Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2013
Comparative StudyClinical outcomes after intravenous fibrinolysis in cryptogenic strokes with or without patent foramen ovale.
Pivotal clinical trials suggest that intravenous (IV) recombinant tissue plasminogen activator (rt-PA) benefits stroke patients regardless of the underlying etiology. Paradoxical strokes, presumed to be caused by fibrin-rich clots originating in the venous circulation, may respond better to fibrinolysis than other ischemic stroke subtypes. In this study, we compared the response with IV rt-PA in paradoxical stroke patients and other stroke subtypes. ⋯ Paradoxical strokes had better outcomes after IV fibrinolysis than other ischemic stroke subtypes, but this difference is attributable to younger age and milder stroke severity on presentation.
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J Stroke Cerebrovasc Dis · Nov 2013
Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage.
Cerebral vasospasm is one of the leading causes of poor outcome after aneurysmal subarachnoid hemorrhage. The risk factors for the development of vasospasm have been evaluated in many clinical studies. However, it remains unclear if vasospasm severity can be predicted. The purpose of this study was to determine if different demographic and clinical factors that appear to be predictors of vasospasm can also prognosticate the severity of cerebral vasospasm. ⋯ Younger age and early onset of vasospasm on transcranial Doppler ultrasound are important predictors for vasospasm severity. We recommend early and aggressive therapy in this subgroup.
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J Stroke Cerebrovasc Dis · Nov 2013
Observational StudyRegional differences in emergency medical services use for patients with acute stroke (findings from the National Hospital Ambulatory Medical Care Survey Emergency Department Data File).
Our objectives were to describe the proportion of stroke patients who arrive by ambulance nationwide and to examine regional differences and factors associated with the mode of transport to the emergency department (ED). ⋯ Patients with stroke arrive by ambulance more frequently in the Northeast than in other regions of the United States. Identifying reasons for this difference may be useful in improving stroke care.
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J Stroke Cerebrovasc Dis · Nov 2013
Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke.
Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies. ⋯ Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH.
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J Stroke Cerebrovasc Dis · Nov 2013
Comparative StudySignal intensity changes for the middle cerebral artery on 3-dimensional time-of-flight magnetic resonance angiography indicate acute hemodynamic changes after carotid endarterectomy.
For 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), the signal intensity (SI) loss depends on the flow velocity. In this study, we aimed to evaluate whether 3D-TOF-MRA could be used as an alternative to single-photon emission computed tomography (SPECT) for assessing the increase in the regional cerebral blood flow (rCBF) after carotid endarterectomy (CEA). To do this, we compared the SI of the middle cerebral artery (MCA) on magnetic resonance angiography (MRA) and the rCBF on SPECT. ⋯ Because MRA identified increased rCBF after CEA, we recommend that patients first be screened using MRA.