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 Trial Multicenter Study Comparative StudyClinical features and racial/ethnic differences among the 3020 participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial.
This study examined the baseline characteristics, racial/ethnic differences, and geographic differences among participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. The SPS3 trial enrolled patients who experienced a symptomatic small subcortical stroke (lacunar stroke) within the previous 6 months and an eligible lesion on detected on magnetic resonance imaging. The patients were randomized, in a factorial design, to antiplatelet therapy (aspirin 325 mg daily plus clopidogrel 75 mg daily vs aspirin 325 mg daily plus placebo) and to one of two levels of systolic blood pressure targets ("intensive" [<130 mmHg] or "usual" [130-149 mmHg]). ⋯ Mean systolic blood pressure at study entry was 4 mmHg lower in the Spanish subjects compared with the North American subjects (P <.01). The SPS3 cohort is the largest magnetic resonance imaging-defined series of patients with S3. Among the racially/ethnically diverse SPS3 participants, important differences in patient features and vascular risk factors could influence prognosis for recurrent stroke and response to interventions.
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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
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.
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J Stroke Cerebrovasc Dis · Aug 2013
Comparative StudyWake-up stroke within 3 hours of symptom awareness: imaging and clinical features compared to standard recombinant tissue plasminogen activator treated stroke.
Patients with wake-up stroke (WUS) are excluded from thrombolysis because of unknown time of symptom onset. Previous studies have reported similar stroke severity and early ischemic changes (EICs) in patients with WUS and stroke of known onset. These studies, however, included patients within a large timeframe to imaging or did not quantify EICs. The aim of our study was to quantify EICs of patients with WUS presenting within 3 hours of symptom recognition compared to standard 3-hours recombinant tissue plasminogen activator (rt-PA)-treated patients and assess the extent of ischemic lesion and functional independence at follow-up. ⋯ Within 3 hours of symptom recognition, patients with WUS have EICs similar to rt-PA-treated patients. It is reasonable to expect that selected WUS patients might benefit from thrombolysis within 3 hours of symptom awareness.