Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2011
Multicenter StudyThrombolysis at 3-4.5 hours after acute ischemic stroke onset--evidence from the Canadian Alteplase for Stroke Effectiveness Study (CASES) registry.
Extending the therapeutic window for thrombolysis is an important strategy in maximizing the proportion of patients treated. ECASS III examined a 3-4.5-hour window and showed a benefit to treated patients. We examined the experience in Canadian centres using intravenous tPA treatment in the 3-4.5-hour time window. ⋯ Our study suggests that patients with acute ischemic stroke may be successfully treated with intravenous tPA in the 3-4.5-hour treatment window, but cautions that later time window treatment may result in greater adverse events.
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Cerebrovascular diseases · Jan 2011
Comparative StudyConcerns for the reliability and validity of the National Stroke Project Stroke Severity Scale.
The National Stroke Project (NSP) was a retrospective cohort study of US Medicare beneficiaries hospitalized with stroke or transient ischemic attack (TIA). The NSP included a simple assessment of stroke severity (NSP-Stroke Scale, NSP-SS). Used for risk adjustment in outcome studies, the reliability and validity of the NSP-SS have not been assessed. We determined the reliability, concurrent and construct validity of the NSP-SS. ⋯ The NSP-SS has moderate-substantial reliability but poor content validity and poor to moderate concurrent validity as compared with the NIH-SS. In addition, it is not clear that the NSP-SS is easier to extract from medical records than the NIH-SS. Given this, and its other limitations, the utility of this scale for risk adjustment in future stroke outcome studies is questionable.
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Cerebrovascular diseases · Jan 2011
ReviewTemperature management in stroke - an unsolved, but important topic.
Clinical data clearly show that elevated body temperature contributes to an unfavorable outcome after ischemic and hemorrhagic stroke. Two promising therapeutic strategies arise from this observation: (1) treatment of fever aiming to sustain normothermia and (2) induced hypothermia, targeting core body temperatures below 36.5°C. A limited number of studies investigated antipyretic strategies after acute stroke and their results were rather disappointing in terms of clinical efficacy. ⋯ Therefore, induced hypothermia may be considered safe and feasible after ischemic stroke, but little can be said regarding efficacy. This review summarizes the data, both on fever treatment and induced hypothermia following stroke, starting with a synopsis of the most important experimental investigations, leading to the latest clinical trials. Given the promising data and the lack of successful acute neuroprotective therapies available thus far, suggestions are given for future investigation on both topics.
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Cerebrovascular diseases · Jan 2011
Fluid-attenuated inversion recovery hyperintensity in acute ischemic stroke may not predict hemorrhagic transformation.
Fluid-attenuated inversion recovery (FLAIR) hyperintensity within an acute cerebral infarct may reflect delayed onset time and increased risk of hemorrhage after thrombolysis. Given the important implications for clinical practice, we examined the prevalence of FLAIR hyperintensity in patients 3-6 h from stroke onset and its relationship to parenchymal hematoma (PH). ⋯ Visible FLAIR hyperintensity is almost universal 3-6 h after stroke onset and did not predict subsequent hemorrhage in this dataset. Our findings question the value of excluding patients with FLAIR hyperintensity from reperfusion therapies. Larger studies are required to clarify what implications FLAIR-positive lesions have for patient selection.
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Cerebrovascular diseases · Jan 2011
Randomized Controlled TrialCilostazol improves outcome after subarachnoid hemorrhage: a preliminary report.
Cerebral vasospasm (VS) is the most common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). Reversal of VS by intra-arterial infusion of cyclic adenosine monophosphate (cAMP)-elevating agents has been reported; however, the preventive role in the development of VS is not fully understood. This study is designed to evaluate the possible efficacy of using cilostazol, a selective inhibitor of phosphodiesterase type 3 and a cAMP-elevating agent, in patients with SAH. ⋯ Cilostazol may improve outcomes after SAH, but further double-blind, placebo-controlled studies are required for a definitive conclusion.