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  • 1
    Online Resource
    Online Resource
    Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY) : A Randomized, Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 9 ( 2007-09), p. 2518-2525
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 9 ( 2007-09), p. 2518-2525
    Abstract: Background and Purpose— Decompressive surgery (hemicraniectomy) for life-threatening massive cerebral infarction represents a controversial issue in neurocritical care medicine. We report here the 30-day mortality and 6- and 12-month functional outcomes from the DESTINY trial. Methods— DESTINY (ISRCTN01258591) is a prospective, multicenter, randomized, controlled, clinical trial based on a sequential design that used mortality after 30 days as the first end point. When this end point was reached, patient enrollment was interrupted as per protocol until recalculation of the projected sample size was performed on the basis of the 6-month outcome (primary end point=modified Rankin Scale score, dichotomized to 0 to 3 versus 4 to 6). All analyses were based on intention to treat. Results— A statistically significant reduction in mortality was reached after 32 patients had been included: 15 of 17 (88%) patients randomized to hemicraniectomy versus 7 of 15 (47%) patients randomized to conservative therapy survived after 30 days ( P =0.02). After 6 and 12 months, 47% of patients in the surgical arm versus 27% of patients in the conservative treatment arm had a modified Rankin Scale score of 0 to 3 ( P =0.23). Conclusions— DESTINY showed that hemicraniectomy reduces mortality in large hemispheric stroke. With 32 patients included, the primary end point failed to demonstrate statistical superiority of hemicraniectomy, and the projected sample size was calculated to 188 patients. Despite this failure to meet the primary end point, the steering committee decided to terminate the trial in light of the results of the joint analysis of the 3 European hemicraniectomy trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.485649
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Stroke MRI in Intracerebral Hemorrhage : Is There a Perihemorrhagic Penumbra?
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 7 ( 2003-07), p. 1674-1679
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 7 ( 2003-07), p. 1674-1679
    Abstract: Background and Purpose— Cerebral ischemia has been proposed as a contributing mechanism to secondary neuronal injury after intracerebral hemorrhage (ICH). The search for surrogate parameters that allow treatment stratification for spontaneous ICH continues. We sought to assess the presence and prognostic effect of perihemorrhagic ischemic changes and hypoperfusion in a prospective stroke MRI study. Methods— We performed stroke MRI in 32 patients with hyperacute ICH (mean, 16.9±17.2 mL) within 6 hours after symptom onset (mean, 3.1±1.3 hours). Clinical data at baseline (National Institutes of Health Stroke Scale) and on day 90 (Barthel Index, modified Rankin Scale) were assessed. Perihemorrhagic perfusion- and diffusion-weighted imaging changes were assessed in a 1-cm-wide area around the clot. Results— Despite a mild perihemorrhagic mean transit time prolongation of 0.7±1.1 second, there were no significant perihemorrhagic apparent diffusion coefficient or mean transit time changes indicating irreversible ischemia or hypoperfusion. ICH size, time to imaging, or clinical severity at baseline or outcome were not reflected by changes of relative apparent diffusion coefficient or perfusion-weighted imaging. ICH size correlated with baseline clinical severity ( r =0.51, P =0.005). There was a significant association ( P =0.0494) and a significant negative correlation ( r =−0.468, P =0.0103) of perihemorrhagic perfusion change with time from symptom onset not associated with ICH size. Conclusions— Perihemorrhagic hypoperfusion probably is a consequence of reduced metabolic demand (diaschisis) rather than a sign of ischemia. We found no evidence for a perihemorrhagic and potentially salvageable ischemic penumbra in hyperacute ICH. Further studies should address metabolic, toxic, apoptotic, and microvascular aspects.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000076010.10696.55
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 11 ( 2007-11), p. 2941-2947
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 11 ( 2007-11), p. 2941-2947
    Abstract: Background and Purpose— Several recent studies analyzing perfusion changes in acute intracerebral hemorrhage fed the debate whether there is secondary ischemic tissue damage in the vicinity of intracerebral hemorrhage. We used perfusion CT to address this question. Methods— We examined 36 patients between 2001 and 2002 with acute intracerebral hemorrhage (within 24 hours after symptom onset). A subgroup of 8 patients was examined serially on day 1, between days 2 and 4, and after day 5. Nonenhanced CT images and maps of cerebral blood flow, cerebral blood volume, and time to peak were evaluated by region of interest analysis. Results— In comparison to the contralateral hemisphere, perfusion values were clearly reduced around the hematoma (relative values: cerebral blood flow 0.51, cerebral blood volume 0.62, time to peak 1.7 seconds). There was no difference in size between the area of reduced perfusion and the area of edema (5.17 versus 5.75 cm 2 , respectively) surrounding the hematoma. At time point 2, the edema grew significantly. Conclusions— In accordance with previous studies, we found reduced perfusion as well as edema surrounding acute intracerebral hemorrhage. Regarding ischemic tissue damage, we did not detect an initial mismatch between the perfusion deficit and the edema and therefore could not identify any tissue at risk of ischemia. We therefore interpret the reduced perfusion as a secondary phenomenon, ie, reduced oxygen demand of tissue damaged by pressure and clot components, not as the cause of any tissue damage associated with acute intracerebral hemorrhage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.486977
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Prothrombin Gene G 20210 →A Transition Is a Risk Factor for Cerebral Venous Thrombosis
    Ovid Technologies (Wolters Kluwer Health) ; 1998
    In:  Stroke Vol. 29, No. 9 ( 1998-09), p. 1765-1769
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 9 ( 1998-09), p. 1765-1769
    Abstract: Background and Purpose —It has been recently reported that a G→A transition at nucleotide position 20210 in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increased risk of deep venous thrombosis. To date, it is unknown whether this polymorphism also represents a risk factor for cerebral venous thrombosis (CVT). Methods —Venous blood samples were collected from 45 patients with CVT and from 354 healthy blood donors as controls. A second control group consisted of 131 subjects with acute ischemic stroke or transient ischemic attack (TIA). Genomic DNA was isolated from peripheral blood leukocytes. Amplification of DNA was performed by polymerase chain reaction (PCR). The G→A transition at nucleotide position 20210 of the prothrombin gene was detected by allele-specific restriction digestion. Results —The G 20210 →A transition in the prothrombin gene was found in a heterozygous form in 4 of 45 patients with CVT (8.9%) and in 8 of 354 healthy control subjects (2.3%). This difference was statistically significant ( P =0.010). The G 20210 →A transition increased the relative risk for CVT approximately 5-fold (age-adjusted odds ratio 5.7; 95% CI 1.5 to 21.5). In contrast, in the group of patients with acute cerebral ischemia, only 3 of 131 subjects (2.3%) were heterozygous for the G 20210 →A transition, which corresponded to the prevalence in the group of healthy blood donors. Conclusions —The recently described G 20210 →A transition in the 3′-untranslated region of the prothrombin gene is an inherited risk factor for CVT but obviously not for acute ischemic stroke or TIA.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.29.9.1765
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1998
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Therapy for early reperfusion after stroke
    Springer Science and Business Media LLC ; 2006
    In:  Nature Clinical Practice Cardiovascular Medicine Vol. 3, No. 12 ( 2006-12), p. 656-663
    Details
    In: Nature Clinical Practice Cardiovascular Medicine, Springer Science and Business Media LLC, Vol. 3, No. 12 ( 2006-12), p. 656-663
    Type of Medium: Online Resource
    ISSN: 1743-4297 , 1743-4300
    URL: Article
    DOI: 10.1038/ncpcardio0721
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2006
    detail.hit.zdb_id: 2166915-6
    detail.hit.zdb_id: 2490378-4
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  • 6
    Online Resource
    Online Resource
    Intracerebral Hemorrhage With Severe Ventricular Involvement : Lumbar Drainage for Communicating Hydrocephalus
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 1 ( 2007-01), p. 183-187
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 1 ( 2007-01), p. 183-187
    Abstract: Background and Purpose— The objective was to analyze the feasibility of a lumbar drainage (LD) for a communicating malresorptive hydrocephalus in patients with supratentorial hemorrhage (intracerebral hemorrhage) accompanied by severe ventricular involvement (intraventricular hemorrhage) who required an external ventricular drain (EVD). Methods— In this retrospective study, 16 patients received an EVD and concurrent LD and were compared with 39 historical patients treated with EVD alone. The duration of required EVD and need for permanent ventriculoperitoneal-shunt were analyzed. Results— LD was inserted after 12 (4 to 18) days. In LD-treated patients, the LD was capable to replace repeated EVD exchanges, resulting in a shorter EVD-duration (12 versus 16 days) compared with patients treated with EVD alone. The overall duration of extracorporal cerebrospinal fluid drainage was longer (16 days EVD versus 21 days EVD+LD) and the frequency of ventriculoperitoneal-shunt lower (18.75% versus 33%; P 〈 0.03) in LD-treated patients. Conclusion— Our data suggest that LD is safe and feasible for treatment of nonpersistent communicating hydrocephalus after intracerebral hemorrhage. After adequate treatment of the occlusive hydrocephalus using an EVD in the acute phase, LD discloses an alternative for further extracorporal cerebrospinal fluid drainage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000251795.02560.62
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Long-Term Outcome After Surgical Treatment for Space-Occupying Cerebellar Infarction : Experience in 56 Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 9 ( 2009-09), p. 3060-3066
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 9 ( 2009-09), p. 3060-3066
    Abstract: Background and Purpose— Surgical management of space-occupying cerebellar infarction is still controversial. Data on long-term outcome are lacking. The objective of this study was (1) to evaluate outcome after at least 3 years poststroke in patients with space-occupying cerebellar infarction treated by ventriculostomy/extraventricular drainage (EVD) or suboccipital decompressive craniectomy (SDC), or both, and (2) to determine predicting factors for outcome. Methods— In this retrospective single-center study 56 consecutive patients with acute space-occupying cerebellar infarction treated surgically between 1996 and 2005 were included. Baseline data included clinical findings, Glasgow Coma Scale on admission and before surgery, NIHSS on admission, mass effects on neuroimaging, and surgical treatment strategies. Modified Rankin Scale, NIHSS, and Scale for the Assessment and Rating of Ataxia were used to assess outcome. Results— 39.3% of patients had died, 51.8% had a mRS ≤3, 35.7% had a mRS ≤2, 28.6% had a mRS ≤1. There were no significant differences in survival between treatment groups. In multivariate analysis age and mRS score at discharge were the most evident independent predictors for outcome. Conclusions— So far this is the largest study on long-term outcome after space-occupying cerebellar infarction. The value of different treatment strategies and prognostic factors for patient selection remain unclear and should be evaluated in larger prospective case-series or registries. To investigate the issue of preventive SDC randomized trials are needed.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.109.550913
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 1467823-8
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