Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · May 2014
Randomized Controlled Trial Multicenter Study Comparative StudyA matched comparison of eptifibatide plus rt-PA versus rt-PA alone in acute ischemic stroke.
The Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator (rt-PA) in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER) trial found that intravenous rt-PA plus eptifibatide (combination arm) in acute ischemic stroke (AIS) was safe and had a direction of effect that would justify a phase III trial. CLEAR-ER had unanticipated imbalances between treatment groups. We compared the rates of symptomatic intracranial hemorrhage (sICH) and good outcomes for combination therapy patients in the CLEAR-ER trial to a matched cohort of rt-PA patients from the National Institute of Neurological Disorders and Stroke (NINDS) trial. ⋯ The safety and direction of effect of eptifibatide plus rt-PA were confirmed. A phase III trial is needed to determine the efficacy of eptifibatide plus rt-PA for improving long-term outcomes after AIS.
-
J Stroke Cerebrovasc Dis · May 2014
Multicenter StudyEfficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry.
The aim of this nationwide, prospective registry of acute cerebral large-vessel occlusion was to assess the efficacy of endovascular treatment (EVT) on outcome in the "real-world" settings. ⋯ EVT significantly improved clinical outcomes in IV t-PA-failed and t-PA-ineligible patients with ICA/M1/BA occlusion. These findings support the introduction of EVT for acute proximal artery occlusion.
-
The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the "SAH score." ⋯ The SAH score was found to be more accurate in predicting aSAH mortality compared with the Hunt and Hess grade and WFNS scale.
-
J Stroke Cerebrovasc Dis · May 2014
Multicenter StudyPoor recognition of prompted treatment seeking even with good knowledge of stroke warning signs contribute to delayed arrival of acute ischemic stroke patients in Thailand.
Intravenous recombinant tissue plasminogen activator given within 4.5 hours after the onset of ischemic stroke is the most powerful standard treatment for patients with acute ischemic stroke. However, most of the patients arrive at the hospital later than 4.5-hours time window for intravenous thrombolysis. We study the factors that might contribute to delayed arrival in patients with acute ischemic stroke. ⋯ Association factors including day interval of the onset, mode of transportation, place of onset and knowledge of stroke warning signs are not different between groups (P > .05), whereas recognition of prompted treatment seeking is better in on-time group than in delayed group. In conclusion, good knowledge of stroke warning signs, most severe stroke, onset at workplace, onset during daytime, and ambulance for transportation are not associated with early arrival within 4.5-hours time window. However, sudden-onset nature and prompted treatment seeking may predict early arrival.
-
J Stroke Cerebrovasc Dis · May 2014
Comparative StudyRisk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke.
The aim of this study was to investigate differences in risk factors, lipid profiles, mortality, and poor functional outcome in the long term in patients who had stroke associated with intracranial and/or extracranial atherosclerotic stenosis. ⋯ Patients with IS and IES were at higher risk of poor functional outcome and mortality than were patients with NCAS. Risk factors and lipid profiles differed among the stenosis subtypes. Thus, targeted strategies may need to take these differences into account to prevent or manage poor functional outcomes and mortality.