Stroke; a journal of cerebral circulation
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Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age. ⋯ In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
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Concurrent atherosclerosis of the intracranial and extracranial cerebrovascular system is common in Asians. The typical lesion patterns and the mechanisms of stroke in patients with concurrent stenoses are unclear. This study aimed to determine these stroke features of such patients in Hong Kong. ⋯ Concomitant perforating artery infarct, pial infarct, and borderzone infarcts; multiple diffusion-weighted imaging lesions, and infarcts in the leptomeningeal branches of the middle cerebral artery were more common in patients with concurrent stenoses, especially those with tandem lesions. This study suggested that the combination of hemodynamic compromise attributable to concurrent stenoses and artery-to-artery embolization is a common stroke mechanism in these patients.
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This is a retrospective review of patients who underwent endovascular recanalization > or = 8 hours after acute ischemic stroke symptom onset, including wake-up strokes, between June 2005 and June 2008. ⋯ Our data show that delayed endovascular revascularization of carefully selected patients is safe, effective, and improves clinical outcome.
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Letter
Total mismatch: negative diffusion-weighted imaging but extensive perfusion defect in acute stroke.
The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients. ⋯ PWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.