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  • 1
    Online Resource
    Online Resource
    Anticoagulation After Cardioembolic Stroke : To Bridge or Not to Bridge?
    American Medical Association (AMA) ; 2008
    In:  Archives of Neurology Vol. 65, No. 9 ( 2008-09-01), p. 1169-
    Details
    In: Archives of Neurology, American Medical Association (AMA), Vol. 65, No. 9 ( 2008-09-01), p. 1169-
    Type of Medium: Online Resource
    ISSN: 0003-9942
    URL: Article
    DOI: 10.1001/archneur.65.9.noc70105
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2008
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  • 2
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    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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  • 3
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    Identifying Patients at High Risk for Poor Outcome After Intra-Arterial Therapy for Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 5 ( 2009-05), p. 1780-1785
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 5 ( 2009-05), p. 1780-1785
    Abstract: Background and Purpose— Intra-arterial recanalization therapy (IAT) is increasingly used for acute stroke. Despite high rates of recanalization, the outcome is variable. We attempted to identify predictors of outcome that will enable better patient selection for IAT. Methods— All patients who underwent IAT at the University of Texas Houston Stroke Center were reviewed. Poor outcome was defined as modified Rankin Scale score 4 to 6 on hospital discharge. Findings were validated in an independent data set of 175 patients from the University of California at Los Angeles Stroke Center. Results— One hundred ninety patients were identified. Mean age was 62 years and median baseline National Institutes of Health Stroke Scale score was 0.18. Recanalization rate was 75%, symptomatic hemorrhage rate was 6%, and poor outcome rate was 66%. Variables associated with poor outcome were: age, baseline National Institutes of Health Stroke Scale, admission glucose, diabetes, heart disease, previous stroke, and the absence of mismatch on the pretreatment MRI. Logistic regression identified 3 variables independently associated with poor outcome: age ( P =0.049; OR, 1.028), National Institutes of Health Stroke Scale ( P =0.013; OR, 1.084), and admission glucose ( P =0.031; OR, 1.011). Using these data, we devised the Houston IAT score: 1 point for age 〉 75 years; 1 for National Institutes of Health Stroke Scale score 〉 18, and 1 point for glucose 〉 150 mg/dL (range, 0 to 3 mg/dL). The percentage of poor outcome by Houston IAT score was: score of 0, 44%; 1, 67%; 2, 97%; and 3, 100%. Recanalization rates were similar across the scores ( P =0.4). Applying Houston IAT to the external cohort showed comparable trends in outcome and nearly identical rates in the Houston IAT therapy 3 tier. Conclusions— The Houston IAT score estimates the chances of poor outcome after IAT, even with recanalization. It may be useful in comparing cohorts of patients and when assessing the results of clinical trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.535146
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
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  • 4
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    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
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  • 5
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    Safety of Eptifibatide for Subcortical Stroke Progression
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 28, No. 6 ( 2009), p. 595-600
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 28, No. 6 ( 2009), p. 595-600
    Abstract: 〈 i 〉 Background: 〈 /i 〉 There is no proven treatment for stroke progression in patients with subcortical infarcts. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, might halt stroke progression by improving flow in the microcirculation. 〈 i 〉 Methods: 〈 /i 〉 We conducted a retrospective analysis of patients with subcortical stroke who experienced deterioration and were treated with eptifibatide (loading dose 180 μg/kg; infusion 2 μg/kg/min) for 24–48 h. Oral antiplatelet agents were started 6 h before discontinuation of eptifibatide. 〈 i 〉 Results: 〈 /i 〉 Twenty-four patients with subcortical strokes were treated. The median admission NIHSS score was 5.0, which worsened to 8.5 (motor 5.0) before starting eptifibatide. The median NIHSS score 24 h after starting eptifibatide was 5.5. At 24 h, 42% had motor NIHSS scores less than or equal to pre-deterioration scores (50% for total NIHSS), and 50% had improved at least 1 motor point compared to pre-eptifibatide scores, which was sustained until hospital discharge. At discharge, the median total NIHSS score was 4.5. Ninety-two percent of patients were discharged home or to inpatient rehabilitation. Treatment was stopped early in 1 case due to a platelet drop 〈 100,000/μl. No systemic or intracerebral bleeding occurred. 〈 i 〉 Conclusions: 〈 /i 〉 Eptifibatide infusion may be safe in patients with subcortical ischemic strokes. Future studies are needed to test the safety and potential efficacy of this agent in subcortical stroke progression.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000247604
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1482069-9
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  • 6
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    Online Resource
    SITS-MOST: old myths laid to rest
    Elsevier BV ; 2007
    In:  The Lancet Neurology Vol. 6, No. 4 ( 2007-04), p. 292-293
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 6, No. 4 ( 2007-04), p. 292-293
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(07)70063-7
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2007
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  • 7
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    Type 2 Diabetes Mellitus and Impaired Renal Function Are Associated With Brain Alterations and Poststroke Cognitive Decline
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 9 ( 2017-09), p. 2368-2374
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 9 ( 2017-09), p. 2368-2374
    Abstract: Type 2 diabetes mellitus (T2DM) is associated with diseases of the brain, kidney, and vasculature. However, the relationship between T2DM, chronic kidney disease, brain alterations, and cognitive function after stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort. Methods— The TABASCO (Tel Aviv brain acute stroke cohort) is a prospective cohort of stroke/transient ischemic attack survivors. The volume and white matter integrity, ischemic lesions, and brain and hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were performed on 507 patients, who were diagnosed as having mild cognitive impairment, dementia, or being cognitively intact after 24 months. Results— At baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] 〈 60 mL/min) were associated with smaller brain and hippocampal volumes, reduced cortical thickness, and worse white matter microstructural integrity. Two years later, both T2DM and eCCl 〈 60 mL/min were associated with poorer cognitive scores, and 19.7% of the participants developed cognitive decline (mild cognitive impairment or dementia). Multiple analysis, controlling for age, sex, education, and apolipoprotein E4, showed a significant association of both T2DM and eCCl 〈 60 mL/min with cognitive decline. Having both conditions doubled the risk compared with patients with T2DM or eCCl 〈 60 mL/min alone and almost quadrupled the risk compared with patients without either abnormality. Conclusions— T2DM and impaired renal function are independently associated with abnormal brain structure, as well as poorer performance in cognitive tests, 2 years after stroke. The presence of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl have an independent and additive effect on brain atrophy and the risk of cognitive decline. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01926691.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.017709
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
    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
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  • 9
    Online Resource
    Online Resource
    The Spot Sign in Intracerebral Hemorrhage: The Importance of Looking for Contrast Extravasation
    S. Karger AG ; 2010
    In:  Cerebrovascular Diseases Vol. 29, No. 3 ( 2010), p. 217-220
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 29, No. 3 ( 2010), p. 217-220
    Abstract: 〈 i 〉 Background: 〈 /i 〉 The ‘spot sign’ is a bright spot on computerized tomography angiography (CTA) source images predictive of hematoma growth. Contrast extravasation (CE) is seen on routine head CT following CTA as pooling of contrast within the hematoma. Our aim was to re-evaluate the predictive value of both the spot sign and CE and measure the reliability of scoring them. 〈 i 〉 Methods: 〈 /i 〉 Consecutive cases of spontaneous intracerebral hemorrhage (ICH) presenting within 4 h. The presence of a ‘spot’ and CE, ICH and intraventricular hemorrhage volume at baseline and on follow-up scans were assessed. Clinical outcome was captured using the modified Rankin Scale on hospital discharge. 〈 i 〉 Results: 〈 /i 〉 We identified 28 patients with a mean age of 56.8 years, median ICH volume of 19 ml, and median NIH Stroke Scale score on admission of 17.5. 11/27 (40.7%) had a positive spot and 13/22 (59.1%) had CE. Interrater reliability was 0.812 (95% CI 0.57–0.91, p 〈 0.001) for the spot sign and 0.952 (95% CI 0.89–0.98, p 〈 0.001) for CE. ICH volume increased in 16/28 (57.1%) patients. Both the spot sign and CE were associated with ICH growth (p 〈 0.001) and poor outcome (p 〈 0.001). 〈 i 〉 Conclusions: 〈 /i 〉 In ICH patients, the presence of the spot sign or CE is highly correlated with early ICH growth. In our experience, CE is a more sensitive predictor of ICH growth with a better negative predictive value than the spot sign; CE is more consistently identified even by experienced clinicians. Postcontrast CT should be done routinely after CTA in patients presenting with ICH within 4 h. Patients who are CE-positive may be candidates for hemostatic therapies or early surgical intervention.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000267842
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
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  • 10
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    Online Resource
    Intracranial Atherosclerosis Is Associated with Progression of Neurological Deficit in Subcortical Stroke
    S. Karger AG ; 2012
    In:  Cerebrovascular Diseases Vol. 33, No. 1 ( 2012), p. 64-68
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 33, No. 1 ( 2012), p. 64-68
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Progression of neurological deficit (PND) is a frequent complication of acute subcortical ischemic stroke (SCS). The role of intracranial atherosclerosis (IAS) in PND is controversial. Our goal was to evaluate IAS on admission, as predictor of PND in SCS patients. 〈 i 〉 Methods: 〈 /i 〉 SCS patients were identified from our prospective database from 2004 to 2008. Clinical and laboratory data were collected from charts, and radiographic data from original radiographs. The proximal intracranial arteries were graded as patent, irregular, stenotic, or occlusion. IAS was defined as irregularity or stenosis. PND was defined as a change in the National Institutes of Health Stroke Scale 〉 1 point. 〈 i 〉 Results: 〈 /i 〉 Two hundred and two SCS patients were identified. In 14%, PND occurred at a median of 2 days from onset. Univariate analysis by infarct location showed the following to be associated with PND: for anterior circulation infarcts (centrum semiovale/basal ganglia), M1 atherosclerosis (p = 0.042); for posterior circulation infarcts, vertebral artery atherosclerosis (p = 0.018). For both groups, we found a non-significant association with age (p = 0.2) and HbA1c levels (p = 0.095). No association was found with admission glucose levels. Multivariate analysis showed the following association with PND: for anterior circulation infarcts, M1 atherosclerosis (OR 4.7; 95% CI 1.2–18.8; p = 0.03); for pontine infarcts, vertebral artery atherosclerosis (OR 5.8; 95% CI 1.1–29.4; p = 0.033). There was an increase in PND likelihood with an increasing number of atherosclerotic vessels. 〈 i 〉 Discussion: 〈 /i 〉 In our cohort of SCS patients, PND was associated with IAS of the responsible vessels. These results suggest a role for IAS in the pathogenesis of PNF in SCS patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000333388
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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