Neurology June 11, 2013 Objective: Specific guidelines for management of cerebrovascular risk in women are currently lacking. This study aims to provide a consensus expert opinion to help make clinical decisions in women with carotid stenosis. Methods: Proposals for the use of carotid endarterectomy (CEA), carotid stenting (CAS), and medical therapy for stroke prevention in women with carotid […]
Background: Controversy surrounds the safety of intravenous (IV) tissue plasminogen activator (tPA) in ischemic stroke patients treated with warfarin. The European tPA license precludes its use in anticoagulated patients altogether. American guidelines accept IV tPA use with an international normalized ratio (INR) ≤1.7. The influence of warfarin on symptomatic intracerebral hemorrhage (SICH), arterial recanalization and […]
The Lancet Neurology: May 31, 2013. Systemic thrombolysis with alteplase is the only approved medical treatment for patients with acute ischaemic stroke. Thrombectomy is also increasingly used to treat proximal occlusions of the cerebral arteries, but has not shown superiority over systemic thrombolysis with alteplase. Many patients with acute ischaemic stroke are pretreated with antiplatelet or […]
AHA – May 30, 2013 Background and Purpose—Wake-up ischemic stroke (WUIS) patients are not thrombolysed even if they meet other criteria for treatment. We hypothesized that patients with WUIS showing no or early ischemic changes on brain imaging will have thrombolysis outcomes comparable with those with known time of symptom onset. Methods—Consecutive sampling of a […]
AHA – May 30, 2013 Background and Purpose—Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥10 mm). Methods—Forty patients treated […]
Stroke: June 1, 2013 The only treatment shown to improve outcome in acute ischemic stroke is tissue-type plasminogen activator administered within 3 hours (and perhaps longer) after stroke onset.1–3 Definitive data to support a role for acute endovascular stroke therapy, however, are lacking. Despite this lack of data, endovascular therapy is being used much more widely […]
Stroke. June 1, 2013 Stroke-related mortality in the United States fell by nearly 35% between 1999 and 2008. Arguably, the reduction was largely the result of reduced stroke incidence, a reflection of improved prevention.1 Consistent with this observation, the failures of several recent secondary stroke prevention trials were, in part, attributable to lower than historically expected […]
Annals of Neurology: May 30, 2013 ABSTRACT Approximately 700,000 people in the United States have an ischemic stroke annually. Substantial research has tested therapies for the very early treatment of ischemic stroke but, to date, only intravenous thrombolysis and intra-arterial measures to restore perfusion have shown success. Despite a 15-year effort to increase the use […]
STROKEAHA. May 28, 2013 Background and Purpose—An earlier study demonstrated significantly improved access, treatment, and outcomes after the implementation of a progressive, comprehensive stroke program at a tertiary care community hospital, Saint Luke’s Neuroscience Institute (SLNI). This study evaluated the costs associated with implementing such a program. Methods—Retrospective analysis of total hospital costs and payments for […]
Neurology May 28, 2013 Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review with practice recommendations. Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from […]
