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  • 1
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    Online Resource
    Role of Cardiac Multidetector Computed Tomography in Acute Ischemic Stroke: A Preliminary Report
    S. Karger AG ; 2010
    In:  Cerebrovascular Diseases Vol. 29, No. 4 ( 2010), p. 313-320
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 29, No. 4 ( 2010), p. 313-320
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Cardiac multidetector computed tomography (MDCT) is less dependent upon the patient’s condition and may be valuable in the diagnosis of embolic sources when the patient’s cooperation is limited due to a neurologic deficit. However, its role has never been validated in acute stroke patients whose stroke mechanism is assumed to be embolic. 〈 i 〉 Methods: 〈 /i 〉 Consecutive patients who were admitted with acute ischemic stroke from May 1, 2007 to November 30, 2007 were included in this study. Inclusion criteria were (1) any cardiac evidence of high-risk embolic sources for cerebral embolism, or (2) radiological or (3) clinical evidence of embolic stroke. All patients underwent transthoracic echocardiography first, and then cardiac MDCT or transesophageal echocardiography (TEE) was attempted, if possible. The results and feasibility of cardiac MDCT and TEE were compared. 〈 i 〉 Results: 〈 /i 〉 One hundred and forty-three patients met the inclusion criteria. Cardiac MDCT was performed in 124 patients (86.7%), TEE in 83 patients (57.3%), whereas 75 patients (52.4%) underwent both studies. Renal insufficiency for cardiac MDCT and lack of cooperation for TEE were found to be the most impeding factors. Among the patients with both evaluations, cardiac MDCT identified a high-risk intracardiac embolic source in 8 and an extracardiac source in 20, while TEE found an intracardiac source in 1 and an extracardiac source in 7. Statistically significant differences were found with respect to detecting cardioembolic sources and high-risk aortic atheroma. 〈 i 〉 Conclusions: 〈 /i 〉 Cardiac MDCT is a feasible and accurate diagnostic tool for embolic sources in an acute stroke setting.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000278926
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
    detail.hit.zdb_id: 1482069-9
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  • 2
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    The Significance of Blood Pressure Variability for the Development of Hemorrhagic Transformation in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 11 ( 2010-11), p. 2512-2518
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 11 ( 2010-11), p. 2512-2518
    Abstract: Background and Purpose— Elevated blood pressure (BP) is commonly observed in acute ischemic stroke and is known to be associated with hemorrhagic transformation (HT). However, the effect of BP variability on the development of HT is not known well. Methods— A consecutive series of patients with acute ischemic stroke, who were hospitalized within 24 hours of onset and showed no HT on initial gradient echo MRI, were enrolled in this study. BP measurements during the first 72 hours were obtained, and BP variability of each patient was described using various summary parameters: SD, maximum (max), minimum (min), difference between max and min (max−min), average squared difference between successive measurements (sv), and maximum sv (svmax). Results— Of 792 patients meeting the eligibility criteria, 70 (8.8%) developed HT. Among BP variability parameters categorized into quartiles, SBP max , SBP min , SBP max−min , SBP svmax , DBP SD , DBP max , DBP min , DBP max−min , and DBP svmax were significantly associated with HT independent of mean SBP, age, interval from onset to arrival, initial stroke severity, diabetes mellitus, stroke subtype, thrombolysis, initial glucose, and total cholesterol ( P 〈 0.05 on likelihood ratio test of trend). The analyses about the interaction between thrombolysis and variability parameters showed that the effects of BP variability on the development of HT did not differ by whether patients received thrombolysis or not. Conclusions— Our study suggests that we may consider not only the absolute level of BP but also its variability to prevent hemorrhagic transformation.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.595561
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    ERRATUM: Table Correction: Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea
    Korean Stroke Society ; 2015
    In:  Journal of Stroke Vol. 17, No. 3 ( 2015-09-30), p. 377-378
    Details
    In: Journal of Stroke, Korean Stroke Society, Vol. 17, No. 3 ( 2015-09-30), p. 377-378
    Type of Medium: Online Resource
    ISSN: 2287-6391 , 2287-6405
    URL: Article
    DOI: 10.5853/jos.2015.17.3.377
    Language: English
    Publisher: Korean Stroke Society
    Publication Date: 2015
    detail.hit.zdb_id: 2814366-8
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  • 4
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    Different Antiplatelet Strategies in Patients With New Ischemic Stroke While Taking Aspirin
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 1 ( 2016-01), p. 128-134
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 1 ( 2016-01), p. 128-134
    Abstract: Selecting among different antiplatelet strategies when patients experience a new ischemic stroke while taking aspirin is a common clinical challenge, currently addressed by a paucity of data. Methods— This study is an analysis of a prospective multicenter stroke registry database from 14 hospitals in South Korea. Patients with acute noncardioembolic stroke, who were taking aspirin for prevention of ischemic events at the time of onset of stroke, were enrolled. Study subjects were divided into 3 groups according to the subsequent antiplatelet therapy strategy pursued; maintaining aspirin monotherapy (MA group), switching aspirin to nonaspirin antiplatelet agents (SA group), and adding another antiplatelet agent to aspirin (AA group). The primary study end point was the composite of stroke (ischemic and hemorrhagic), myocardial infarction, and vascular death up to 1 year after stroke onset. Results— A total of 1172 patients were analyzed for this study. Antiplatelet strategies pursued in study patients were MA group in 212 (18.1%), SA group in 246 (21.0%), and AA group in 714 (60.9%). The Cox proportional hazards regression analysis showed that, compared with the MA group, there was a reduction in the composite vascular event primary end point in the SA group (hazard ratio, 0.50; 95% confidence interval, 0.27–0.92; P =0.03) and in the AA group (hazard ratio, 0.40; 95% confidence interval, 0.24–0.66; P 〈 0.001). Conclusions— This study showed that, compared with maintaining aspirin, switching to or adding alternative antiplatelet agents may be better in preventing subsequent vascular events in patients who experienced a new ischemic stroke while taking aspirin.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011595
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
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    Clinical Outcomes of Posterior Versus Anterior Circulation Infarction With Low National Institutes of Health Stroke Scale Scores
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 1 ( 2017-01), p. 55-62
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 1 ( 2017-01), p. 55-62
    Abstract: We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods— This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results— A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2–6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI ( P =0.07), and death was 1.3% and 1.5%, respectively ( P =0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09–1.37; P 〈 0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions— Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.013432
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 6
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    Impact of Guidelines on Clinical Practice : Intravenous Heparin Use for Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 6 ( 2016-06), p. 1577-1583
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 6 ( 2016-06), p. 1577-1583
    Abstract: Since its introduction, controversy has existed about the administration of intravenous heparin for the treatment of acute ischemic stroke. We studied trends in the intravenous heparin use during a 6-year time period and the potential influence of clinical guidelines in national language on intravenous heparin administration in Korea. Methods— On the basis of a prospective nationwide multicenter stroke registry, we collected data on patients with acute ischemic stroke who arrived within 7 days of symptom onset during the time period 2008 to 2013. We studied patient demographics, prestroke medical history, stroke characteristics, and stroke treatment. Data from a total of 23 425 patients from 12 university hospitals or regional stroke centers were analyzed. Results— The administration of intravenous heparin steadily decreased throughout the study period: 9.7% in 2008, 10.9% in 2009, 9.4% in 2010, 6.0% in 2011, 4.7% in 2012, and 4.3% in 2013 ( P for trend 〈 0.001). The reduced intravenous heparin use was associated with moderate stroke severity, atrial fibrillation, and stroke of cardioembolic, other-, and undetermined etiology. In a multivariable logistic model, increase of 1 calendar year (odds ratio, 0.89; 95% confidence interval, 0.84–0.95; P 〈 0.001) and release of clinical practice guidelines in Korean (odd ratio, 0.74; 95% confidence interval, 0.59–0.91; P 〈 0.01) were independent factors associated with reduction in the frequency of intravenous heparin use. Conclusions— Use of intravenous heparin for acute ischemic stroke treatment has decreased in Korea, and this change may be attributable to the spread and successful implementation of regional clinical practice guidelines.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.012639
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 7
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    Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis?
    SAGE Publications ; 2016
    In:  International Journal of Stroke Vol. 11, No. 7 ( 2016-10), p. 783-790
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 11, No. 7 ( 2016-10), p. 783-790
    Abstract: Current guidelines have contraindicated history of intracerebral hemorrhage for intravenous recombinant tissue plasminogen activator. Aim This study aimed to investigate the safety and effectiveness of intravenous recombinant tissue plasminogen activator for patients who had previous intracerebral hemorrhage on history or initial brain magnetic resonance imaging. Methods Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 4.5 h of onset. Previous intracerebral hemorrhage was defined as having a clinical history or evidence of old intracerebral hemorrhage on initial brain magnetic resonance imaging. Associations of previous intracerebral hemorrhage with symptomatic hemorrhagic transformation during hospitalization and functional outcome and mortality at discharge and three months were analyzed. Results Among 1495 patients who were treated with intravenous recombinant tissue plasminogen activator, 73 (4.9%) had previous intracerebral hemorrhage; 9 on history only, 61 on magnetic resonance imaging only and 3 on both. Of those 1495 patients, 71 (4.7%) experienced symptomatic hemorrhagic transformation; 6.8% in patients with previous intracerebral hemorrhage and 4.6% in those without previous intracerebral hemorrhage. Multivariable logistic regression analysis showed that previous intracerebral hemorrhage did not significantly increase the risk of symptomatic hemorrhagic transformation (odds ratio 1.08, 95% confidence interval 0.39–2.96) mortality, and most of functional outcome measures Conclusions Previous intracerebral hemorrhage may neither increase the risk of symptomatic hemorrhagic transformation nor alter major clinical outcomes in acute ischemic stroke patients receiving intravenous recombinant tissue plasminogen activator. This study suggests reconsideration of prior history of intracerebral hemorrhage as an exclusion criterion for intravenous recombinant tissue plasminogen activator administration in acute ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493016654289
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2211666-7
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  • 8
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    Online Resource
    Current Status of Acute Stroke Management in Korea: A Report on a Multicenter, Comprehensive Acute Stroke Registry
    SAGE Publications ; 2014
    In:  International Journal of Stroke Vol. 9, No. 4 ( 2014-06), p. 514-518
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 4 ( 2014-06), p. 514-518
    Abstract: There are limited data on the utilization of diagnostics and the variation of treatments at the national level in acute stroke care. Clinical Research Center for Stroke – 5th division stroke registry aimed to describe stroke statistics and quality of care in Korea and to implement quality indicators. Clinical Research Center for Stroke – 5th division registry was established in April 2008 and covers pretreatment demographics, medical and stroke severity measures, diagnostic evaluation, hyperacute revascularization, in-hospital management, discharge disposition, quality indicators, and long-term functional outcomes. Consecutive stroke cases from 12 participating centers are registered to a web-based database. Meticulous data management and auditing policy were applied. A total of 14 792 ischemic stroke cases were enrolled from April 2008 to January 2012. The median National Institutes of Health Stroke Scale score was 4 at admission, with median delay of onset to arrival of 14 h. Rate of risk factor management before stroke exceeds more than 80% for hypertension and diabetes. Revascularization procedures were performed in 1736 subjects (12%), and 34% were endovascular ( n = 598). Substantial variability was noted in the preferred modality of hyperacute revascularization (range of endovascular recanalization = 6–60%), use of computed tomography (30–93%), and perfusion imaging (2–96%). The Clinical Research Center for Stroke – 5th division registry documented that the current practice of acute stroke care in South Korea largely met the standard of guidelines, but variability of practice still remains. The registry would provide an opportunity to evaluate the quality of stroke care across South Korea and compare it with that of other countries.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/ijs.12199
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 9
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    Abstract 186: Effectiveness of Endovascular Recanalization for Acute Stroke: A Transition Toward Superiority Over Intravenous Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background: There is skepticism in clinical practice about the comparative effectiveness of endovascular recanalization compared to intravenous thrombolysis for acute ischemic stroke, and there is a paucity of information about effectiveness and safety trends. Methods: We identified 872 acute ischemic stroke patients who underwent recanalization therapy with intravenous thrombolysis only (IVT; n=533) or endovascular recanalization with or without intravenous thrombolysis (EVT; n=339) from a prospective, multicenter stroke registry database between April 2008 and January 2012. All study subjects had NIHSS score ≥10 and arrived within 4.5 hours of onset. Inverse probability of EVT weighting by propensity score was used to remove baseline imbalance between treatment groups. Primary outcome was mRS score 0 – 2 at the time of discharge. Year-by-year effectiveness and safety of EVT over IVT were estimated with further adjustment by age, NIHSS score, onset to arrival time, duration of hospitalization and treatment year. Results: Before 2010, the primary outcome was not associated with treatment modality. However in 2011, EVT increased the odds of better primary outcome compared to IVT (adjusted OR, 1.87; 95% CI, 1.08 – 3.23). Also in year 2011, EVT became superior to IVT for mRS score 0 – 2 (1.99; 1.10 – 3.59) at 3 months after stroke. The odds of mortality during admission and at 3 month and symptomatic hemorrhagic transformation were not different between recanalization methods throughout the study period (see Figure). Subgroup analyses showed that effect estimates from EVT were significantly modified by total stroke volume of hospital (higher in ≥30 stroke cases per month) and time from onset to arrival (higher in ≥2-hour delay). Conclusion: Over time, endovascular recanalization has become superior to intravenous thrombolysis for improvement of clinical outcomes in acute ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.186
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 10
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    Abstract 72: Comparative Effectiveness of Intravenous Thrombolysis in patients with Mild Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background: One third of patients with initially mild strokes have unfavorable outcome, and the efficacy of intravenous thrombolysis (IVT) in those patients has not proven. This study aimed to evaluate the comparative effectiveness of IVT over no thrombolysis in patients with mild ischemic stroke presenting within 4.5 hours of onset. Methods: From a multicenter prospective stroke registry database, we identified acute ischemic stroke patients (1) who were aged 18 years or more, (2) whose neuroimaging confirmed relevant acute ischemic lesions, (3) who were presented within 4.5 hours of onset, and (4) whose initial NIHSS scores were 5 points or less. Matching and inverse probability of treatment weighting (IPTW) by propensity score (PS) were used to remove baseline imbalance between the IVT and no treatment groups. Further adjustments for potential confounders were made in the IPTW analysis. The adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) of IVT compared to no treatment were calculated for 3-month modified Rankin Scale (mRS) 0-1 (primary efficacy outcome), the full distribution of mRS scores (sedoncary efficacy outcome, by an ordinal logistic regression analysis), and symptomatic hemorrhagic transformation (sHT, safety outcome). Results: Between April 2008 and May 2012, 13,117 stroke patients were hospitalized to the 12 participating centers. Among them, 1,386 subjects met the eligibility criteria, and 194 (14.0%) were treated with IVT. The proportions of 3-month mRS 0-1 were not different between the IVT and no treatment groups (71% vs. 75%, p=0.18), but those of sHT were different (4.1% vs. 0.5%, p 〈 0.001). The adjusted ORs (95% CIs, p values) were 1.46 (0.95-2.25, 0.08) by PS-matching and 1.47 (0.77-2.82, 0.24) by IPTW for 3-month mRS 0-1; 1.05 (0.73-1.49, 0.80) by PS-matching and 1.09 (0.65-1.81, 0.75) for an increment of 3-month mRS score; and 7.47 (1.52-36.64, 0.01) by PS-matching and 3.85 (0.82-18.06, 0.09) by IPTW for sHT. Conclusion: This comparative effectiveness analysis based on the large multicenter stroke registry database failed to prove the superiority of intravenous thrombolysis over no treatment in patients with mild ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.72
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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