Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
ReviewStent usage in the treatment of intracranial aneurysms: past, present and future.
As endovascular approaches to intracranial aneurysm (IA) treatment continue to evolve, the use of intracranial stents has advanced from an infrequent adjunct to potential curative monotherapy. Early results of endovascular therapy for IAs have clearly underscored large aneurysm size, low coil packing density and wide aneurysm neck as factors limiting successful long term obliteration. ⋯ As evidence of their utility as flow diversion devices and as catalysts for aneurysm neck remodeling surfaced, their potential as standalone therapy was realised and is currently under close scrutiny. Here we review the evolution of stents in the treatment of IAs, from balloon expandable stents, to self-expanding stents, to the exciting advances in monotherapeutic flow diverting stents, amalgamating occlusion rates and reviewing complication rates.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Effect of the neutral CLOTS 1 trial on the use of graduated compression stockings in the Efficacy of Nitric Oxide Stroke (ENOS) trial.
Current evidence suggests that the time lag from the publication of randomised clinical trial results to changes in prescribing behaviour for drugs is gradually reducing. However, the effect of results of clinical trials of devices and non-pharmacological interventions on clinical practice is less clear. ⋯ GCS use declined dramatically following the reporting of the CLOTS-1 trial. The results support the notion that a neutral trial of a device can influence clinical practice rapidly, which is important with a widely used and moderately expensive (time and finance) intervention.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Impact of stroke-associated infection on long-term survival: a cohort study.
The effects of stroke-associated infection (SAI) on long-term survival are unclear. We performed a prospective evaluation to explore risk factors of SAI, and compared survival status over the 3 years following stroke onset between those who experienced SAI and those who did not. ⋯ SAIs have long-lasting effects on patient survival. This serves to emphasise the importance of immediate access to organised stroke unit care for people with acute stroke, with active physiological monitoring and protocols for early detection and treatment of SAIs.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Early neurological deterioration after subarachnoid haemorrhage: risk factors and impact on outcome.
Early neurological deterioration occurs frequently after subarachnoid haemorrhage (SAH). The impact on hospital course and outcome remains poorly defined. ⋯ Early worsening after SAH occurs in 35% of patients, is predicted by clot burden and is associated with mortality and poor functional outcome at 1 year.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Feasibility, safety and cost of outpatient management of acute minor ischaemic stroke: a population-based study.
Outpatient management safely and effectively prevents early recurrent stroke after transient ischaemic attack (TIA), but this approach may not be safe in patients with acute minor stroke. ⋯ Outpatient management of clinic-referred minor stroke is feasible and may be as safe as inpatient care. Rates of early hospital admission and recurrent stroke were low and uptake and maintenance of secondary prevention was high.