Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Aug 2013
Randomized Controlled Trial Multicenter StudyThe iScore predicts efficacy and risk of bleeding in the National Institute of Neurological disorders and Stroke Tissue Plasminogen Activator Stroke Trial.
The iScore is a validated tool to estimate outcomes after an acute ischemic stroke. A previous study showed the iScore can predict clinical response and risk of intracerebral hemorrhage (ICH) after administration of tissue plasminogen activator (tPA). We applied the iScore (www.sorcan.ca/iscore) to participants in the National Institute of Neurological Disorders and Stroke tPA stroke trials to evaluate its ability to estimate clinical response and risk of ICH after thrombolysis. ⋯ Despite the higher favorable composite outcome of tPA therapy in patients with an iScore <200 (58.7% v 41.9%; P < .001), this therapy had no benefit in patients with an iScore ≥ 200 (15.4% v 13.4%; P = .77). In patients receiving tPA in the National Institute of Neurological Disorders and Stroke trial, the iScore estimated the clinical response and risk of hemorrhagic complications. Further prospective studies are needed before a change in practice can be recommended.
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J Stroke Cerebrovasc Dis · Aug 2013
Randomized Controlled TrialValidating imaging biomarkers of cerebral edema in patients with severe ischemic stroke.
There is no validated neuroimaging marker for quantifying brain edema. We sought to test whether magnetic resonance imaging (MRI)-based metrics would reliably change during the early subacute period in a manner consistent with edema and whether they would correlate with relevant clinical endpoints. ⋯ In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation.
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J Stroke Cerebrovasc Dis · Aug 2013
Multicenter Study Comparative StudyDisparities in stroke type and vascular risk factors between 2 Hispanic populations in Miami and Mexico city.
The heterogeneous nature and determinants of stroke among different Hispanic groups was examined by comparing hospitalized Hispanic stroke patients in Miami, where the Hispanic population is largely of Caribbean origin, to a Mestizo population in Mexico City. ⋯ We found significant differences in the frequency of hypertension, diabetes, dyslipidemia, and atrial fibrillation in Miami Hispanics and Mexican stroke patients, highlighting the heterogeneity of the Hispanic ethnic group. Future studies are needed to clarify the relative contribution of genetic and environmental disparities amongst Mexican and Caribbean Hispanic stroke patients.
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J Stroke Cerebrovasc Dis · Aug 2013
Cardioembolic stroke is frequent in late recurrence after transient ischemic attack.
Transient ischemic attack (TIA) is often followed by a stroke episode. Differences between early and late recurrent stroke, however, have not been elucidated. ⋯ The frequency of cardioembolic stroke did not decline as time after TIA passed. More than one quarter of AF patients had been asymptomatic before stroke, suggesting the need for repeated examinations to detect AF in patients with TIA of unknown etiology.
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J Stroke Cerebrovasc Dis · Aug 2013
Efficacy and limitations of multimodal endovascular revascularization other than clot retrieval for acute stroke caused by large-vessel occlusion.
The purpose of this study was to evaluate the efficacy of multimodal endovascular treatment (EVT) other than clot retrieval for acute large-vessel occlusion (LVO). ⋯ Multimodal EVT for acute LVO yields a high reperfusion rate with a minimal risk of sICH and contributes to favorable patient outcomes. These techniques should be considered when clot retrieval is unsuitable or ineffective.