Stroke; a journal of cerebral circulation
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Thin-section noncontrast computed tomography images can be used to measure hyperdense clot length in acute ischemic stroke. Clots≥8 mm have a very low probability of intravenous tissue-type plasminogen activator recanalization and hence may benefit from a bridging intra-arterial approach. To understand the prevalence of such clots, we sought to determine the distribution and predictors of clot lengths in consecutive anterior circulation proximal artery occlusions. ⋯ The majority of anterior circulation proximal occlusions are ≥8 mm long, helping to explain the low published rates of intravenous tissue-type plasminogen activator recanalization. Internal carotid artery-terminus occlusion is an excellent marker for clot length≥8 mm; vessel-imaging status alone may be sufficient. Thin-section noncontrast computed tomography seems useful for patients with middle cerebral artery occlusion because of the wide variability of clot lengths.
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Randomized Controlled Trial
CHANCE trial: early short-term dual antiplatelet treatment for stroke prevention.
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Use of the modified Rankin scale (mRS) in multicenter trials may be limited by interobserver variability. We assessed the effect of this on trial power and developed a novel group adjudication approach. ⋯ Achievable improvements in interobserver reliability may substantially reduce study sample size, with associated financial benefits. Central adjudication of mRS assessments is feasible (including across international centers), valid and reliable despite the challenges of mRS assessment in large clinical trials.
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Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. ⋯ In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.
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The association between stroke and subsequent dementia or Alzheimer disease is well established. What is less understood is the extent to which this association is dependent on prestroke cognitive functioning. The study estimated the occurrence in poststroke dementia as a function of prestroke cognitive status and incident stroke. ⋯ Stroke and prestroke cognition were independently associated with increased probability of poststroke dementia. Stroke results in disproportionate increase in the risk of dementia when premorbid cognitive functioning is high.