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
Randomized Controlled Trial Multicenter Study Comparative StudyA matched comparison of eptifibatide plus rt-PA versus rt-PA alone in acute ischemic stroke.
The Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator (rt-PA) in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER) trial found that intravenous rt-PA plus eptifibatide (combination arm) in acute ischemic stroke (AIS) was safe and had a direction of effect that would justify a phase III trial. CLEAR-ER had unanticipated imbalances between treatment groups. We compared the rates of symptomatic intracranial hemorrhage (sICH) and good outcomes for combination therapy patients in the CLEAR-ER trial to a matched cohort of rt-PA patients from the National Institute of Neurological Disorders and Stroke (NINDS) trial. ⋯ The safety and direction of effect of eptifibatide plus rt-PA were confirmed. A phase III trial is needed to determine the efficacy of eptifibatide plus rt-PA for improving long-term outcomes after AIS.
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J Stroke Cerebrovasc Dis · May 2014
Multicenter StudyEfficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry.
The aim of this nationwide, prospective registry of acute cerebral large-vessel occlusion was to assess the efficacy of endovascular treatment (EVT) on outcome in the "real-world" settings. ⋯ EVT significantly improved clinical outcomes in IV t-PA-failed and t-PA-ineligible patients with ICA/M1/BA occlusion. These findings support the introduction of EVT for acute proximal artery occlusion.
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J Stroke Cerebrovasc Dis · May 2014
Multicenter StudyPoor recognition of prompted treatment seeking even with good knowledge of stroke warning signs contribute to delayed arrival of acute ischemic stroke patients in Thailand.
Intravenous recombinant tissue plasminogen activator given within 4.5 hours after the onset of ischemic stroke is the most powerful standard treatment for patients with acute ischemic stroke. However, most of the patients arrive at the hospital later than 4.5-hours time window for intravenous thrombolysis. We study the factors that might contribute to delayed arrival in patients with acute ischemic stroke. ⋯ Association factors including day interval of the onset, mode of transportation, place of onset and knowledge of stroke warning signs are not different between groups (P > .05), whereas recognition of prompted treatment seeking is better in on-time group than in delayed group. In conclusion, good knowledge of stroke warning signs, most severe stroke, onset at workplace, onset during daytime, and ambulance for transportation are not associated with early arrival within 4.5-hours time window. However, sudden-onset nature and prompted treatment seeking may predict early arrival.
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J Stroke Cerebrovasc Dis · May 2014
Multicenter Study Comparative StudyWhite matter hyperintensities in mild cognitive impairment: clinical impact of location and interaction with lacunes and medial temporal atrophy.
This study was to evaluate the influence on cognition and activities of daily living (ADL) by white matter hyperintensities (WMHs) based on the severity and location, as well as the interactions among WMHs, lacunes, and medial temporal atrophy (MTA). In 150 patients with amnestic mild cognitive impairment, WMHs were quantified with the use of a semiautomated volumetric method. Lacune counting and MTA assessment were performed by visual rating. ⋯ Anterior PVWMHs demonstrated the most powerful impact on frontal executive dysfunction and poor performance of IADL. WMHs had synergistic effects with the number of lacunes on them. Therefore, it is desirable to consider WMHs and lacunes simultaneously as potential imaging biomarkers for predicting cognition and IADL in aMCI.