Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Mar 2017
Demographic and Systemic Hemodynamic Influences in Mechanisms of Cerebrovascular Regulation in Healthy Adults.
A competent cerebrovascular regulation maintains an adequate cerebral blood flow by 3 major mechanisms: cerebral autoregulation (CA), vasomotor reactivity (VMR), namely to CO2, and neurovascular coupling (NVC). However, most studies generalize their results based on a response to a single parameter. Using a full battery of neurovascular stress tests, our study aims to evaluate the relationships among grades of CA, VMR, and NVC, and how their interplay is influenced by demographic and systemic hemodynamic factors. ⋯ Age and gender do not have major influence on the 3 major cerebrovascular regulation mechanisms. Our results also pinpoint the fact that neurovascular stress tests measure different aspects of cerebrovascular control, and that their outputs are uncorrelated and cannot be used interchangeability. Being independent of age and cognitive status, neurovascular stress tests seem adequate for studying several cerebrovascular conditions affecting the aging brain.
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J Stroke Cerebrovasc Dis · Mar 2017
Experience on Mechanical Thrombectomy for Acute Stroke Treatment in a Brazilian University Hospital.
Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke. ⋯ Our study, the first ever large series of mechanical thrombectomy in Brazil, demonstrates acceptable efficacy and safety results, even under restricted conditions outside the ideal scenario of trial studies.
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J Stroke Cerebrovasc Dis · Feb 2017
Comparative StudyNoncontrast Computed Tomography versus Computed Tomography Angiography Source Images for Predicting Final Infarct Size in Anterior Circulation Acute Ischemic Stroke: a Prospective Cohort Study.
There has been a recent debate regarding the superiority of computed tomography angiography source images (CTASIs) over noncontrast computed tomography (NCCT) to predict the final infarct size in acute ischemic stroke (AIS). We hypothesized that the parenchymal abnormality on CTASI in faster scanners would overestimate ischemic core. ⋯ In a 256-slice scanner, the CTASI parenchymal abnormality includes ischemic penumbra and thus overestimates final infarct size-this could result in inappropriate exclusion of patients from thrombolysis or thrombectomy.
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J Stroke Cerebrovasc Dis · Feb 2017
Automatic Algorithm for Segmentation of Atherosclerotic Carotid Plaque.
Carotid atherosclerosis is one of the major causes of stroke. The determination of the intima-media thickness, the identification of carotid atherosclerotic plaque, and the classification of the different stenoses are considered as important parameters for the assessment of atherosclerotic diseases. The aim of this work is to segment the plaques and to allow a better comprehension of carotid atherosclerosis. ⋯ In this study, we developed an automatic method to identify the carotid plaque. Our results showed that an automatic system of image segmentation could be used to identify, characterize, and measure atherosclerotic carotid plaques.
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J Stroke Cerebrovasc Dis · Jan 2017
Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke.
Prehospital clinical scales to identify patients with acute stroke with a large vessel occlusion (LVO) and direct them to an endovascular-capable stroke center are needed. We evaluated whether simplification of the Rapid Arterial oCclusion Evaluation (RACE) scale, a 5-item scale previously validated in the field, could maintain its high performance to identify patients with LVO. ⋯ We recommend the original RACE scale for prehospital assessment of patients with suspected stroke for its ease of use and its high performance to predict the presence of a LVO. The use of simplified versions would reduce its predictive value.