Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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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.
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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.
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J Stroke Cerebrovasc Dis · May 2014
Imaging negative stroke: diagnoses and outcomes in intravenous tissue plasminogen activator-treated patients.
Intravenous (IV) Alteplase (tissue plasminogen activator [t-PA]) improves outcome in patients with acute ischemic stroke. Of those with full recovery, some may not have had ischemia. We analyzed the frequency and post-treatment outcomes of stroke code patients with no imaging evidence of stroke to establish the incidence of neuroimaging negative cerebral ischemia (NNCI) and stroke mimics treated with t-PA. In addition, we compared these patients with the group of stroke patients with imaging evidence of acute stroke to determine whether there was a difference in adverse events and functional outcomes. ⋯ Because most INS patients were found to have NNCI, which may represent either transient ischemic attack or aborted stroke, and there were no intracerebral hemorrhages in the INS group, our data support the safety of administering IV t-PA to all patients in whom acute ischemic stroke is clinically suspected. We have demonstrated that NNCI patients and stroke mimics are common, and future larger scale prospective studies are required to delineate the true frequencies of each and to evaluate differences in outcomes.
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J Stroke Cerebrovasc Dis · May 2014
Comparative StudySocioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke.
Previous studies have demonstrated that socioeconomic disparities in access to treatment of cerebrovascular diseases exist. We studied the Nationwide Inpatient Sample (NIS) to determine if disparities exist in utilization of mechanical thrombectomy for acute ischemic stroke. ⋯ Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.
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J Stroke Cerebrovasc Dis · May 2014
Comparative StudyNoninvasive evaluation of collateral blood flow through circle of Willis in cervical carotid stenosis using selective magnetic resonance angiography.
Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. ⋯ Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis.