Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · May 2014
Multicenter Study Comparative Study Observational StudyCurrent status of recanalization therapy in acute ischemic stroke with symptomatic intracranial arterial occlusion in Korea.
Recent methodological advances in recanalization therapy may alter recanalization strategies and clinical outcomes in patients with symptomatic occlusion of intracranial cerebral arteries. However, few studies have analyzed these changes at a national level, with none conducted in Korea. ⋯ The variety and active use of endovascular approaches were quite noticeable. As a whole, recanalization therapy tended to contribute to favorable outcomes despite a significant increase of symptomatic hemorrhage.
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J Stroke Cerebrovasc Dis · May 2014
Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations.
The occlusion of the artery of Percheron results in bilateral thalamic and mesencephalic infarctions. In this series, we attempted to classify the subtypes of clinical presentations and long-term prognosis with regards to radiological patterns. ⋯ Our findings suggest that it is possible to identify clinical and radiological subgroups of Percheron artery infarct. The long-term follow-up outcome is generally good, except in cases with midbrain involvement.
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J Stroke Cerebrovasc Dis · May 2014
Imaging negative stroke: diagnoses and outcomes in intravenous tissue plasminogen activator-treated patients.
Intravenous (IV) Alteplase (tissue plasminogen activator [t-PA]) improves outcome in patients with acute ischemic stroke. Of those with full recovery, some may not have had ischemia. We analyzed the frequency and post-treatment outcomes of stroke code patients with no imaging evidence of stroke to establish the incidence of neuroimaging negative cerebral ischemia (NNCI) and stroke mimics treated with t-PA. In addition, we compared these patients with the group of stroke patients with imaging evidence of acute stroke to determine whether there was a difference in adverse events and functional outcomes. ⋯ Because most INS patients were found to have NNCI, which may represent either transient ischemic attack or aborted stroke, and there were no intracerebral hemorrhages in the INS group, our data support the safety of administering IV t-PA to all patients in whom acute ischemic stroke is clinically suspected. We have demonstrated that NNCI patients and stroke mimics are common, and future larger scale prospective studies are required to delineate the true frequencies of each and to evaluate differences in outcomes.
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J Stroke Cerebrovasc Dis · May 2014
ReviewSearching for salvageable brain: the detection of ischemic penumbra using various imaging modalities?
Various imaging modalities are used to identify the ischemic penumbra in patients with acute ischemic stroke. Although single-photon emission computed tomography (CT), perfusion-weighted magnetic resonance imaging (MRI), and perfusion CT are used to evaluate residual cerebral blood flow in the ischemic area, validation of the perfusion threshold for the penumbra has not been established. ⋯ A mismatch of these abnormalities is thought to correspond to the ischemic penumbra and has been used in clinical trials. Although new ligands, such as (18)F-fluoromisonidazole, that bind to hypoxic but viable ischemic tissue are currently available, positron emission tomography has yet to be developed as a clinical tool.
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J Stroke Cerebrovasc Dis · May 2014
Does symptom onset to primary stroke center time goals affect stroke outcome?
Treating acute ischemic stroke (AIS) within 4.5 hours and door-to-needle time of less than 60 minutes may optimize recovery. It is unknown if onset to Primary Stroke Center (PSC) time goals affect outcome. The purpose of this study was to examine effects of symptom onset to PSC time goals on outcome. ⋯ In our Comprehensive Stroke Center (CSC), onset to PSC time goals were not significant predictors of the 90-day outcome. Expedited care processes in CSC may compensate for differences in outcome. These results should be validated in a larger cohort and in PSCs versus CSCs.