Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jul 2014
Proposed approach to thrombolysis in dabigatran-treated patients presenting with ischemic stroke.
Acute ischemic stroke thrombolysis in patients taking dabigatran is controversial because of a presumed increased risk of symptomatic hemorrhagic transformation. Using data from our local hematopathology laboratory, we developed a thrombolysis protocol for acute ischemic stroke patients taking dabigatran. ⋯ Administration of intravenous tPA in dabigatran-treated patients is feasible. Although, the relationship between dabigatran concentrations and coagulation measures varies between laboratories, individual protocols, preferably based on TT, can be developed at acute stroke treatment centers.
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J Stroke Cerebrovasc Dis · Jul 2014
Improvement of cognitive function after carotid endarterectomy--a new strategy for the evaluation of cognitive function.
Significant carotid stenosis is known to cause ischemic stroke and cognitive impairment. However, it remains controversial whether carotid endarterectomy (CEA) can improve cognitive function in patients with carotid stenosis. We used the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) to compare cognitive function between before and after CEA. ⋯ After surgery, the MoCA score improved in patients who were 73 years or younger, who underwent CEA in the left side of their carotid lesion, who had severe carotid stenosis of more than 80%, who had bilateral lesion, who did not have abnormal lesion on diffusion-weighted imaging after surgery, or who had cerebral blood flow of pre-CEA over 34.5 mL. In conclusion, MoCA was feasible in patients soon after undergoing CEA. Using MoCA not MMSE, CEA may improve cognitive function in patients with significant carotid stenosis.
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J Stroke Cerebrovasc Dis · Jul 2014
Activation of peroxisome proliferator-activated receptor β/δ attenuates acute ischemic stroke on middle cerebral ischemia occlusion in rats.
Peroxisome proliferator-activated receptor (PPAR)-β/δ is a transcription factor that belongs to the nuclear hormone receptor family. There is little information about the effects of the immediate administration of specific ligands of PPAR-β/δ (GW0742) in animal models of acute ischemic stroke. Using a rat model of middle cerebral ischemia occlusion (MCAO) in vivo, we have investigated the effect of pretreatment with GW0742 before MCAO. ⋯ The study suggests the neuroprotective effect of the PPAR-β/δ ligand GW0742 in acute ischemic stroke by a mechanism that may involve its anti-inflammatory and antiapoptotic action.
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J Stroke Cerebrovasc Dis · Jul 2014
Randomized Controlled TrialTranexamic acid for spontaneous intracerebral hemorrhage: a randomized controlled pilot trial (ISRCTN50867461).
Spontaneous intracerebral hemorrhage (ICH) can be devastating, particularly if hematoma expansion (HE) occurs. Tranexamic acid (TA), an antifibrinolytic drug, significantly reduced mortality in bleeding patients after trauma in the large CRASH-2 trial. The CRASH-2 ICH substudy found that TA nonsignificantly reduced mortality and dependency in traumatic ICH. The aim of this study was to assess the feasibility of performing a randomized controlled trial of tranexamic acid in spontaneous ICH, ahead of a definitive study. ⋯ This, the first randomized controlled trial of TA in ICH, found that the protocol could be delivered on schedule (2 patients/mo) and was feasible. Larger studies are needed to assess safety and efficacy of TA in ICH.
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J Stroke Cerebrovasc Dis · Jul 2014
Multicenter StudyRelationship between magnetic resonance angiography-diffusion-weighted imaging mismatch and clinical outcome in endovascular treatment for acute ischemic stroke: subgroup analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism--Japan Registry.
The presence or absence of the penumbra area is important when performing reperfusion therapy in patients with acute ischemic stroke. As a predictor of this penumbra area, magnetic resonance angiography (MRA)-diffusion-weighted imaging (DWI) mismatch is attracting attention. The usefulness of MRA-DWI mismatch (MDM) using the DWI-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in endovascular treatment (EVT) of patients with cerebral large vessel occlusion was evaluated. ⋯ This study demonstrated the safety and efficacy of EVT in MDM-P patients within 3 hours of symptom onset. Although the ratio of patients who had a favorable outcome was high in the MDM-P patients admitted 3-8 hours after the onset, the difference was not significant.