Stroke; a journal of cerebral circulation
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Review Meta Analysis
Endovascular treatment of intracranial aneurysms in elderly patients: a systematic review and meta-analysis.
Use of endovascular coiling for treatment of ruptured and unruptured intracranial aneurysms (IAs) in the elderly is increasing. We performed a meta-analysis of the literature examining clinical and angiographic outcomes for treatment of IAs in the elderly. ⋯ This study suggests that endovascular treatment of IAs in the elderly is associated with high long-term occlusion rates. Given the morbidity and mortality associated with endovascular treatment of IAs in the elderly, careful patient selection, especially in the case of patients with unruptured aneurysm, is recommended.
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Review Meta Analysis
Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review.
The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous and/or intra-arterial therapy, according to diabetes mellitus and AGL. ⋯ These results confirm that AGL and history of diabetes mellitus are associated with poor clinical outcome after thrombolysis. AGL may be a surrogate marker of brain infarction severity rather than a causal factor. However, randomized controlled evidences are needed to address the significance of a tight glucose control during thrombolysis on clinical outcome.
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Blood pressure (BP) lowering is often conducted as part of general acute management in patients with acute intracerebral hemorrhage. However, the relationship between BP after antihypertensive therapy and clinical outcomes is not fully known. ⋯ High achieved SBP after standardized antihypertensive therapy in hyperacute intracerebral hemorrhage was independently associated with poor clinical outcomes. Aggressive antihypertensive treatment may ameliorate clinical outcomes.
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Comparative Study
Comparison of short-term outcomes of thrombolysis for in-hospital stroke and out-of-hospital stroke in United States.
In-hospital stroke (IHS) differs from out-of-hospital stroke (OHS) in risk factors and outcomes. We compared IHS and OHS treated with thrombolysis from a large national cohort in a cross-sectional study to further clarify these differences. ⋯ Thrombolysed IHS is associated with worse discharge outcomes compared with thrombolysed OHS, likely because of their higher comorbidities and additional medical reasons for the index admission. Thrombolysis is not associated with a higher rate of intracerebral hemorrhage among IHS.
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To investigate relationships between the degree of early reperfusion achieved on perfusion-weighted imaging and clinical outcomes in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution studies. We hypothesized that there would be a strong correlation between the degree of reperfusion achieved and clinical outcomes in target mismatch (TMM) patients. ⋯ The degree of reperfusion documented on perfusion-weighted imaging after reperfusion therapies corresponds closely with clinical outcomes in TMM patients. Reperfusion of ≥90% of the perfusion lesion is an appropriate goal for reperfusion therapies to aspire to.