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  • 1
    Online Resource
    Online Resource
    Progress in cerebrovascular disease research in the last year
    Springer Science and Business Media LLC ; 2012
    In:  Journal of Neurology Vol. 259, No. 2 ( 2012-2), p. 391-394
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 259, No. 2 ( 2012-2), p. 391-394
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-012-6408-7
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 1421299-7
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  • 2
    Online Resource
    Online Resource
    Outcomes of a Contemporary Cohort of 536 Consecutive Patients With Acute Ischemic Stroke Treated With Endovascular Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 4 ( 2014-04), p. 1046-1052
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 4 ( 2014-04), p. 1046-1052
    Abstract: We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome. Methods— We used data from a mandatory, population-based registry that includes external monitoring of completeness, which assesses reperfusion therapies for consecutive patients with acute ischemic stroke since 2011. We described outcomes overall and by subgroups (age ≤ or 〉 80 years; onset-to-groin puncture ≤ or 〉 6 hours; anterior or posterior strokes; previous IV recombinant tissue-type plasminogen activator or isolated endovascular treatment/therapy; revascularization or no revascularization), and determined independent predictors of good outcome (modified Rankin Scale score ≤2) and mortality at 3 months by multivariate modeling. Results— We analyzed 536 patients, of whom 285 received previous IV recombinant tissue-type plasminogen activator. Overall, revascularization (modified Thrombolysis In Cerebral Infarction scores, 2b and 3) occurred in 73.9%, 5.6% developed symptomatic intracerebral hemorrhages, 43.3% achieved good functional outcome, and 22.2% were dead at 90 days. Adjusted comparisons by subgroups systematically favored revascularization (lower proportion of symptomatic intracerebral hemorrhages and death rates and higher proportion of good outcome). Multivariate analyses confirmed the independent protective effect of revascularization. Additionally, age 〉 80 years, stroke severity, hypertension (deleterious), atrial fibrillation, and onset-to-groin puncture ≤6 hours (protective) also predicted good outcome, whereas lack of previous disability and anterior circulation strokes (protective) as well as and hypertension (deleterious) independently predicted mortality. Conclusions— This study reinforces the role of revascularization and time to treatment to achieve enhanced functional outcomes and identifies other clinical features that independently predict good/fatal outcome after endovascular treatment/therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.003489
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Oral anticoagulant-associated intracerebral hemorrhage
    Springer Science and Business Media LLC ; 2012
    In:  Journal of Neurology Vol. 259, No. 2 ( 2012-2), p. 212-224
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 259, No. 2 ( 2012-2), p. 212-224
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-011-6153-3
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 1421299-7
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  • 4
    Online Resource
    Online Resource
    Translational Stroke Research of the Combination of Thrombolysis and Antioxidant Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 5 ( 2011-05), p. 1495-1499
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 5 ( 2011-05), p. 1495-1499
    Abstract: Stroke is an enormous public health problem with an imperative need for more effective therapy. Recombinant tissue plasminogen activator is the only licensed drug for acute stroke, but its efficacy may be limited by the toxicity of the compound and by reperfusion injury. The coadministration of neuroprotective drugs could augment the value of thrombolytic therapy, but the evidence in support of this approach is scarce. The use of the free radical trapping NXY-059, either with or without recombinant tissue plasminogen activator, was not successful in Phase III studies. However, these results could reflect its weak antioxidant capacity, poor blood–brain barrier penetration, and lack of synergism with recombinant tissue plasminogen activator as well as the overly broad treatment window used in the reported trials. This article contends that further translational research should explore newer antioxidant drugs in combination with thrombolytic agents, but only if the combination yields additive or synergistic effects in preclinical thromboembolic models or in biomarker-assisted Phase II studies. Edaravone and novel nitrones endowed with a better pharmacokinetic profile or multitarget and thrombolytic activity are discussed as well as the latest research data on uric acid, a strong endogenous antioxidant in blood that is early consumed after acute stroke. The coadministration of uric acid and recombinant tissue plasminogen activator has shown to provide synergistic neuroprotection in experimental thromboembolic models and to lessen several biomarkers of oxidative stress in patients with acute stroke. The clinical efficacy of uric acid is currently under investigation in a Phase III trial that follows current recommendations of also evaluating surrogate biomarkers of treatment effects.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.615039
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke : A Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 4 ( 2011-04), p. 1129-1131
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 4 ( 2011-04), p. 1129-1131
    Abstract: The value of multimodal CT to assist thrombolysis has received little attention in stroke. Methods— We assessed prospectively the impact derived from the routine application of CT perfusion and CTA in patients with acute stroke treated consecutively with alteplase. The safety and efficacy of thrombolytic therapy were compared in 106 patients assisted with CT/CTA/CT perfusion (multimodal CT group) and 262 patients assisted without full multimodal brain imaging (control group) during a 5-year period (2005–2009). Results— Good outcome (modified Rankin scale score ≤2) at 3 months was increased in the multimodal group compared with controls (adjusted OR, 2.88; 95% CI, 1.50–5.52). Multimodal-assisted thrombolysis yielded superior benefits in patients treated beyond 3 hours (adjusted OR, 4.48; 95% CI, 1.68–11.98) than treated within 3 hours (adjusted OR, 1.31; 95% CI, 0.80–2.16; interaction test P =0.043). Mortality (14% and 15%) and symptomatic hemorrhage (5% and 7%) were similar in both groups. Conclusions— Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated 〉 3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.605766
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 6
    Online Resource
    Online Resource
    Abstract W P256: Influence of Withdrawal of Care on Spontaneous Intracerebral Hemorrhage Predictive Scales
    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: Various scoring systems combining different predictors have been developed to more accurately predict the short and long-term outcome after ICH. However, these different scoring systems do not take into account the major influence of the primary cause of mortality in ICH, namely the withdrawal of care (WC). We aim to compare the in-hospital mortality prediction performance after accounting for WC of three widely used scoring systems, the original ICH score (oICH), the ICH Grading scale (ICH-GS), and the simplified ICH score (sICH), in a cohort of ICH patients prior to the development of the aforementioned scales. Methods: Retrospective observational single center cohort study of adult patients presenting a confirmed diagnosis of ICH. Admission clinical and radiological criteria were obtained through review of medical records and CT at admission. In-hospital mortality was selected as a primary outcome and obtained from the medical records. In the event of death, groups weredivided into: ICH-direct cause of death (cardiac arrest or brain death) andneurological devastation leading to WC. Scoring systems were calculated in each individual patient. Receiver operating characteristic (ROC) analysis was used to assess the ability of each score to predict in-hospital mortality and the maximum Youden Index was identified to denote each score’s optimal predictive cutoff point for each scale. The area under the curve (AUC) between groups was compared by using the Delong et al method. P 〈 0.05 was set as statistically significant. Conclusion: Performance of ICH scoring systems accurately predicted in-hospital mortalityeven when WC care is taken into account.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.wp256
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Uric Acid Levels Are Relevant in Patients With Stroke Treated With Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 1_suppl_1 ( 2011-01)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 1_suppl_1 ( 2011-01)
    Abstract: Uric acid (UA) is a neuroprotective antioxidant that improves the benefits of alteplase in experimental ischemia. However, it is unknown whether endogenous UA also influences the response to thrombolysis in patients with stroke. Methods— A total of 317 consecutive patients treated with thrombolysis were included in a prospective stroke registry. Demographics, laboratory data, neurological course, and infarction volume were prospectively collected. Excellent outcome was defined as achieving a modified Rankin Scale score 〈 2 at 90 days. Binary and ordinal logistic regression models were used to analyze modified Rankin Scale score at 90 days. Results— UA levels were significantly higher in patients with an excellent outcome than in patients with a poor outcome (5.82 [1.39] versus 5.42 [1.81] , P =0.029). In multivariate models, increased UA levels (OR, 1.23; 95% CI, 1.03 to 1.49; P =0.025) were associated with an excellent outcome and with an increased risk of shifting to a better category across the modified Rankin Scale (OR, 1.19; 95% CI, 1.04 to 1.38; P =0.014) independently of the effect of confounders. The levels of UA and the volume of final infarction were inversely correlated ( r =−0.216, P 〈 0.001) and the inverse correlation remained after adjustment for age, sex, and baseline National Institutes of Health Stroke Scale score (t value=−2.54, P =0.01). Significantly lower UA levels were found in patients with malignant middle cerebral artery infarction and parenchymal hemorrhage postthrombolysis. Conclusions— Increased UA serum levels are associated with better outcome in patients with stroke treated with reperfusion therapies. These results support the assessment of the potential neuroprotective role of the exogenous administration of UA in patients with stroke treated with thrombolysis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.596528
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    Single-Center Experience of Cerebral Artery Thrombectomy Using the TREVO Device in 60 Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 6 ( 2012-06), p. 1657-1659
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 6 ( 2012-06), p. 1657-1659
    Abstract: We sought to explore the safety and efficacy of the new TREVO stent-like retriever in consecutive patients with acute stroke. Methods— We conducted a prospective, single-center study of 60 patients (mean age, 71.3 years; male 47%) with stroke lasting 〈 8 hours in the anterior circulation (n=54) or 〈 12 hours in the vertebrobasilar circulation (n=6) treated if CT perfusion/CT angiography confirmed a large artery occlusion, ruled out a malignant profile, or showed target mismatch if symptoms 〉 4.5 hours. Successful recanalization (Thrombolysis In Cerebral Infarction 2b–3), good outcome (modified Rankin Scale score 0–2) and mortality at Day 90, device-related complications, and symptomatic hemorrhage (parenchymal hematoma Type 1 or parenchymal hematoma Type 2 and National Institutes of Health Stroke Scale score increment ≥4 points) were prospectively assessed. Results— Median (interquartile range) National Institutes of Health Stroke Scale score on admission was 18 (12–22). The median (interquartile range) time from stroke onset to groin puncture was 210 (173–296) minutes. Successful revascularization was obtained in 44 (73.3%) of the cases when only the TREVO device was used and in 52 (86.7%) when other devices or additional intra-arterial tissue-type plasminogen activator were also required. The median time (interquartile range) of the procedure was 80 (45–114) minutes. Good outcome was achieved in 27 (45%) of the patients and the mortality rate was 28.3%. Seven patients (11.7%) presented a symptomatic intracranial hemorrhage. No other major complications were detected. Conclusions— The TREVO device was reasonably safe and effective in patients with severe stroke. These results support further investigation of the TREVO device in multicentric registries and randomized clinical trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.640011
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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