTEnsive blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT2) study. ⋯ URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.