Journal of vascular and interventional neurology
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J Vasc Interv Neurol · Aug 2012
Expansion of recruitment time window in antihypertensive treatment of acute cerebral hemorrhage (ATACH) II trial.
The Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II trial is an ongoing multi-center, randomized phase III trial to determine the efficacy of early, intensive, antihypertensive treatment using intravenous (IV) nicardipine initiated within 3 h of onset of intracerebral hemorrhage (ICH). On March 11th, 2012, the National Institutes of Neurological Disorders and Stroke approved recruitment of patients with ICH within 4.5 h of symptom onset. ⋯ Another recent single center study further identified that hematoma expansion, the primary target for systolic blood pressure reduction, appeared to be equally prevalent in subjects who are presenting between 3 and 4.5 h. The expansion has the potential to evaluate the efficacy of the treatment intervention in a larger group of patients with ICH.
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J Vasc Interv Neurol · Jul 2011
Clinical outcome of patients with acute posterior circulation stroke and bilateral vertebral artery occlusion.
Patients presenting with posterior circulation acute ischemic events are occasionally noted to have occlusion of bilateral vertebral arteries with basilar artery blood flow entirely dependent from the anterior circulation. There is limited data about prognosis of such patients in literature. ⋯ Patients with acute posterior circulation ischemic stroke and bilateral vertebral artery occlusion are at high risk of having early recurrent ischemic events. Reestablishment of the antegrade vertebro-basilar blood flow through endovascular re-canalization might be an option to decrease stroke recurrence in selected patients with acute posterior circulation stroke and bilateral vertebral artery occlusion.
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J Vasc Interv Neurol · Jan 2011
Earlier Hypothermia Attainment is Associated with Improved Outcomes after Cardiac Arrest.
Therapeutic hypothermia (TH, 32-34ºC) reduces mortality and improves neurologic outcomes after ventricular fibrillation cardiac arrest (CA). The relationship between time to achieve TH and outcomes remains undefined. We hypothesized that a shorter interval from CA to achieve TH would be associated with improved neurologic outcome. ⋯ Attaining TH within 6 hours of in or out-of-hospital CA was associated with a greater likelihood of a good neurological outcome at discharge. Time from CA to achieved TH should be included as a clinically important covariate in future studies of predictors of outcome after CA.
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J Vasc Interv Neurol · Jan 2009
Prolonged Mild-to-Moderate Hypothermia for Refractory Intracranial Hypertension.
Therapeutic hypothermia is an emerging therapy for brain injury and cerebral edema. Hypothermia is known to reduce death and neurologic morbidity in survivors of cardiac arrest from ventricular fibrillation. Traumatic brain injury (TBI) trials studies of short-term hypothermia (24 to 48hours) have had conflicting results. Recent evidence however suggests prolonged hypothermia (48 hours to 14 days) may be beneficial for TBI and select cases of nontraumatic brain injury especially when the duration of cerebral edema and intracranial hypertension is expected to last longer than 24 hours. ⋯ We report the first case of prolonged therapeutic hypothermia over a total of 14days to control nontraumatic brain injury-related refractory intracranial pressure and global cerebral edema. More studies are needed comparing clinical outcomes and complication rates between short duration and prolonged hypothermia for brain injury.
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J Vasc Interv Neurol · Oct 2008
Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization.
The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called 'Reversed-Robinhood syndrome'. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease. ⋯ Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive disease of the ICA or MCA is helpful in the identification and quantification of failed vasodilatory reserve. This approach may be useful in selecting patients for possible revascularization procedures.