Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Feb 2019
Endovascular Treatment of Ruptured Tiny Intracranial Aneurysms with Low-Profile Visualized Intraluminal Support Device.
Ruptured tiny intracranial aneurysms (TIAs) have been challenging both for endovascular and neurosurgical interventions. Thus, we aimed to evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) device in the treatment of ruptured TIAs (rTIAs). ⋯ Stent-assisted coiling of rTIAs with LVIS device provides high rates of technical success and complete occlusion at mid-term follow-up with an excellent safety profile.
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J Stroke Cerebrovasc Dis · Feb 2019
Comparative Study Observational StudyA Regional Network Organization for Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation; Timing, Safety, and Effectiveness.
Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). ⋯ Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.
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J Stroke Cerebrovasc Dis · Feb 2019
Case ReportsSuccessful mechanical thrombectomy in stroke with thrombolysis-associated intracerebral hemorrhage-a case report.
Intravenous thrombolysis and mechanical thrombectomy are the standard of care for patients with acute ischemic stroke with large vessel occlusion. Intracerebral hemorrhage is a main complication of intravenous thrombolysis, however, no data are available on the efficacy and safety of mechanical thrombectomy in patients with thrombolysis-associated intracerebral hemorrhage. This constellation is expected to become more frequent as increasing numbers of patients are treated under the drip-and-ship paradigm. ⋯ Mechanical thrombectomy may be safe and effective in ischemic stroke with large vessel occlusion and thrombolysis-associatied intracerebral hemorrhage.
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J Stroke Cerebrovasc Dis · Feb 2019
The Impact of Covert Lacunar Infarcts and White Matter Hyperintensities on Cognitive and Motor Outcomes After Stroke.
In addition to overt stroke lesions, co-occurring covert lesions, including white matter hyperintensities (WMH) and covert lacunar infarcts (CLI), contribute to poststroke outcome. The purpose of this study was to examine the relationship between covert lesions, and motor and cognitive outcomes in individuals with chronic stroke. ⋯ Covert lesion type and location have important consequences for post-stroke cognitive and motor outcome. Limiting the progression of covert lesions in aging populations may enhance the degree of recovery post-stroke.
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J Stroke Cerebrovasc Dis · Feb 2019
Comparative StudyHospital Quality Metrics: "America's Best Hospitals" and Outcomes After Ischemic Stroke.
Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News & World Report ranking of "America's Best Hospitals" is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stroke measures. ⋯ Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke. There was heterogeneity in outcomes among the 50 top-ranked hospitals.