International journal of stroke : official journal of the International Stroke Society
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There is an urgent need to identify patients at high risk during the ongoing coronavirus disease (COVID-19) pandemic. Whether a history of stroke is associated with increased severity of disease or mortality is unknown. ⋯ There is a ∼2.5-fold increase in odds of severe COVID-19 illness with a history of cerebrovascular disease.
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The COVID-19 pandemic affecting all parts of the world is having huge implications for stroke care. Not only do stroke patients appear to be more susceptible to severe infection, but the pandemic is having major implications on how we deliver stroke care, while ensuing safety of both our patients and health care professionals. ⋯ The World Stroke Organization has been monitoring the impact of the pandemic globally, and has identified an initial marked fall in stroke presentations as well as a widespread impact on stroke services. The pandemic is changing the way we deliver care, and has highlighted the enormous potential of telemedicine in stroke care.
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Randomized Controlled Trial Multicenter Study
TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion: Prioritize IV or endovascular treatment-A randomized trial.
For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. ⋯ Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.
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Recent prospective registration studies of transient ischemic attack in Western countries demonstrated that large artery atherosclerosis is the highest risk etiology for early stroke recurrence under urgent evaluation and treatment. On the other hand, some limited transient ischemic attack studies from East Asian countries showed transient ischemic attack patients due to small vessel occlusion were at a higher early stroke risk. ⋯ Small vessel occlusion-transient ischemic attack, especially with acute small deep infarct, had a higher early stroke risk compared with other etiologies in Japanese transient ischemic attack patients who received early management.
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Randomized Controlled Trial Comparative Study
Estimated treatment effect of ticagrelor versus aspirin by investigator-assessed events compared with judgement by an independent event adjudication committee in the SOCRATES trial.
Adjudication of endpoints is a standard procedure in cardiovascular clinical trials. However, several studies indicate that the benefit of adjudication in estimating treatment effect may be limited. ⋯ In SOCRATES, there was no clinically meaningful difference in the estimated treatment effect, on either the primary endpoint or stroke, by using investigator- or adjudicator-assessed events. Double-blind treatment outcome studies with stroke endpoints may not benefit from adjudication.