Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Barriers to the use of intravenous tissue plasminogen activator for in-hospital strokes.
Patients who have ischemic strokes (ISs) while hospitalized for other conditions may be less likely to receive intravenous tissue plasminogen activator (IV tPA) when compared to patients who have strokes in the community. This study explored possible barriers to IV tPA use in these patients. ⋯ Seventy percent of in-hospital IS cases in our single hospital retrospective study were postoperative, clinically subtle, or had contraindications to IV tPA, preventing its use. Of the remaining untreated patients, the biggest barrier to IV tPA administration was delay in stroke discovery, which was largely dependent on observation by hospital staff or family rather than patient report.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsInternal carotid artery dissection caused by an elongated styloid process: usefulness of transoral ultrasonography.
We report a case of internal carotid artery (ICA) occlusion caused by arterial dissection triggered by an elongated styloid process. A 43-year-old man presented with a headache followed by speech disturbance. Magnetic resonance imaging and magnetic resonance angiography scans revealed acute infarction and right ICA occlusion. ⋯ Six months later, the occluded ICA recanalized spontaneously, and computed tomographic angiography at that time revealed a close relation between the tip of the styloid process and the recanalized ICA. This finding suggests that an elongated styloid process is involved in arterial dissection. In patients with ICA occlusion of unknown etiology, an evaluation for intramural hematoma and styloid process length are useful for the diagnosis of dissection and its etiology.
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J Stroke Cerebrovasc Dis · Nov 2012
Efficiency of enrollment in a successful phase II acute stroke clinical trial.
Recruitment challenges are common in acute stroke clinical trials. In a population-based study, we determined eligibility and actual enrollment for a successful, phase II acute stroke clinical trial. We hypothesized that missed opportunities for enrollment of eligible patients occurred frequently, despite the success of the trial. ⋯ Although the CLEAR trial was successful in meeting its delineated recruitment goals, our findings suggest enrollment could have been more efficient. Three out of 4 patients approached for enrollment participated in the trial. Eligible patients who were not approached and those treated with recombinant tissue plasminogen activator but not enrolled represent targets for improving enrollment rates.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsMultistage indocyanine green videoangiography for the convexity dural arteriovenous fistula with angiographically occult pial fistula.
Recently, intraoperative indocyanine green (ICG) videoangiography has become a common technique for treating cerebrovascular diseases. We report a case of dural arteriovenous fistula (AVF) treated with direct surgery using intraoperative ICG videoangiography. A 41-year-old man with right hemiplegia caused by a left subcortical hemorrhage was transferred to our hospital. ⋯ Accurate detection of all fistular points and complete resection, including the dura mater and pial vessels, are necessary to avoid rebleeding caused by the residual dural AVF due to incomplete obliteration of the fistular points. Intraoperative ICG videoangiography could provide information on angiographically occult vascular malformation, such as pial fistulas, that cannot be detected by preoperative DSA. Our findings suggest that multistage intraoperative ICG videoangiography can be quite useful for complete resection of a dural AVF with angiographically occult pial fistula.