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  • 1
    Online Resource
    Online Resource
    Aggressive Blood Pressure–Lowering Treatment Before Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic Stroke
    American Medical Association (AMA) ; 2008
    In:  Archives of Neurology Vol. 65, No. 9 ( 2008-09-01)
    Details
    In: Archives of Neurology, American Medical Association (AMA), Vol. 65, No. 9 ( 2008-09-01)
    Type of Medium: Online Resource
    ISSN: 0003-9942
    URL: Article
    DOI: 10.1001/archneur.65.9.1174
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2008
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  • 2
    Online Resource
    Online Resource
    Intravenous Tissue Plasminogen Activator in Patients With Cocaine-Associated Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 11 ( 2009-11), p. 3635-3637
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 11 ( 2009-11), p. 3635-3637
    Abstract: Background and Purpose— The safety of thrombolytic therapy in patients with cocaine-associated acute ischemic stroke (CIS) is unknown. Methods— We conducted a retrospective review of patients with CIS who presented to our stroke center. Thrombolytic treatment was compared between cocaine-positive (n=29) and cocaine-negative (n=75) patients. We also compared patients with CIS treated with tissue plasminogen activator versus those who did not receive tissue plasminogen activator (n=58). Safety outcomes were determined by the incidence of symptomatic intracerebral hemorrhage, in-hospital mortality, and modified Rankin Scale at hospital discharge. Results— There were no complications in tissue plasminogen activator-treated patients with CIS. Cocaine-positive and cocaine-negative treated patients had similar stroke severity and safety outcomes. Patients with CIS treated with tissue plasminogen activator had more severe strokes on baseline National Institutes of Health Stroke Scale but similar safety outcomes compared with nontreated patients with CIS. Conclusion— Thrombolytic therapy for CIS appears to be safe in this small study. Further research is needed to more definitively assess safety and efficacy of tissue plasminogen activator for CIS.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.109.559823
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Can Comprehensive Stroke Centers Erase the ‘Weekend Effect’?
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 27, No. 2 ( 2009), p. 107-113
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 27, No. 2 ( 2009), p. 107-113
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Prior epidemiological work has shown higher mortality in ischemic stroke patients admitted on weekends, which has been termed the ‘weekend effect’. Our aim was to assess stroke patient outcomes in order to determine the significance of the ‘weekend effect’ at 2 comprehensive stroke centers. 〈 i 〉 Methods: 〈 /i 〉 Consecutive stroke patients were identified using prospective databases. Patients were categorized into 4 groups: intracerebral hemorrhage (ICH group), ischemic strokes not treated with IV t-PA (intravenous tissue plasminogen activator; IS group), acute ischemic strokes treated with IV t-PA (AIS-TPA group), and transient ischemic attack (TIA group). Weekend admission was defined as the period from Friday, 17:01, to Monday, 08:59. Patients treated beyond the 3-hour window, receiving intra-arterial therapy, or enrolled in nonobservational clinical trials were excluded. Patient demographics, NIHSS scores, and admission glucose levels were examined. Adverse events, poor functional outcome (modified Rankin scale, mRS, 3–6), and mortality were compared. 〈 i 〉 Results: 〈 /i 〉 A total of 2,211 patients were included (1,407 site 1, 804 site 2). Thirty-six percent (800/2,211) arrived on a weekend. No significant differences were found in the ICH, IS, AIS-TPA, or TIA groups with respect to the rate of symptomatic ICH, mRS on discharge, discharge disposition, 90-day mRS, or 90-day mortality when comparing weekend and weekday groups. Using multivariate logistic regression to adjust for site, age, admission NIHSS, and blood glucose, weekend admission was not a significant independent predictive factor for in-hospital mortality in all strokes (OR = 1.10, 95% CI 0.74–1.63, p = 0.631). 〈 i 〉 Conclusions: 〈 /i 〉 Our results suggest that comprehensive stroke centers (CSC) may ameliorate the ‘weekend effect’ in stroke patients. These results may be due to 24/7 availability of stroke specialists, advanced neuroimaging, or ongoing training and surveillance of specialized nursing care available at CSC. While encouraging, these results require confirmation in prospective studies.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000177916
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1482069-9
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  • 4
    Online Resource
    Online Resource
    Does Study Enrollment Delay Treatment With Intravenous Thrombolytics for Acute Ischemic Stroke?
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 2 ( 2009-02), p. 663-663
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 2 ( 2009-02), p. 663-663
    Abstract: Background and Purpose— Enrollment in acute stroke trials at a stroke center with multiple study protocols may delay the initiation of intravenous thrombolytics in patients who present within 3 hours of symptom onset. Methods— We studied all patients presenting with acute ischemic stroke over the past 3.5 years who qualified for thrombolysis within 3 hours of symptom onset. We collected demographics, baseline National Institutes of Health Stroke Scale scores, CT findings, and arrival-to-treatment times and compared patients treated with intravenous thrombolytics in a clinical trial with patients who received standard of care intravenous tissue plasminogen activator. Results— Of 290 treated patients, 19 were enrolled in prelytic studies, 46 were enrolled in postlytic studies, and 225 were treated with standard intravenous tissue plasminogen activator. There was no significant difference in age, gender, National Institutes of Health Stroke Scale score, admission glucose, or changes on CT. There was no difference in onset-to-arrival time or arrival-to-treatment time between patients enrolled in clinical studies and those who received standard treatment. However, among study patients, prelytic randomization led to a significantly longer arrival-to-treatment time by 13 minutes ( P =0.028). Conclusion— We found that trials requiring prethrombolytic randomization can lead to a delay in the initiation of treatment. Future studies are needed to determine if such a delay is clinically significant and can be shortened by improved enrollment strategies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.525352
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
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  • 5
    Online Resource
    Online Resource
    Thrombus Burden Is Associated With Clinical Outcome After Intra-Arterial Therapy for Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 12 ( 2008-12), p. 3231-3235
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 12 ( 2008-12), p. 3231-3235
    Abstract: Background and Purpose— Studies have established a relation between recanalization and improved clinical outcome in acute ischemic stroke patients; however, intra-arterial clot size has not been routinely assessed. The aim of the study was to determine the impact of intra-arterial thrombus burden on intra-arterial treatment (IAT) and clinical outcome. Methods— A retrospective review of our IAT stroke database included procedure time, recanalization, symptomatic intracranial hemorrhage, poor outcome (modified Rankin Scale score ≥4 at discharge), and mortality. The modified Thrombolysis in Myocardial Infarction thrombus grade was dichotomized into grades 0 to 3 (no clot or moderate thrombus, 〈 2 vessel diameters) versus grade 4 (large thrombus, 〉 2 vessel diameters). Results— Data were collected on 135 patients with thrombus grading. The baseline median National Institutes of Health Stroke Scale score was higher in patients of grade 4 compared with grades 0 to 3 (19 vs 17, P =0.012). Grade 4 thrombi required longer (median, range) times for IAT (113, 37 to 415 minutes vs 74, 22 to 215 minutes, respectively; P 〈 0.001) and higher rates of mechanical clot disruption (wire, angioplasty, snare, stent, or Merci retriever) compared with grades 0 to 3 (76% vs 53%, P =0.005). There were no differences in rates of symptomatic intracranial hemorrhage (6.6% vs 4.1%, P =0.701) or recanalization (50% vs 61%, P =0.216) in grade 4 versus grades 0 to 3. Multivariate analysis adjusted for age, baseline National Institutes of Health Stroke Scale score, and artery of involvement showed that grade 4 thrombi were independently associated with poor outcome (odds ratio=2.4; 95% CI, 1.06 to 5.57; P =0.036) and mortality (odds ratio=4.0; 95% CI, 1.2 to 13.2; P =0.023). Conclusions— High thrombus grade as measured by the modified Thrombolysis in Myocardial Infarction criteria may be a risk factor that contributes to poor clinical outcome.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.521054
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Intracerebral Hemorrhage in Cocaine Users
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 4 ( 2010-04), p. 680-684
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 4 ( 2010-04), p. 680-684
    Abstract: Background and Purpose— Cocaine is a cause of intracerebral hemorrhage (ICH), but there are no large studies that have characterized the location, pathology, and outcome of patients with cocaine-associated ICH. Methods— We performed a retrospective analysis of all patients admitted to our stroke service from 2004 to 2007 who had nontraumatic ICH and urine drug screens positive for cocaine and compared them with similar patients who had negative drug screens for cocaine. Results— We identified 45 patients with cocaine-associated ICH and 105 patients with cocaine-negative ICH. There were no significant differences in age or gender, but there was a significantly higher incidence of black patients in the cocaine-positive group. Cocaine-associated ICH patients had higher admission blood pressures, significantly more subcortical hemorrhages, and higher rates of intraventricular hemorrhage compared to patients with cocaine-negative ICH. Cocaine-positive patients had worse functional outcome, defined as modified Rankin Scale score 〉 3 at the time of discharge (OR, 4.90; 95% CI, 2.19–10.97), and were less likely to be discharged home or to inpatient rehabilitation. Patients with cocaine-associated ICH were nearly 3-times more likely to die during their acute hospitalization when compared to cocaine-negative patients. Conclusion— Recent cocaine ingestion is associated with hemorrhages that occur more frequently in subcortical locations, have a higher risk of intraventricular hemorrhage, and have a poor prognosis compared to patients with cocaine-negative, spontaneous ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.109.573147
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 7
    Online Resource
    Online Resource
    The Complications of Cardioembolic Stroke: Lessons from the VISTA Database
    S. Karger AG ; 2008
    In:  Cerebrovascular Diseases Vol. 26, No. 1 ( 2008), p. 38-40
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 26, No. 1 ( 2008), p. 38-40
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Cardioembolic stroke (CES) accounts for 20–30% of ischemic strokes. We attempted to describe the complications of CES. 〈 i 〉 Methods: 〈 /i 〉 We analyzed a cohort of CES patients from the VISTA database who were not given thrombolytics. 〈 i 〉 Results: 〈 /i 〉 397 patients were included. Recurrent stroke occurred in 2.5% (10/397); stroke progression in 7.8% (31/397); systemic bleeding in 3% (12/397), and hemorrhagic transformation (HT) in 1.5% (6/397). A bimodal temporal distribution was observed for HT. The mortality rate was 103/397 (25.9%) and was associated with stroke progression and recurrence. 〈 i 〉 Conclusions: 〈 /i 〉 HT is common in CES patients and presents in a bimodal distribution. Stroke progression is the most frequent serious complication. Further study is indicated to identify predictors of stroke progression.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000135651
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2008
    detail.hit.zdb_id: 1482069-9
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  • 8
    Online Resource
    Online Resource
    Recovery after Ischemic Stroke: Criteria for Good Outcome by Level of Disability at Day 7
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 28, No. 4 ( 2009), p. 341-348
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 28, No. 4 ( 2009), p. 341-348
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Ischemic stroke is a leading cause of morbidity. Assessing the chances of recovery is critical to optimize poststroke care. 〈 i 〉 Methods: 〈 /i 〉 We used a cohort of patients from the Virtual International Stroke Trial Archive that participated in acute stroke trials (control arm) and were followed for 90 days. The cohort was grouped by day 7 (D7) modified Rankin scale (mRS) scores. Variables that were associated with good outcome (mRS 0–2 at 90 days) in the univariate analysis were entered into a logistic regression model to determine the independent good outcome criteria for each D7 mRS tier. 〈 i 〉 Results: 〈 /i 〉 We analyzed 1,798 patients. The independent good outcome criteria identified for different mRS tiers were: D7 mRS of 3: age ≤70, 0–2 vascular risk factors, D7 NIH Stroke Scale (NIHSS) arm strength ≤1, D7 NIHSS language score = 0; D7 mRS of 4: age ≤70, male, D7 NIHSS facial palsy ≤1, D7 NIHSS visual = 0, D7 NIHSS leg strength ≤1, D7 NIHSS dysarthria = 0; D7 mRS of 5: age ≤70, IV tPA treatment, D7 NIHSS dysarthria = 0, D7 NIHSS leg strength ≤2. For each mRS tier, we observed a graded increase in the percentage of the primary and secondary end points with increase in the number of criteria. 〈 i 〉 Conclusions: 〈 /i 〉 We identified clinical variables that predict good outcome, are specific to each day 7 mRS tier, and enable easy and informative assessment of the patient’s likelihood of achieving varying degrees of recovery at day 90. These results may be useful in both clinical practice and research but require validation in an independent patient cohort.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000229552
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
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  • 9
    Online Resource
    Online Resource
    The Effect of Activated Factor VII for Intracerebral Hemorrhage Beyond 3 Hours Versus Within 3 Hours
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 2 ( 2008-02), p. 473-475
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 2 ( 2008-02), p. 473-475
    Abstract: Background and Purpose— Recombinant-activated factor VII (rFVIIa) is an investigational treatment for intracerebral hemorrhage (ICH). We have evaluated the drug’s treatment effect based on time to treatment. Methods— ICH patients treated up to 4 hours from symptom onset were divided based on time to treatment: ≤3 hours (3H) and 3 to 4 hours (4H). Head CT was done at baseline and 24 hours. Outcome measures included: ICH growth at 24 hours, mortality, favorable outcome and discharge disposition. A cohort of nontreated matched ICH patients was used to asses the clinical efficacy. Results— Forty-six patients were treated with rFVIIa: 24 in the 3H group (range 70 to 180 minutes), 22 in the 4H group (range 181 to 300). One hundred and forty-eight patients formed the control group. Mean baseline ICH volume was 8.8 mL for 3H and 10.1 mL for 4H. Mean 24-hour volume was 9.3 mL for 3H (absolute increase 1.05 mL, relative increase 11.9%) and 11.5 mL for 4H (absolute increase 1.1 mL, relative increase 10.9%); P =0.47 is for the difference in relative increase. Mortality was 12.5% for 3H group, 13.6% for 4H, and 13.1% for the control. In the 3H group, 58.3% were discharged with a poor outcome, compared with 54.5% in 4H and 54.1% in the control. Thrombotic adverse events occurred in 11.1% of patients treated with rFVIIa. Conclusions— In our off-label with rFVIIa, we did not find evidence of a treatment effect based on time to treatment. Other criteria should be sought to identify patients who might benefit clinically from rFVIIa.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.497651
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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  • 10
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    Online Resource
    Response to Letter by Steiner et al
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 7 ( 2008-07)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 7 ( 2008-07)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.519256
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 1467823-8
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