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Latest & greatest articles for stroke
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on stroke or other clinical topics then use Trip today.
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Efficacy of Endovascular Therapy in Acute IschemicStroke Depends on Age and Clinical Severity Efficacy of endovascular treatment (EVT) for ischemicstroke because of large vessel occlusion may depend on patients' age and stroke severity; we, therefore, developed a prognosis score based on these variables and examined whether EVT efficacy differs between patients with good, intermediate, or poor prognostic score.A total of 4079 patients with an acute ischemicstroke were identified from (...) the Paris Stroke Consortium registry. We developed the stroke checkerboard (SC) score (SC score=1 point per decade ≥50 years of age and 2 points per 5 points on the National Institutes of Health Stroke Scale) to predict spontaneous outcome. The primary outcome was the adjusted common odds ratio for an improvement in the modified Rankin Scale at 90 days after EVT, in patients with low, intermediate, or high SC scores. To rule out potential selection biases, a nested case-control analysis, with individual
ischemic injury in a PRACTICE PARAMETER 3 Acute Stroke defined vascular distribution, or clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting >24 hours or until death, and other etiologies excluded. (Note: CNS infarction includes hemorrhagic infarctions (HI), types I and II; see “Hemorrhagic Infarction” [15-18].) Diagnostic catheter angiography – a minimally invasive procedure involving percutaneous catheterization of any of the arteries or veins (...) and/or recommendations regarding performance and reporting of the endovascular procedure and periprocedural care, and v) recommendations on quality control and performance improvement. Every year in the United States, an estimated 795,000 people suffer an ischemicstroke. It is estimated that at least approximately 10%, or nearly 80,000, of these strokes will be caused by an emergent large-vessel occlusion (ELVO) affecting the intracranial internal carotid artery, the proximal middle cerebral artery
Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial Dysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this group of patients. We aimed to replicate and extend this single-centre experience.We did a prospective, single (...) -blind, randomised controlled trial across nine sites (seven acute care hospitals, two rehabilitation facilities) in Germany, Austria, and Italy. Patients with recent stroke who required tracheotomy were randomly assigned to receive 3 days of either PES or sham treatment (1:1). All patients had the stimulation catheter inserted; sham treatment was applied by connecting the PES base station to a simulator box instead of the catheter. Randomisation was done via a computerised interactive system
Clinical Prediction Rules to Classify Types of Stroke at Prehospital Stage: Japan Urgent Stroke Triage (JUST) Score Background and Purpose- Endovascular therapy is effective against acute cerebral large vessel occlusion (LVO). However, many patients do not receive such interventions because of the lack of timely identification of the type of stroke. If the types of stroke (any stroke, LVO, intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were to be predicted at the prehospital (...) stage, better access to appropriate interventions would be possible. Japan Urgent Stroke Triage (JUST) score was clinical prediction rule to classify suspected patients of acute stroke into different types at the prehospital stage. Methods- We obtained information for signs and symptoms and medical history of consecutive suspected patients of acute stroke at prehospital stage from paramedics and final diagnosis from the receiving hospital. We constructed derivation cohort in the historical
. The proximal landing of the stent graft was in zone 0 in 22 patients, zone 1 in 23 patients, and zone 2 in 32 patients. The shagginess score of each patient was calculated from preoperative contrast-enhanced computed tomography images of the aorta using a workstation. The relationships between preoperative factors, including the shagginess score, and the development of perioperative stroke and late survival were analyzed retrospectively.Perioperative ischemicstroke occurred in nine patients (...) , and no patient died within 30 days postoperatively. Univariate analyses demonstrated that the shagginess score was significantly higher in patients who developed postoperative cerebralinfarction than in those who did not (P = .04). The median follow-up period was 1570 days, and the 5-year cumulative survival rate was 69.2%. Cox proportional hazards analyses showed that comorbid hypercholesterolemia was significantly associated with all-cause mortality (hazard ratio [HR], 3.22; 95% confidence interval [CI
Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.A pilot, randomized, single-blind, controlled trial.Stroke rehabilitation inpatient unit.Participants (N=48 (...) ) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.Primary outcome measures were changes in Fugl-Meyer Assessment
and unpublished data.We included one pilot trial with nine participants. The trial was a feasibility trial that included participants with an unknown onset of stroke and signs on perfusion computed tomography of ischaemic tissue at risk of infarction, who were randomised to alteplase (0.9 mg/kg) or placebo. One trial was prematurely terminated due to signs of efficacy of the intervention arm; we did not include this trial because we were not able to obtain data for the portion of the participants with wake-up (...) Recanalisation therapies for wake-up stroke. About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have traditionally been considered ineligible for thrombolytic treatment because the time of stroke onset is unknown. However, some studies suggest that these people may benefit from recanalisation therapies.To assess the effects of intravenous thrombolysis and other recanalisation therapies versus control in people with acute ischaemicstroke presenting
Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation.This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke (...) rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption.We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions
. Further, AF may be newly diagnosed with prolonged cardiac monitoring modalities in nearly a quarter of patients after stroke or transientischemicattack . The American Heart Association, American College of Cardiology, and . Given the associated morbidity of AF and significant stroke risk reduction with oral anticoagulation , should patients be screened for AF in primary stroke prevention? Opportunistic versus systematic screening Opportunistic screening is offered during a routine (...) the Atiral Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J . 2005;149(4):657-63. Lubitz SA, Yin X, McManus DD, et al. Stroke as the initial manifestation of atrial fibrillation: the Framingham Heart Study. 2017;48(2):490-2. Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transientischaemicattack: a systematic review and meta-analysis. Lancet Neurol . 2015;14(4):377-87. January CT, Wann LS
The effect of Tai Chi training on the dual-tasking performance of stroke survivors: a randomized controlled trial To compare the effect of Tai Chi training with conventional exercise on dual-tasking performance among stroke survivors.An assessor-blinded, randomized controlled trial.Community-dwelling stroke survivors.Community centers and university.Subjects in the Tai Chi group and the conventional exercise group were trained with the corresponding exercises for 12 weeks (1 hour/session, 2 (...) effect on dual-tasking performance compared with conventional exercise among stroke survivors. Further studies with larger sample size, longer training, and follow-up periods are needed.
Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial The risk of stroke associated with carotid artery restenosis after stenting or endarterectomy is unclear. We aimed to compare the long-term risk of restenosis after these treatments and to investigate if restenosis causes stroke in a secondary analysis of the International Carotid Stenting Study (ICSS).ICSS (...) is a parallel-group randomised trial at 50 tertiary care centres in Europe, Australia, New Zealand, and Canada. Patients aged 40 years or older with symptomatic carotid stenosis measuring 50% or more were randomly assigned either stenting or endarterectomy in a 1:1 ratio. Randomisation was computer-generated and done centrally, with allocation by telephone or fax, stratified by centre, and with minimisation for sex, age, side of stenosis, and occlusion of the contralateral carotid artery. Patients were
Clinical Utility of Electronic Alberta Stroke Program Early Computed Tomography Score Software in the ENCHANTED Trial Database Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke.All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemicstroke who participated in the alteplase (...) dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded. Included scans had e-ASPECTS scores correlated with baseline neurological severity (National Institutes of Health Stroke Scale scores) and 90-day disability outcomes (modified Rankin Scale scores). Multivariable logistic regression models were used to determine the predictive ability of e-ASPECTS
Preferred rehabilitation setting among stroke survivors in Nigeria and associated personal factors Incorporating patients' preferences in the care they receive is an important component of evidence-based practice and patient-centred care.This study assessed stroke patients' preferences regarding rehabilitation settings.A cross-sectional design was used to examine preferences of stroke patients receiving physiotherapy at three hospitals in Northern Nigeria. Personal factors and preferred (...) rehabilitation setting data were obtained using the Modified Rankin Scale (to assess global disability) and a researcher-developed questionnaire. Associations between preferences and personal factors were explored using bivariate statistics.Sixty stroke patients whose mean age was 53.6 ± 14.8 years participated in the study. Most of the participants (38.3%) preferred an outpatient setting, 19 (31.7%) preferred rehabilitation in their homes, 14 chose inpatient rehabilitation (23.3%), while 4 (6.7%) preferred
Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute IschemicStroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. More than half of patients with acute ischemicstroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled.To evaluate (...) the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling.The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemicstroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could
The efficacy comparison of citalopram, fluoxetine, and placebo on motor recovery after ischemicstroke: a double-blind placebo-controlled randomized controlled trial The present study aimed to assess the effectiveness of oral citalopram, compared with fluoxetine and a placebo, in patients with post-stroke motor disabilities.A randomized double-blind placebo-controlled clinical trial was conducted between January 2015 and January 2016.The neurology department of a university-affiliated urban (...) hospital in Tehran, Iran.Ninety adult patients with acute ischemicstroke, hemiplegia, or hemiparesis and a Fugl-Meyer Motor Scale score of below 55 were included.Participants were randomly allocated to one of three groups: Group A received 20 mg PO of fluoxetine daily, Group B received 20 mg PO of citalopram daily, and Group C received a placebo PO The duration of the therapy was 90 days. In addition to the medications, all of the participants received physiotherapy.Functional status at 90 days, which
with an average age of 73.6 years and higher prevalence of vascular risk factors. Adjusting for validated stroke risk factors, the risk of ischemicstroke within 1 year after THA or TKA in patients with new-onset atrial fibrillation was 2.7 times higher than in those without a history of atrial fibrillation (odds ratio: 2.7, 95% confidence interval: 1.5-4.8). Hospital length of stay and charges for patients with new-onset atrial fibrillation were also greater than patients with either a prior diagnosis (...) Risk of IschemicStroke After Perioperative Atrial Fibrillation in Total Knee and Hip Arthroplasty Patients To determine if new-onset perioperative atrial fibrillation during arthroplasty represents a benign response to intraoperative cardiac stress or is a risk factor for stroke, we evaluated the subsequent risk of ischemicstroke in patients with new-onset atrial fibrillation occurring during primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).Discharge data of all adult
Prevention of cardiovascular events in Asian patients with ischaemicstroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial The optimal treatment for patients with ischaemicstroke with a high risk of cerebral haemorrhage is unclear. We assessed the efficacy and safety of cilostazol versus aspirin, with and without probucol, in these patients.In this randomised, controlled, 2 × 2 factorial trial, we enrolled patients with ischaemicstroke (...) to assignment. The co-primary outcomes were incidence of the composite of stroke, myocardial infarction, or vascular death (efficacy) and incidence of haemorrhagic stroke (safety), which were assessed in intention-to-treat and modified intention-to-treat populations. Efficacy was analysed with a non-inferiority test and a superiority test if non-inferiority was satisfied. Safety was assessed with a superiority test only. This trial is registered with ClinicalTrials.gov, NCT01013532.Between Aug 1, 2009
Dynamic Changes of CHA2DS2-VASc Score and the Risk of IschaemicStroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic (...) changes in risk factors may increase the CHA2DS2-VASc score, stroke risk category and absolute ischaemicstroke rate. This article evaluates the 'dynamic' changes of CHA2DS2-VASc variables and its effect on prediction of stroke risk. From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015
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