Stroke; a journal of cerebral circulation
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Randomized Controlled Trial Multicenter Study Clinical Trial
Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis.
The benefit of carotid endarterectomy is highly dependent on surgical risk. However, little data are available concerning factors affecting the risk of endarterectomy performed for asymptomatic carotid artery stenosis outside the setting of a randomized controlled trial. The purpose of this study was to analyze the impact of potential preoperative risk factors on the frequency of postoperative complications in patients undergoing the operation for asymptomatic disease in academic medical centers. ⋯ The overall risk of postoperative stroke or death was nearly twice that reported by Asymptomatic Carotid Atherosclerosis Study (ACAS) investigators in the setting of a clinical trial but was within acceptable guidelines. Women were at higher postoperative risk than men, which supported ACAS findings. Additional high-risk groups were those aged 75 years or older, those with a history of congestive heart failure, and those undergoing prophylactic endarterectomy for asymptomatic stenosis in combination with coronary surgery. Knowledge of these rates may help to better assess an individual's postoperative risk and therefore the anticipated benefit of surgery.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group.
Piracetam, a nootropic agent with neuroprotective properties, has been reported in pilot studies to increase compromised regional cerebral blood flow in patients with acute stroke and, given soon after onset, to improve clinical outcome. We performed a multicenter, randomized, double-blind trial to test whether piracetam conferred benefit when given within 12 hours of the onset of acute ischemic stroke to a large group of patients. ⋯ Piracetam did not influence outcome when given within 12 hours of the onset of acute ischemic stroke. Post hoc analyses suggest that piracetam may confer benefit when given within 7 hours of onset, particularly in patients with stroke of moderate and severe degree. A randomized, placebo-controlled, multicenter study, the Piracetam Acute Stroke Study II (PASS II) will soon begin.
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Multicenter Study Clinical Trial
A systems approach to immediate evaluation and management of hyperacute stroke. Experience at eight centers and implications for community practice and patient care. The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study Group.
With the approval by the Food and Drug Administration of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke within 180 minutes of symptom onset, patients and prehospital and hospital systems will now have to treat stroke as a medical emergency. It is thus critical to develop efficient hospital-based methods for hyperacute stroke patient evaluation and intervention at both community-based and tertiary care academic centers. ⋯ Hyperacute stroke treatment can be initiated, often within 55 minutes of patient arrival at the hospital, in both community and academic settings when all aspects of stroke care processes are identified, streamlined, and built into the day-to-day operations of the prehospital and hospital healthcare delivery system.
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Multicenter Study Clinical Trial
We need stronger predictors of major vascular events in patients with a recent transient ischemic attack or nondisabling stroke. Dutch TIA Trial Study Group.
It has been proposed that most prognostic factors in patients with transient ischemic attack or nondisabling stroke are weak and consequently that patients at high risk of recurrent major vascular events cannot be reliably identified. ⋯ This analysis indicates that we need stronger predictors of recurrence risk in patients with a transient ischemic attack or nondisabling stroke.
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Multicenter Study Comparative Study
Ambulatory blood pressure monitoring in acute stroke. The West Birmingham Stroke Project.
Ambulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but their value in patients after a stroke is unknown, despite the fact that hypertension is an important cause of stroke and many patients have relatively high blood pressure (BP) levels at presentation. We therefore investigated the clinical use of a 24-hour oscillometric ABPM device in patients after acute stroke. We also investigated ABPM in different types of stroke (thrombosis, hemorrhage, and transient ischemic attack) and ethnic and sex differences. ⋯ This study demonstrates higher systolic BPs as recorded by ABPM (but not manually) in patients with intracerebral hemorrhage than in those with cerebral infarcts; higher levels were also found in blacks. ABPM recordings are useful in the assessment of BP in patients with stroke, who may be considered nondippers.