Stroke; a journal of cerebral circulation
-
Clinical Trial
Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler.
The aim of this study was to assess the first multifrequency transcranial Doppler system that was specially developed to automatically detect and discriminate between solid and gaseous cerebral microemboli. ⋯ This study has shown that multifrequency transcranial Doppler can be used to automatically differentiate between solid and gaseous microemboli online. Most detected microemboli in this initial study of mechanical heart valves were classified as gaseous, whereas most were classified as solid in the patients with carotid stenosis.
-
Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) after stroke increases risk of hemorrhagic transformation, particularly in areas with blood-brain barrier leakage. Our aim was to characterize acute effects of rtPA administration on the integrity of microvascular barriers. ⋯ The DeltaR2* changes during rtPA delivery in MION-injected animals indicate extravasation of MION, which reflects increased permeability of the blood-brain barrier. This implies that late rtPA treatment rapidly aggravates early ischemia-induced damage to microvascular barriers, thereby enhancing hemorrhagic transformation.
-
Methods of performing and reporting randomized clinical trials (RCTs) are available, but weaknesses still occur. For observational studies, methodology is less well described, and weaknesses are even more likely. In recent guidelines for patients with subarachnoid hemorrhage (SAH), 25% of treatment recommendations are based on clinical trials. To interpret the results of research on the therapeutic effect of treatment modalities, definition of outcome measures is essential. We assessed quality of study design and outcome measures and presence and precision of definitions concerning major complications of SAH in studies evaluating treatment strategies in patients with aneurysmal SAH. ⋯ Most studies on treatment strategies in SAH suffer from methodological weaknesses. This implies that current management of patients with SAH is based on weak evidence.