Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2009
Multicenter Study Comparative StudyRisk of symptomatic intracerebral hemorrhage in patients treated with intra-arterial thrombolysis.
In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous (IV) recombinant tissue plasminogen activator (tPA); this observation could have been due to the inclusion of more severely affected patients in IA thrombolysis trials. In the present study, we investigated the rate of sICH in IA and combined IV + IA thrombolysis versus IV thrombolysis after adjusting for differences in clinical and MRI parameters. ⋯ In this series, IA and IV + IA thrombolysis is associated with an increased sICH risk as compared to IV thrombolysis, and this risk is independent of differences in baseline parameters such as age, initial NIHSS score or pretreatment lesion size.
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Cerebrovascular diseases · Jan 2009
Meta AnalysisAssociation analysis of genes involved in the maintenance of the integrity of the extracellular matrix with intracranial aneurysms in a Japanese cohort.
An association between versican (CSPG2), perlecan (HSPG2), fibrillin 2 (FBN2) and collagen 4A1 (COL4A1) gene variants and intracranial aneurysms (IA) has been reported in 2 studies analyzing Dutch IA patients. The aim of this study was to verify these associations in a Japanese IA population. In addition, a meta-analysis on the association of these genes and IA for the combined Dutch and Japanese populations was performed. ⋯ By analyzing HSPG2, CSPG2, FBN2 and COL4A1, we were able to replicate the association of CSPG2 and show that there is a trend for HSPG2 towards association in the Japanese IA population by means of a meta-analysis combining the Dutch and Japanese results. The association of FBN2 and COL4A1 could not be replicated in the Japanese IA population.
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The lack of physicians with specialty stroke training represents a significant challenge to the future of stroke. This deficit limits both quality stroke care and clinical research initiatives. ⋯ Greater diffusion and long-term sustainability of telestroke systems will be dependent upon improvements in patient and hospital reimbursement for acute stroke and telestroke care.
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Cerebrovascular diseases · Jan 2009
Comparative StudyGender differences in mortality after hospital admission for stroke.
Differences between men and women in stroke symptoms, management and disability have been reported to be unfavorable for women. Yet, studies into differences between men and women in survival after a stroke yielded inconsistent results. We investigated whether gender was associated with all-cause mortality after hospital admission for stroke. ⋯ Women have lower 28-day case-fatality and long-term mortality risks after an ischemic stroke and lower 1-year and 5-year mortality risks after an intracerebral hemorrhage compared to men, whereas no differences in mortality risks were found for subarachnoid hemorrhage.
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Cerebrovascular diseases · Jan 2009
Multicenter StudyUtilization of intravenous tissue plasminogen activator for ischemic stroke: are there sex differences?
We evaluated whether there were sex-related differences in the administration of intravenous tissue plasminogen activator (IV-tPA) to patients with acute ischemic stroke admitted to US academic medical centers. ⋯ Women admitted to academic hospitals receive IV-tPA as often as men; however, a substantial percentage of both women and men are not arriving within the 3-hour time window required for diagnostic assessment and administration of intravenous thrombolytic therapy. Additional efforts are needed to improve the rapid identification, evaluation and treatment of stroke patients.