Latest & greatest articles for stroke

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Top results for stroke

21. Meta-Regression to Identify Patients Deriving the Greatest Benefit from Dual Antiplatelet Therapy after Stroke or Transient Ischemic Attack Without Thrombolytic or Thrombectomy Treatment

Meta-Regression to Identify Patients Deriving the Greatest Benefit from Dual Antiplatelet Therapy after Stroke or Transient Ischemic Attack Without Thrombolytic or Thrombectomy Treatment The patient's profile drawing the greatest benefit from dual antiplatelet therapy (DAPT) after a noncardioembolic, ischemic cerebrovascular event is not well characterized. Aim of this metaregression analysis was to compare DAPT versus single antiplatelet therapy (SAPT) in patients with stroke or transient (...) ischemic attack (TIA). We searched randomized trials evaluating clinical outcome with aspirin plus a P2Y12 inhibitor versus SAPT in patients with noncardioembolic stroke or TIA. Primary end point was the incidence of recurrent stroke; safety outcome measure was major bleeding. Eleven trials were included in the analysis, enrolling 24,175 patients treated with DAPT (aspirin plus clopidogrel, n = 12,074) or SAPT (n = 12,101) after a stroke or TIA event. In the DAPT group the rates of recurrent stroke

2019 EvidenceUpdates

22. Antiplatelet Therapy After Noncardioembolic Stroke

Antiplatelet Therapy After Noncardioembolic Stroke Background and Purpose- We assessed the efficacy and safety of antiplatelet agents after noncardioembolic stroke or transient ischemic attack and examined how these vary according to patients' demographic and clinical characteristics. Methods- We did a network meta-analysis (NMA) of data from 6 randomized trials of the effects of commonly prescribed antiplatelet agents in the long-term (≥3 months) secondary prevention of noncardioembolic stroke (...) or transient ischemic attack. Individual patient data from 43 112 patients were pooled and reanalyzed. Main outcomes were serious vascular events (nonfatal stroke, nonfatal myocardial infarction, or vascular death), major bleeding, and net clinical benefit (serious vascular event or major bleeding). Subgroup analyses were done according to age, sex, ethnicity, hypertension, qualifying diagnosis, type of vessel involved (large versus small vessel disease), and time from qualifying event to randomization

2019 EvidenceUpdates

23. Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral (...) . For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral

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2019 EvidenceUpdates

24. Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. (PubMed)

Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. Hyperglycemia during acute ischemic stroke is common and is associated with worse outcomes. The efficacy of intensive treatment of hyperglycemia in this setting remains unknown.To determine the efficacy of intensive treatment of hyperglycemia during acute ischemic stroke.The Stroke Hyperglycemia Insulin Network Effort (SHINE) randomized clinical (...) trial included adult patients with hyperglycemia (glucose concentration of >110 mg/dL if had diabetes or ≥150 mg/dL if did not have diabetes) and acute ischemic stroke who were enrolled within 12 hours from stroke onset at 63 US sites between April 2012 and August 2018; follow-up ended in November 2018. The trial included 1151 patients who met eligibility criteria.Patients were randomized to receive continuous intravenous insulin using a computerized decision support tool (target blood glucose

2019 JAMA

25. Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice. (PubMed)

Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice. Randomized clinical trials suggest benefit of endovascular-reperfusion therapy for large vessel occlusion in acute ischemic stroke (AIS) is time dependent, but the extent to which it influences outcome and generalizability to routine clinical practice remains uncertain.To characterize the association of speed of treatment with outcome (...) among patients with AIS undergoing endovascular-reperfusion therapy.Retrospective cohort study using data prospectively collected from January 2015 to December 2016 in the Get With The Guidelines-Stroke nationwide US quality registry, with final follow-up through April 15, 2017. Participants were 6756 patients with anterior circulation large vessel occlusion AIS treated with endovascular-reperfusion therapy with onset-to-puncture time of 8 hours or less.Onset (last-known well time) to arterial

2019 JAMA

26. Diagonal Earlobe Crease: A Warning Sign of Stroke

Diagonal Earlobe Crease: A Warning Sign of Stroke "Diagonal Earlobe Crease: A Warning Sign of Stroke" by Matthew Elyea and Justin Curran > > > > Title Author Date of Graduation 8-10-2019 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Abstract Background : The diagonal earlobe crease (DELC), commonly referred to as “Frank’s sign”, was first described in 1973 by an American physician as a crease in the earlobe that originates (...) at the tragus and runs diagonally towards the outer, lower edge. Over the past half-century, research on this dermatologic finding has found a significant correlation between the presence of a DELC and coronary artery disease (CAD). Additionally, DELC has also been associated with other risk factors associated with both CAD and stroke, which include hypertension (HTN), diabetes mellitus (DM), and age. Despite this, skepticism has led to this physical exam finding being overlooked as a predictive marker

2019 Pacific University EBM Capstone Project

27. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis

The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis To investigate the effectiveness of trunk training on trunk control, sitting and standing balance and mobility.PubMed/MEDLINE, Web of Science, Physiotherapy Evidence Database (PEDro), Cochrane Library, Rehab+ and ScienceDirect were searched until January 2019.Randomized controlled trials were included if they investigated the effect of trunk (...) exercises on balance and gait after stroke. Four reviewers independently screened and performed data extraction and risk of bias assessment with the PEDro scale. Disagreements were resolved by a fifth independent reviewer. A meta-analysis was performed to quantitatively describe the results.After screening of 1881 studies, 22 studies and 394 participants met the inclusion criteria. Trunk training was executed as core stability, reaching, weight-shift or proprioceptive neuromuscular facilitation

2019 EvidenceUpdates

28. Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial

Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial Although dual antiplatelet therapy with aspirin and clopidogrel reduces early recurrence of ischaemic stroke, with long-term use this type of therapy is no longer effective and the risk of bleeding increases. Given that cilostazol prevents stroke recurrence without increasing the incidence of serious bleeding compared (...) with aspirin, we aimed to establish whether dual antiplatelet therapy involving cilostazol is safe and appropriate for long-term use.In a multicentre, open-label, randomised controlled trial across 292 hospitals in Japan, patients with high-risk non-cardioembolic ischaemic stroke identified on MRI were randomly assigned to two groups in a 1:1 ratio to receive monotherapy with either oral aspirin (81 or 100 mg, once per day) or clopidogrel (50 or 75 mg, once per day) alone, or a combination of cilostazol

2019 EvidenceUpdates

29. Dopamine Augmented Rehabilitation in Stroke (DARS): a multicentre double-blind, randomised controlled trial of co-careldopa compared with placebo, in addition to routine NHS occupational and physical therapy, delivered early after stroke on functional rec

Dopamine Augmented Rehabilitation in Stroke (DARS): a multicentre double-blind, randomised controlled trial of co-careldopa compared with placebo, in addition to routine NHS occupational and physical therapy, delivered early after stroke on functional rec Dopamine Augmented Rehabilitation in Stroke (DARS): a multicentre double-blind, randomised controlled trial of co-careldopa compared with placebo, in addition to routine NHS occupational and physical therapy, delivered early after stroke (...) , physical functioning, mood or cognition following stroke. {{author}} {{($index , , , , , , , , , , , , & . Gary A Ford 1, * , Bipin B Bhakta 2, † , Alastair Cozens 3 , Bonnie Cundill 4 , Suzanne Hartley 4 , Ivana Holloway 4 , David Meads 5 , John Pearn 2 , Sharon Ruddock 4 , Catherine M Sackley 6 , Eirini-Christina Saloniki 5 , Gillian Santorelli 4 , Marion F Walker 7 , Amanda J Farrin 4 1 Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK 2 Academic Department

2019 NIHR HTA programme

30. Stroke in Patients With Peripheral Artery Disease

Stroke in Patients With Peripheral Artery Disease Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods (...) - EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were

2019 EvidenceUpdates

31. Nurse-Initiated Acute Stroke Care in Emergency Departments

Nurse-Initiated Acute Stroke Care in Emergency Departments Background and Purpose- We aimed to evaluate the effectiveness of an intervention to improve triage, treatment, and transfer for patients with acute stroke admitted to the emergency department (ED). Methods- A pragmatic, blinded, multicenter, parallel group, cluster randomized controlled trial was conducted between July 2013 and September 2016 in 26 Australian EDs with stroke units and tPA (tissue-type plasminogen activator) protocols (...) . Hospitals, stratified by state and tPA volume, were randomized 1:1 to intervention or usual care by an independent statistician. Eligible ED patients had acute stroke <48 hours from symptom onset and were admitted to the stroke unit via ED. Our nurse-initiated T3 intervention targeted (1) Triage to Australasian Triage Scale category 1 or 2; (2) Treatment: tPA eligibility screening and appropriate administration; clinical protocols for managing fever, hyperglycemia, and swallowing; (3) prompt (<4 hours

2019 EvidenceUpdates

32. Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians.EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search.Randomized controlled (...) trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria.A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination

2019 EvidenceUpdates

33. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. (PubMed)

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used

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2019 Lancet

34. Marine-derived n-3 fatty acids therapy for stroke. (PubMed)

Marine-derived n-3 fatty acids therapy for stroke. Currently, with stroke burden increasing, there is a need to explore therapeutic options that ameliorate the acute insult. There is substantial evidence of a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs) in experimental stroke, leading to a better functional outcome.To assess the effects of administration of marine-derived n-3 PUFAs on functional outcomes and dependence in people with stroke.Our secondary (...) outcomes were vascular-related death, recurrent events, incidence of other type of stroke, adverse events, quality of life, and mood.We searched the Cochrane Stroke Group trials register (6 August 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, January 2019), MEDLINE Ovid (from 1948 to 6 August 2018), Embase Ovid (from 1980 to 6 August 2018), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; from 1982 to 6 August 2018), Science Citation Index Expanded

2019 Cochrane

35. Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke. (PubMed)

Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke. Reducing postprocedural stroke is important to improve the safety of transcatheter aortic valve replacement (TAVR).This study evaluated the trends of stroke occurring within 30 days after the procedure during the first 5 years TAVR was used in the United States, the association of stroke with 30-day mortality, and the association of medical therapy with 30-day stroke risk.Retrospective cohort study (...) including 101 430 patients who were treated with femoral and nonfemoral TAVR at 521 US hospitals in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry from November 9, 2011, through May 31, 2017. Thirty-day follow-up ended June 30, 2017.TAVR.The rates of 30-day transient ischemic attack and stroke were assessed. Association of stroke with 30-day mortality and association of antithrombotic medical therapies with postdischarge 30-day stroke were assessed

2019 JAMA

36. Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. (PubMed)

Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke. Transcatheter aortic valve replacement (TAVR) indications are expanding, leading to an increasing number of patients with bicuspid aortic stenosis undergoing TAVR. Pivotal randomized trials conducted to obtain US Food and Drug Administration approval excluded bicuspid anatomy.To compare the outcomes of TAVR with a balloon-expandable valve for bicuspid vs tricuspid aortic (...) stenosis.Registry-based prospective cohort study of patients undergoing TAVR at 552 US centers. Participants were enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies Registry from June 2015 to November 2018.TAVR for bicuspid vs tricuspid aortic stenosis.Primary outcomes were 30-day and 1-year mortality and stroke. Secondary outcomes included procedural complications, valve hemodynamics, and quality of life assessment.Of 81 822 consecutive

2019 JAMA

37. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. (PubMed)

Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. To test the hypothesis that ticagrelor plus aspirin is safe and superior to clopidogrel plus aspirin for reducing high platelet reactivity at 90 days and stroke recurrence in patients with minor stroke or transient ischaemic attack, particularly in carriers of the CYP2C19 loss-of-function (...) allele and patients with large artery atherosclerosis.Open label, blinded endpoint, randomised controlled phase II trial.Prospective studies conducted at 26 centres in China, August 2015 to March 2017.675 patients with acute minor stroke or transient ischaemic attack.Ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300 mg loading dose, 75 mg daily thereafter) on a background of aspirin (100 mg daily for the first 21 days) within 24 hours of symptom onset.Primary outcome

2019 BMJ

38. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association

Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update | Stroke Search Hello Guest! Login to your account Email Password Keep me logged in Search July 2019 June 2019 May 2019 April 2019 March 2019 February 2019 February 2019 January 2019 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies (...) . Free Access article Share on Jump to Free Access article Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update A Policy Statement From the American Stroke Association , MD, MS, FAHA, Chair , RN, MSN, FAHA , MD , CRNP , MD , MD , MD, MS, FAHA , MD, MHS, FAHA , MD , MD , MD, FAHA , MA , MD, FAHA MD, MS, FAHA Opeolu Adeoye , Karin V. Nyström , Dileep R. Yavagal , Jean Luciano , Raul G. Nogueira , Richard D. Zorowitz , Alexander A. Khalessi , Cheryl Bushnell , William G. Barsan

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2019 American Heart Association

39. ACR–ASNR–SIR–SNIS Practice Parameter for the Performance of Endovascular Embolectomy and Revascularization in Acute Stroke

ACR–ASNR–SIR–SNIS Practice Parameter for the Performance of Endovascular Embolectomy and Revascularization in Acute Stroke PRACTICE PARAMETER 1 Acute Stroke The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services (...) , and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Adopted 2018 (Resolution 18)* ACR –ASNR –SIR –SNIS PRACTICE PARAMETER FOR THE PERFORMANCE OF ENDOVASCULAR EMBOLECTOMY AND REVASCULARIZATION IN ACUTE STROKE PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters

2019 American Society of Neuroradiology

40. Therapeutic hypothermia for acute ischaemic stroke

Therapeutic hypothermia for acute ischaemic stroke Ther Therapeutic h apeutic hypothermia for acute ischaemic ypothermia for acute ischaemic strok stroke e Interventional procedures guidance Published: 29 May 2019 www.nice.org.uk/guidance/ipg647 Y Y our responsibility our responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully (...) . Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. 1 1 Recommendations Recommendations 1.1 Current evidence on the safety of therapeutic hypothermia for acute ischaemic stroke shows that there are serious

2019 National Institute for Health and Clinical Excellence - Interventional Procedures