Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2013
Early and continuous neurologic improvements after intravenous thrombolysis are strong predictors of favorable long-term outcomes in acute ischemic stroke.
Intravenously administered tissue plasminogen activator (IV tPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Considerable proportion of AIS patients demonstrate changes in their neurologic status within the first 24 hours of intravenous thrombolysis with IV tPA. However, there are little available data on the course of clinical recovery in subacute 2- to 24-hour window and its impact. We evaluated whether neurologic improvement at 2 and 24 hours after IV tPA bolus can predict functional outcomes in AIS patients at 3 months. ⋯ Women are twice as likely to have CNI from the 2- to 24-hour period after IV tPA. ENI and CNI within the first 24 hours are strong predictors of favorable functional outcomes in thrombolyzed AIS patients.
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J Stroke Cerebrovasc Dis · Nov 2013
Mechanical thrombectomy in acute stroke: utilization variances and impact of procedural volume on inpatient mortality.
An increasing number of endovascular mechanical thrombectomy procedures are being performed for the treatment of acute ischemic stroke. This study examines variances in the allocation of these procedures in the United States at the hospital level. We investigate operative volume across centers performing mechanical revascularization and establish that procedural volume is independently associated with inpatient mortality. ⋯ The number of mechanical thrombectomy procedures performed nationally remains relatively low, with a disproportionate distribution of neurointerventional centers in high-volume, urban teaching hospitals. Procedural volume is associated with mortality in facilities performing mechanical thrombectomy for acute ischemic stroke patients. These results suggest a potential benefit for treatment centralization to facilities with substantial operative volume.
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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
Hospital discharges and mortality registries: 2 complementary databases for the epidemiological surveillance of stroke.
Stroke is a public health concern and the availability of a stroke registry would provide valuable information. Administrative hospital data and mortality registries have been previously suggested as suitable sources of information. The aim of this study was to evaluate the utility of merging data from a hospital discharge database and the mortality registry (MR) to estimate the incidence of stroke in La Rioja, Spain. ⋯ Considering both the Minimum Basic Data Set and the MR as data sources appears advisable to build a stroke registry to evaluate the incidence and to perform epidemiological surveillance of stroke.
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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.