Subjects -> MEDICAL SCIENCES (Total: 8447 journals)
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CARDIOVASCULAR DISEASES (330 journals)                  1 2 | Last

Showing 1 - 200 of 330 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 7)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 59)
American Journal of Cardiology     Hybrid Journal   (Followers: 67)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 17)
American Journal of Hypertension     Hybrid Journal   (Followers: 28)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 5)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 3)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 2)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 32)
Artery Research     Hybrid Journal   (Followers: 4)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 2)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 17)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 8)
Cardiology in the Young     Hybrid Journal   (Followers: 34)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 10)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 7)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 1)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 15)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 101)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 252)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 15)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 36)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 11)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 6)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 7)
Current Cardiology Reviews     Hybrid Journal   (Followers: 4)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 14)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 2)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Heart Journal     Hybrid Journal   (Followers: 66)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 8)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 14)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 9)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 6)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 3)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 5)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 2)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 30)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Full-text available via subscription  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 17)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 28)
JMIR Cardio     Open Access  
Jornal Vascular Brasileiro     Open Access  
Journal of Clinical & Experimental Cardiology     Open Access   (Followers: 5)
Journal of Arrhythmia     Open Access  
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)

        1 2 | Last

Similar Journals
Journal Cover
International Journal of Stroke
Journal Prestige (SJR): 1.966
Citation Impact (citeScore): 3
Number of Followers: 30  
Hybrid Journal Hybrid journal   * Containing 3 Open Access Open Access article(s) in this issue *
ISSN (Print) 1747-4930 - ISSN (Online) 1747-4949
Published by Sage Publications Homepage  [1087 journals]
  • Editorial
    • Authors: Hugh Stephen Markus
      Pages: 5 - 6
      Abstract: International Journal of Stroke, Volume 15, Issue 1, Page 5-6, January 2020.

      Citation: International Journal of Stroke
      PubDate: 2020-02-04T02:06:22Z
      DOI: 10.1177/1747493019899833
      Issue No: Vol. 15, No. 1 (2020)
  • Conceptual framework for establishing the African Stroke Organization
    • Authors: Rufus Akinyemi, Fred Sarfo, Foad Abd-Allah, Yomi Ogun, Mofou Belo, Patty Francis, M Bettencourt Mateus, Kathleen Bateman, Pamela Naidoo, Augustina Charway-Felli, Albert Akpalu, Kolawole Wahab, Christian Napon, Oyedunni Arulogun, Ad Adams Ebenezer, Gloria Ekeng, George Scola, Kolapo Hamzat, Stanley Zimba, Paul Macaire Ossou-Nguiet, Julius Ademokoya, Philip Adebayo, Biniyam Alemayehu Ayele, Deise Catamo Vaz, Godwin Ogbole, Patrice Barasukan, Rita Melifonwu, Ikenna Onwuekwe, Sarah Belson, Albertino Damasceno, Njideka Okubadejo, Alfred K Njamnshi, Julius Ogeng’o, Richard W Walker, Amadou Gallo Diop, Adesola Ogunniyi, Rajesh Kalaria, Peter Sandercock, Stephen Davis, Michael Brainin, Bruce Ovbiagele, Mayowa Owolabi
      Abstract: International Journal of Stroke, Ahead of Print.
      Africa is the world’s most genetically diverse, second largest, and second most populous continent, with over one billion people distributed across 54 countries. With a 23% lifetime risk of stroke, Africa has some of the highest rates of stroke worldwide and many occur in the prime of life with huge economic losses and grave implications for the individual, family, and the society in terms of mental capital, productivity, and socioeconomic progress. Tackling the escalating burden of stroke in Africa requires prioritized, multipronged, and inter-sectoral strategies tailored to the unique African epidemiological, cultural, socioeconomic, and lifestyle landscape. The African Stroke Organization (ASO) is a new pan-African coalition that brings together stroke researchers, clinicians, and other health-care professionals with participation of national and regional stroke societies and stroke support organizations. With a vision to reduce the rapidly increasing burden of stroke in Africa, the ASO has a four-pronged focus on (1) research, (2) capacity building, (3) development of stroke services, and (4) collaboration with all stakeholders. This will be delivered through advocacy, awareness, and empowerment initiatives to bring about people-focused changes in policy, clinical practice, and public education. In the spirit of the African philosophy of Ubuntu “I am because we are,” the ASO will harness the power of diversity, inclusiveness, togetherness, and team work to build a strong, enduring, and impactful platform for tackling stroke in Africa.
      Citation: International Journal of Stroke
      PubDate: 2020-02-06T12:46:18Z
      DOI: 10.1177/1747493019897871
  • Sleep for Stroke Management and Recovery Trial (Sleep SMART): Rationale
           and methods
    • Authors: Devin L Brown, Valerie Durkalski, Jeffrey S Durmer, Joseph P Broderick, Darin B Zahuranec, Deborah A Levine, Craig S Anderson, Dawn M Bravata, H Klar Yaggi, Lewis B Morgenstern, Claudia S Moy, Ronald D Chervin
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleObstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events.Aims and/or hypothesisThe Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack.Sample size estimateA total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome.Methods and designSleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) of aCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely.Study outcomesTwo separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively.DiscussionSleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.
      Citation: International Journal of Stroke
      PubDate: 2020-02-05T06:29:12Z
      DOI: 10.1177/1747493020903979
  • Sleep duration and risk of cardiovascular events: The SAVE study
    • Authors: Jingwei Li, Danni Zheng, Kelly A Loffler, Xia Wang, R Doug McEvoy, Richard J Woodman, Yuanming Luo, Geraldo Lorenzi-Filho, Ferran Barbe, Manjari Tripathi, Craig S Anderson
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimControversy exists regarding cardiovascular risk in relation to sleep duration. We determined sleep duration and major recurrent cardiovascular event associations in patients with obstructive sleep apnoea and established cardiovascular disease.MethodsSecondary analyses of the international, multicenter, Sleep Apnea Cardiovascular Endpoints trial. Sleep duration was estimated from overnight home oximetry (ApneaLink monitor) used for obstructive sleep apnoea diagnosis. Cox proportional hazards models were used to determine associations of categorized sleep duration (8 h) and major cardiovascular outcomes: primary composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and any hospitalization for unstable angina, heart failure, or transient ischemic attack; secondary composite of cardiac and cerebral (stroke/transient ischemic attack) events.ResultsOximetry-derived sleep duration estimates were available in 2687 participants (mean 61.2 years, 80.9% males) who experienced a total of 436 cardiovascular events over a mean follow-up of 3.7 years. Compared to the reference category, sleep duration was not associated with risk of the primary composite cardiovascular outcome (adjusted hazard ratio (HR) 1.00, 95% confidence interval 0.76–1.33, and HR 1.22, 95% confidence interval 0.98–1.52, for sleep duration 8 h, respectively). However, long sleep was associated with increased cerebral events (HR 1.67, 95% confidence interval 1.17–2.39; P = 0.005) and stroke alone (HR 1.79, 95% confidence interval 1.22–2.63; P = 0.003).ConclusionsLong sleep duration is associated with an increased risk of stroke but not cardiac events in obstructive sleep apnoea patients with existing cardiovascular disease.Clinical trial registrationThe trial is registered at (NCT00738179).
      Citation: International Journal of Stroke
      PubDate: 2020-02-04T06:35:57Z
      DOI: 10.1177/1747493020904913
  • Risk factors and outcomes of intravenous tissue plasminogen activator and
           endovascular thrombectomy utilization amongst pediatrics acute ischemic
    • Authors: Preeti Malik, Urvish K Patel, Surabhi Kaul, Ramit Singla, Tapan Kavi, Kogulavadanan Arumaithurai, Vishal B Jani
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundPediatric stroke is a debilitating disease. There are several risk factors predisposing children to this life-threatening disease. Although, published literature estimates a relatively high incidence of pediatric stroke, treatment guidelines on intravenous tissue plasminogen activator and endovascular thrombectomy utilization remain a dilemma. There is a lack of large population-based studies and clinical trials evaluating the efficacy and safety outcomes associated with these treatments in this unique population.AimWe sought to determine the prevalence of risk factors, concurrent utilization of intravenous tissue plasminogen activator and endovascular thrombectomy, and associated outcomes in pediatric stroke hospitalizations.MethodsWe performed a retrospective analysis of the Nationwide Inpatient Sample data (2003–2014) in pediatric (1–21 years of age) acute ischemic stroke hospitalizations using ICD-9-CM codes. The multivariable survey logistic regression model was weighted to account for sampling strategy, evaluate predictors of hemorrhagic conversion, and treatment outcomes (mortality, morbidity, and discharge disposition) amongst pediatric stroke hospitalizations.ResultsIn this analysis, 9109 patients between 1 and 21 years of age were admitted during 2003–2014 for acute ischemic stroke. Of these 9109 patients, 119 (1.30%) received endovascular thrombectomy alone, 256 (2.82%) intravenous recombinant tissue plasminogen activator, and 69 (0.75%) both endovascular thrombectomy and intravenous recombinant tissue plasminogen activator. We found overall high prevalence of conditions like epilepsy (19.59%), atrial septal defect (11.76%), sickle cell disease (8.63%), and moyamoya disease (5.41%) in pediatric acute ischemic stroke patients. Unadjusted analysis showed high prevalence of all-cause in-hospital mortality in combined endovascular thrombectomy and intravenous recombinant tissue plasminogen activator utilization group, and higher prevalence of hemorrhagic conversion and morbidity in endovascular thrombectomy utilization group compared to other groups (p 
      Citation: International Journal of Stroke
      PubDate: 2020-02-03T06:55:30Z
      DOI: 10.1177/1747493020904915
  • Corrigendum
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-02-03T06:55:30Z
      DOI: 10.1177/1747493020906096
  • Stroke unit legislation—Mandating a uniform standard of care'
    • Authors: Olga C Pandos, Austin G Milton, Anjali Nagpal, Timothy J Kleinig, Jim Jannes, Simon A Koblar, M Anne Hamilton-Bruce
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-01-30T05:38:06Z
      DOI: 10.1177/1747493020903516
  • Hematoma Hounsfield units and expansion of intracerebral hemorrhage: A
           potential marker of hemostatic clot contraction
    • Authors: Han-Gil Jeong, Jae Seung Bang, Beom Joon Kim, Hee-Joon Bae, Moon-Ku Han
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundClot contraction reinforces hemostasis by providing an impermeable barrier and contractile force. Since computed tomography attenuation of intracerebral hemorrhage is largely determined by the density of red blood cells, clot contraction can be reflected in an increase of Hounsfield unit (HU) of hematoma.AimsWe hypothesized that hematoma expansion is inversely associated with mean HU of intracerebral hemorrhage at presentation.MethodsEighty-nine consecutive spontaneous intracerebral hemorrhage patients with onset to first computed tomography within 24 h were included. Hematomas were segmented using semiautomated planimetry to measure the volume and mean HU. Hematoma expansion was defined as an increase in hematoma volume by over 33% or 6 mL. Multivariable logistic regression was performed for hematoma expansion. The discrimination power of mean HU for hematoma expansion was assessed using C-statistic.ResultsThe computed tomography attenuation of hematoma at presentation was 57.5 ± 3.3 HU and the volume was 16.9 ± 23.2 mL. Hematoma expansion occurred in 37.1% of patients. The computed tomography attenuation of hematoma was lower in patients with hematoma expansion than with no expansion (55.7 ± 2.9 HU vs. 58.6 ± 3.1 HU, p-value 
      Citation: International Journal of Stroke
      PubDate: 2020-01-29T07:03:31Z
      DOI: 10.1177/1747493019895703
  • Corrigendum
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-01-28T01:51:57Z
      DOI: 10.1177/1747493020905964
  • Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery,
           and Community Participation following Stroke. Part Two: Transitions and
           Community Participation Following Stroke
    • Authors: Anita Mountain, M Patrice Lindsay, Robert Teasell, Nancy M Salbach, Andrea de Jong, Norine Foley, Sanjit Bhogal, Naresh Bains, Rebecca Bowes, Donna Cheung, Helene Corriveau, Lynn Joseph, Dana Lesko, Ann Millar, Beena Parappilly, Aleksandra Pikula, David Scarfone, Annie Rochette, Trudy Taylor, Tina Vallentin, Dar Dowlatshahi, Gord Gubitz, Leanne K Casaubon, Jill I Cameron
      Abstract: International Journal of Stroke, Ahead of Print.
      The sixth update of the Canadian Stroke Best Practice Recommendations for Transitions and Community Participation following Stroke is a comprehensive set of evidence-based guidelines addressing issues faced by people following an acute stroke event. Establishing a coordinated and seamless system of care that supports progress achieved during the initial recovery stages throughout the transition to the community is more essential than ever as the medical complexity of people with stroke is also on the rise. All members of the health-care team engaged with people with stroke, their families, and caregivers are responsible for partnerships and collaborations to ensure successful transitions and return to the community following stroke. These guidelines reinforce the growing and changing body of research evidence available to guide ongoing screening, assessment, and management of individuals following stroke as they move from one phase and stage of care to the next without “falling through the cracks.” It also recognizes the growing role of family and informal caregivers in providing significant hours of support that disrupt their own lives and responsibilities and addresses their support and educational needs. According to Statistics Canada, in 2012, eight million Canadians provided care to family members or friends with a long-term health condition, disability, or problems associated with aging. These recommendations incorporate aspects that were previously in the rehabilitation module for the purposes of streamlining, and both modules should be reviewed in order to provide comprehensive care addressing recovery and community reintegration and participation. These recommendations cover topics related to support and education of people with stroke, families, and caregivers during transitions and community reintegration. They include interprofessional planning and communication, return to driving, vocational roles, leisure activities and relationships and sexuality, and transition to long-term care.
      Citation: International Journal of Stroke
      PubDate: 2020-01-27T10:01:00Z
      DOI: 10.1177/1747493019897847
  • Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery,
           and Community Participation following Stroke. Part One: Rehabilitation and
           Recovery Following Stroke; 6th Edition Update 2019
    • Authors: Robert Teasell, Nancy M Salbach, Norine Foley, Anita Mountain, Jill I Cameron, Andrea de Jong, Nicole E Acerra, Diana Bastasi, Sherri L Carter, Joyce Fung, Mary-Lou Halabi, Jerome Iruthayarajah, Jocelyn Harris, Esther Kim, Andrea Noland, Sepideh Pooyania, Annie Rochette, Bridget D Stack, Erin Symcox, Debbie Timpson, Suja Varghese, Sue Verrilli, Gord Gubitz, Leanne K Casaubon, Dar Dowlatshahi, M Patrice Lindsay
      Abstract: International Journal of Stroke, Ahead of Print.
      The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.
      Citation: International Journal of Stroke
      PubDate: 2020-01-27T10:00:01Z
      DOI: 10.1177/1747493019897843
  • Frequency of anxiety after stroke: An updated systematic review and
           meta-analysis of observational studies
    • Authors: Peter Knapp, Alexander Dunn-Roberts, Nimah Sahib, Liz Cook, Felicity Astin, Eirini Kontou, Shirley A Thomas
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAnxiety is a common and distressing problem after stroke.AimsTo undertake an updated systematic review and meta-analysis of observational studies of anxiety after stroke and integrate the findings with those reported previously.Summary of reviewMultiple databases were searched in May 2018 and 53 new studies were included following dual independent sifting and data extraction. These were combined with 44 previous studies to form a combined data set of 97 studies, comprising 22,262 participants. Studies using interview methods were of higher quality. Rates of anxiety by interview were 18.7% (95% confidence interval 12.5, 24.9%) and 24.2% (95% confidence interval 21.5, 26.9%) by rating scale. Rates of anxiety did not lower meaningfully up to 24 months after stroke. Eight different anxiety subtypes were also reported.ConclusionsThis review confirms that anxiety occurs in around one in four patients (by rating scale) and one in five patients (by interview). More research on anxiety subtypes is needed for an informed understanding of its effects and the development of interventions.
      Citation: International Journal of Stroke
      PubDate: 2020-01-25T04:36:51Z
      DOI: 10.1177/1747493019896958
  • Validation of the simplified modified Rankin scale for stroke trials:
           Experience from the ENCHANTED alteplase-dose arm
    • Authors: Xiaoying Chen, Jingwei Li, Craig S Anderson, Richard I Lindley, Maree L Hackett, Thompson Robinson, Pablo M Lavados, Xia Wang, Hisatomi Arima, John Chalmers, Candice Delcourt
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsThe structured, simplified modified Rankin scale questionnaire (smRSq) may increase reliability over the interrogative approach to scoring the modified Rankin scale (mRS) in acute stroke research and practice. During the conduct of the alteplase-dose arm of the international ENhanced Control of Hypertension ANd Thrombolysis StrokE stuDy (ENCHANTED), we had an opportunity to compare each of these approaches to outcome measurement.MethodsBaseline demographic data were recorded together with the National Institutes of Health Stroke Scale (NIHSS). Follow-up measures obtained at 90 days included mRS, smRSq, and the 5-Dimension European Quality of life scale (EQ-5D). Agreements between smRSq and mRS were assessed with the Kappa statistic. Multiple logistic regression was used to identify baseline predictors of Day 90 smRSq and mRS scores. Treatment effects, based on Day 90 smRSq/mRS scores, were tested in logistic and ordinal logistic regression models.ResultsSmRSq and mRS scores had good agreement (weighted Kappa 0.79, 95% confidence interval (CI) 0.78–0.81), while variables of age, atrial fibrillation, diabetes mellitus, pre-morbid mRS (1 vs. 0), baseline NIHSS scores, and imaging signs of cerebral ischemia, similarly predicted their scores. Odds ratios for death or disability, and ordinal shift, 90-day mRS scores using smRSq were 1.05 (95% CI 0.91–1.20; one-sided P = 0.23 for non-inferiority) and 0.98 (95% CI 0.87–1.11; P = 0.02 for non-inferiority), similar to those using mRS.ConclusionsThis study demonstrates the utility of the smRSq in a large, ethnically diverse clinical trial population. Scoring of the smRSq shows adequate agreement with the standard mRS, thus confirming it is a reliable, valid, and useful alternative measure of functional status after acute ischemic stroke.Clinical Trial registrationURL: Unique identifier: NCT01422616.
      Citation: International Journal of Stroke
      PubDate: 2020-01-23T07:10:35Z
      DOI: 10.1177/1747493019897858
  • Epidemiology of stroke in urban northeast China: A population-based study
    • Authors: Liying Xing, Li Jing, Yuanmeng Tian, Weizhong Wang, Jixu Sun, Cuiqin Jiang, Lei Shi, Dong Dai, Shuang Liu
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundStroke has been emerging as the major public health challenge in China. In the present study, we sought to comprehensively estimate of stroke burden in urban northeast China.MethodsWe conducted the cross-sectional study in 5424 adults aged ≥ 40 years (response rate was 85.3%) living in urban northeast China. A multi-stage cluster sampling method was employed to ensure the population was representative. The prevalent stroke patients were defined as survivors on 31 March 2018. Stroke was defined based on the WHO criteria and was classified into ischemic stroke (IS) and hemorrhage stroke (HS) according to the imaging results.ResultsA total of 292 stroke cases were confirmed (IS-260, 35-HS, and IS concomitant HS-3). Crude prevalence of overall stroke, IS and HS were 5.4%, 4.8% and 0.6%, respectively, and the age-standardized prevalence was 3.8%, 3.4% and 0.5%, respectively. The prevalence of stroke was significantly higher in men compared to women. Among stroke population, 4.5% had disabilities and lived with consequences of stroke. Hypertension, dyslipidemia and diabetes were highly prevalent, accounting for 80.5%, 59.7% and 39.3%, respectively, in stroke population. However, the control rates of those comorbidities were unacceptably low (13.2%, 8.1% and 40.4%, respectively).ConclusionThe considerable stroke burden was observed in urban northeast China with high proportion of stroke and related risk factors. Poorly controlled comorbidities are likely to contribute to the substantial burden in the future. Long-term primary and secondary prevention should be highlighted in urban northeast China.
      Citation: International Journal of Stroke
      PubDate: 2020-01-21T06:41:01Z
      DOI: 10.1177/1747493019897841
  • The incidence rate, mortality rate, and functional outcome of
           intracerebral hemorrhage according to age, sex, and ethnic group in the
           state of Qatar
    • Authors: Maher Saqqur, Abdul Salam, Naveed Akhtar, Musab Ali, Sujatha Joseph, Adnan Khan, Ahmed ElSotouhy, Paula Bourke, Atlantic D’Souza, Ashfaq Shuaib
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-01-21T06:41:01Z
      DOI: 10.1177/1747493019897856
  • Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or
           intracranial hemorrhage in Germany—Updated series of 120 cases
    • Authors: Pawel Kermer, Christoph C Eschenfelder, Hans-Christoph Diener, Martin Grond, Yasser Abdalla, Alexej Abraham, Katharina Althaus, Gebhard Becks, Jörg Berrouschot, Jörg Berthel, Felix J. Bode, Lothar Burghaus, Hakan Cangür, Michael Daffertshofer, Sebastian Edelbusch, Jürgen Eggers, Rüdiger Gerlach, Klaus Gröschel, Florian Große-Dresselhaus, Albrecht Günther, Claus G Haase, Carl-Albrecht Haensch, Andreas Harloff, Joseph G Heckmann, Valentin Held, Maren Hieber, Andreas Kauert, Rolf Kern, Thomas Kerz, Martin Köhrmann, Peter Kraft, Peter Kühnlein, Jan Latta, Elke Leinisch, Arne Lenz, Christoph Leithner, Tobias Neumann-Haefelin, Mathias Mäurer, Wolfgang Müllges, Christian H Nolte, Mark Obermann, Someieh Partowi, Peer Patzschke, Sven Poli, Ulrich Pulkowski, Jan Purrucker, Torsten Rehfeldt, Peter A Ringleb, Joachim Röther, Raluca Rossi, Hazem El-Sabassy, Oliver Sauer, Gabriele Schackert, Niklas Schäfer, Peter D Schellinger, Andreas Schneider, Ramona Schuppner, Stefan Schwab, Olav Schwarte, Rüdiger J Seitz, Sebastian Senger, Yogesh P Shah, Eckhart Sindern, Paul Sparenberg, Thorsten Steiner, Kristina Szabo, Christian Urbanek, Bettina von Sarnowksi, Karin Weissenborn, Peter Wienecke, Karsten Witt, Robert Wruck, Silke Wunderlich
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIdarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth.AimsTo provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage.MethodsRetrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used.ResultsOne-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0–3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay.ConclusionAdministration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.
      Citation: International Journal of Stroke
      PubDate: 2020-01-20T05:39:22Z
      DOI: 10.1177/1747493019895654
  • Intracranial atherosclerosis and oily fish intake. A population study in
           frequent fish consumers living in rural Ecuador
    • Authors: Oscar H Del Brutto, Robertino M Mera, Bettsy Y Recalde
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-01-20T05:39:22Z
      DOI: 10.1177/1747493019897857
  • Global epidemiology of atrial fibrillation: An increasing epidemic and
           public health challenge
    • Authors: Giuseppe Lippi, Fabian Sanchis-Gomar, Gianfranco Cervellin
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAtrial fibrillation is the most frequent cardiac arrhythmia. It has been estimated that 6–12 million people worldwide will suffer this condition in the US by 2050 and 17.9 million people in Europe by 2060. Atrial fibrillation is a major risk factor for ischemic stroke and provokes important economic burden along with significant morbidity and mortality.AimWe provide here comprehensive and updated statistics on worldwide epidemiology of atrial fibrillation.MethodsAn electronic search was conducted for atrial fibrillation. The epidemiologic information was retrieved from the Global Health Data Exchange database, which is regarded as one of the most comprehensive worldwide catalogs of surveys, censuses, vital statistics, and other health-related data.ResultsA total of 3046 new cases of atrial fibrillation worldwide were registered in the database during 2017. The estimated incidence rate for 2017 (403/millions inhabitants) was 31% higher than the corresponding incidence in 1997. The worldwide prevalence of atrial fibrillation is 37,574 million cases (0.51% of worldwide population), increased also by 33% during the last 20 years. The highest burden is seen in countries with high socio-demographic index, though the largest recent increased occurred in middle socio-demographic index countries. Future projections suggest that absolute atrial fibrillation burden may increase by>60% in 2050.ConclusionsOur analyses suggest that atrial fibrillation incidence and prevalence have increased over the last 20 years and will continue to increase over the next 30 years, especially in countries with middle socio-demographic index, becoming one of the largest epidemics and public health challenges.
      Citation: International Journal of Stroke
      PubDate: 2020-01-20T05:39:21Z
      DOI: 10.1177/1747493019897870
  • Evaluating recanalization of relevant lenticulostriate arteries in acute
           ischemic stroke using high-resolution MRA at 7T
    • Authors: Takafumi Suzuki, Tatsunori Natori, Makoto Sasaki, Haruna Miyazawa, Shinsuke Narumi, Kohei Ito, Asami Kamada, Makiko Yoshida, Keisuke Tsuda, Kunihiro Yoshioka, Yasuo Terayama
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundOccluded major intracranial arteries can spontaneously recanalize in patients with acute ischemic stroke mainly due to embolic mechanisms. However, it remains unknown whether recanalization can occur in perforating arteries, such as lenticulostriate arteries. Therefore, in the present study, we assessed changes suggesting recanalization of the lenticulostriate arteries in patients with acute ischemic stroke of the lenticulostriate artery territory using high-resolution magnetic resonance angiography (HR-MRA) at 7T.MethodsWe prospectively examined 39 consecutive patients with acute infarcts confined within the lenticulostriate artery territory. Using a 7T scanner during the acute period and one month thereafter, we evaluated imaging findings indicating the recanalization of the relevant lenticulostriate arteries, following which we examined differences in other imaging findings and clinical characteristics between patients with/without recanalization.ResultsHR-MRA findings suggestive of recanalization (i.e. patent lenticulostriate arteries within acute infarct lesions with/without hemorrhagic changes) were observed in 8 (25%) of 32 patients who were eligible for analyses. These findings were detected in three and five patients on the baseline and follow-up images, respectively. The lengths of relevant lenticulostriate arteries on the follow-up MRA were significantly larger in patients with recanalization than in those without (P = 0.01). However, there were no significant differences in the infarct volume or clinical outcomes between the recanalization and non-recanalization groups.ConclusionHR-MRA at 7T revealed that recanalization of the relevant lenticulostriate arteries can occur in patients with acute ischemic stroke confined to the lenticulostriate artery territory.
      Citation: International Journal of Stroke
      PubDate: 2020-01-20T05:39:20Z
      DOI: 10.1177/1747493019897868
  • Flat-panel detector CT assessment in stroke to reduce times to
           intra-arterial treatment: A study of multiphase computed tomography
           angiography in the angiography suite to bypass conventional imaging
    • Authors: Mehdi Bouslama, Diogo C Haussen, Jonathan A Grossberg, Clara M Barreira, Imramsjah Martijn J van der Bom, Fred van Nijnatten, Thijs Grünhagen, Larry Moyer, Michael R Frankel, Raul G Nogueira
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundBypassing the emergency department and the computed tomography suite by directly transporting to the neuroangiography suite for imaging assessment and treatment may shorten reperfusion times while maintaining proper patient selection.ObjectiveTo determine whether flat-panel detector multiphase computed tomography angiography protocol is associated with reduced treatment times and a similar safety profile as the standard imaging protocol.MethodsSingle-center prospective study of consecutive patients with anterior circulation large vessel occlusion strokes transferred to our facility for consideration of endovascular therapy from May 2016 to December 2017. Those with basilar strokes and/or presenting to the emergency department were excluded. Patients were categorized into two groups: (1) flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment group, with patients transferred directly to the suite for multiphase computed tomography angiography; and (2) patients undergoing standard protocol including computed tomography ± computed tomography angiography/CT perfusion. The groups were matched for age, baseline National Institute of Health Stroke Scale, and pretreatment glucose. Baseline characteristics, time metrics, and outcomes were compared.ResultsOut of 419 patients who underwent endovascular therapy over the study period, 210 patients fit inclusion criteria, with 54 (25.7%) in the flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment group. After matching, 49 flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment/control pairs were generated and analyzed. Baseline characteristics were well balanced. Flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment patients had significantly shorter median door-to-puncture (33 [26.5-47] vs. 55 [44.5–66] min, p 
      Citation: International Journal of Stroke
      PubDate: 2020-01-06T08:14:29Z
      DOI: 10.1177/1747493019895655
  • Proteinuria as an independent predictor of stroke: Systematic review and
    • Authors: Dearbhla M Kelly, Peter M Rothwell
      First page: 29
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundProteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined.AimWe aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure.Summary of reviewWe performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ statistics and I2, and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle–Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63–2.46; p 
      Citation: International Journal of Stroke
      PubDate: 2020-01-14T06:13:02Z
      DOI: 10.1177/1747493019895206
  • Stroke in young cannabis users (18–49 years): National trends in
           hospitalizations and outcomes
    • Authors: Rupak Desai, Sandeep Singh, Krupa Patel, Hemant Goyal, Manan Shah, Zeeshan Mansuri, Smit Patel, Zabeen K Mahuwala, Larry B Goldstein, Adnan I Qureshi
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundRecent legalization of therapeutic and recreational cannabis use makes it imperative to have an insight into odds and trends in young-onset stroke-related hospitalizations among cannabis users (18–49 years).MethodsThe National Inpatient Sample dataset (2007–2014) was utilized to assess national trends, odds of young-onset stroke-related hospitalizations, and outcomes among cannabis users vs. nonusers using provided discharge weights, strata, and cluster design. The rates are described per 100,000 hospitalizations among cannabis users and non-users.ResultsA total of 3,307,310 hospitalizations were identified among young adults with current or previous cannabis use. Of these, 34,857 (1.1%) were related to young-onset stroke. A relative increase of 13.92% (553 in 2007 to 630 in 2014; ptrend 
      Citation: International Journal of Stroke
      PubDate: 2019-12-24T05:21:36Z
      DOI: 10.1177/1747493019895651
  • Age-dependent clinical outcomes in primary versus oral
           anticoagulation-related intracerebral hemorrhage
    • Authors: Maximilian I Sprügel, Joji B Kuramatsu, Stefan T Gerner, Jochen A Sembill, Dominik Madžar, Caroline Reindl, Tobias Bobinger, Tamara Müller, Philip Hoelter, Hannes Lücking, Tobias Engelhorn, Hagen B Huttner
      Abstract: International Journal of Stroke, Ahead of Print.
      AimsThis study determined the influence of age on bleeding characteristics and clinical outcomes in primary spontaneous (non-OAC), vitamin K antagonist-related (VKA-) and non-vitamin K antagonist oral anticoagulant-related (NOAC-) ICH.MethodsPooled individual patient data of multicenter cohort studies were analyzed by logistic regression modelling and propensity-score-matching (PSM) to explore the influence of advanced age on clinical outcomes among non-OAC-, VKA-, and NOAC-ICH. Primary outcome measure was functional outcome at three months assessed by the modified Rankin Scale, dichotomized into favorable (mRS = 0–3) and unfavorable (mRS = 4–6) functional outcome. Secondary outcome measures included mortality, hematoma characteristics, and frequency of invasive interventions.ResultsIn VKA-ICH 33.5% (670/2001), in NOAC-ICH 44.2% (69/156) and in non-OAC-ICH 25.2% (254/1009) of the patients were ≥80 years. After adjustment for treatment interventions and relevant parameters, elderly ICH patients comprised worse functional outcome at three months (adjusted odds ratio (aOR) in VKA-ICH: 1.49 (1.21–1.84); p 
      Citation: International Journal of Stroke
      PubDate: 2019-12-24T05:21:35Z
      DOI: 10.1177/1747493019895662
  • Temporal evolution and spatial distribution of quantitative T2 MRI
           following acute ischemia reperfusion injury
    • Authors: Rani Gupta Sah, Sama Nobakht, Deepthi Rajashekar, Pauline Mouches, Nils D Forkert, Amith Sitaram, Adrian Tsang, Michael D Hill, Andrew M Demchuk, Christopher D d'Esterre, Philip A Barber
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundDetermining mechanisms of secondary stroke injury related to cerebral blood flow and the severity of microvascular injury contributing to edema and blood-brain barrier breakdown will be critical for the development of adjuvant therapies for revascularization treatment.AimTo characterize the heterogeneity of the ischemic lesion using quantitative T2 imaging along with diffusion-weighted magnetic resonance imaging (DWI) within five hours of treatment.MethodsQuantitative T2 magnetic resonance imaging was acquired within 5 h (baseline) and at 24 h (follow-up) of stroke treatment in 29 patients. Dynamic contrast enhanced permeability imaging was performed at baseline in a subgroup of patients. Absolute volume change and lesion percent change was determined for the quantitative T2, DWI, and absolute volume change sequences. A Gaussian process with RRELIEFF feature selection algorithm was used for prediction of relative quantitative T2 and DWI lesion growth, baseline and follow-up quantitative T2/DWI lesion ratios, and also NIHSS at 24 h and change in NIHSS from admission to 24 h.ResultsIn n = 27 patients, median (interquartile range) lesion percent change was 114.8% (48.9%, 259.1%) for quantitative T2, 48.2% (−12.6%, 179.6%) for absolute volume change, and 62.7% (26.3%, 230.9%) for DWI, respectively. Our model, consisting of baseline NIHSS, CT ASPECTS, and systolic blood pressure, showed a strong correlation with quantitative T2 percent change (cross correlation R2 = 0.80). There was a strong predictive ability for quantitative T2/DWI lesion ratio at 24 h using baseline NIHSS and last seen normal to 24 h magnetic resonance imaging time (cross correlation R2 = 0.93). Baseline dynamic contrast enhanced permeability was moderately correlated to the baseline quantitative T2 values (rho = 0.38).ConclusionQuantitative T2 imaging provides critical information for development of therapeutic approaches that could ameliorate microvascular damage during ischemia reperfusion.
      Citation: International Journal of Stroke
      PubDate: 2019-12-23T06:35:53Z
      DOI: 10.1177/1747493019895673
  • Contemporary utilization patterns and outcomes of thrombolytic
           administration for ischemic stroke among patients with cancer
    • Authors: Jocelyn Owusu-Guha, Avirup Guha, P Elliott Miller, Sumeet Pawar, Amit K Dey, Tariq Ahmad, Hatim Attar, Farrukh T Awan, Darrion Mitchell, Nihar R Desai, Daniel Addison
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThrombolytic therapy significantly improves outcomes among patients with acute ischemic stroke. While cancer outcomes have dramatically improved, the utilization, safety, and mortality outcomes of patients with cancer who receive thrombolytic therapy for acute ischemic stroke are unknown.MethodsUsing a national database, we identified all hospitalizations for acute ischemic stroke requiring thrombolytic therapy between 2003 and 2015. Patients with contraindications to thrombolytic therapy were excluded. Following propensity score matching for comorbidity burden, trends in thrombolytic therapy use and its effect on in-hospital mortality, intracranial or all-cause bleeding, and the combined endpoint of mortality and all-cause bleeding, by presence/absence of cancer were evaluated. We also evaluated 30- and 90-day readmission rates post-thrombolytic therapy administration.ResultsWe identified 237,687 acute ischemic stroke hospitalizations requiring thrombolytic therapy, of which 26,328 (11%) had an underlying cancer. Over the study period, thrombolytic therapy use increased across all acute ischemic stroke admissions, irrespective of cancer presence (12.4/1000 in 2003 to 81.1/1000 in 2015, P 
      Citation: International Journal of Stroke
      PubDate: 2019-12-23T06:35:52Z
      DOI: 10.1177/1747493019895709
  • The Chemical Optimization of Cerebral Embolectomy trial: Study protocol
    • Authors: Arturo Renú, Jordi Blasco, Mónica Millán, Joan Martí-Fàbregas, Pere Cardona, Laura Oleaga, Juan Macho, Carlos Molina, Jaume Roquer, Sergio Amaro, Antonio Dávalos, Federico Zarco, Carlos Laredo, Alejandro Tomasello, Leopoldo Guimaraens, Roger Barranco, Carlos Castaño, Elío Vivas, Anna Ramos, Antonio López-Rueda, Xabier Urra, Marián Muchada, Elisa Cuadrado-Godía, Pol Camps-Renom, Luis S Román, José Ríos, Enrique C Leira, Tudor Jovin, Ferran Torres, Ángel Chamorro
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleThe potential value of rescue intraarterial thrombolysis in patients with large vessel occlusion stroke treated with mechanical thrombectomy has not been assessed in randomized trials.AimThe CHemical OptImization of Cerebral Embolectomy trial aims to establish whether rescue intraarterial thrombolysis is more effective than placebo in improving suboptimal reperfusion scores in patients with large vessel occlusion stroke treated with mechanical thrombectomy.Sample size estimatesA sample size of 200 patients allocated 1:1 to intraarterial thrombolysis or intraarterial placebo will have>95% statistical power for achieving the primary outcome (5% in the control versus 60% in the treatment group) for a two-sided (5% alpha, and 5% lost to follow-up).Methods and designWe conducted a multicenter, randomized, placebo-controlled, double blind, phase 2b trial. Eligible patients are 18 or older with symptomatic large vessel occlusion treated with mechanical thrombectomy resulting in a modified treatment in cerebral ischemia score 2b at end of the procedure. Patients will receive 20–30 min intraarterial infusion of recombinant tissue plasminogen activator or placebo (0.5 mg/ml, maximum dose limit 22.5 mg).Study outcome(s)The primary outcome is the proportion of patients with an improved modified treatment in cerebral ischemia score 10 min after the end of the study treatment. Secondary outcomes include the shift analysis of the modified Rankin Scale, the infarct expansion ratio, the proportion of excellent outcome (modified Rankin Scale 0–1), the proportion of infarct expansion, and the infarction volume. Mortality and symptomatic intracerebral bleeding will be assessed.DiscussionThe study will provide evidence whether rescue intraarterial thrombolysis improves brain reperfusion in patients with large vessel occlusion stroke and incomplete reperfusion (modified treatment in cerebral ischemia 2b) at the end of mechanical thrombectomy.
      Citation: International Journal of Stroke
      PubDate: 2019-12-19T06:06:54Z
      DOI: 10.1177/1747493019895656
  • Validation of an automated ASPECTS method on non-contrast computed
           tomography scans of acute ischemic stroke patients
    • Authors: Hulin Kuang, Wu Qiu, Mohamed Najm, Dar Dowlatshahi, Robert Mikulik, Alex Y Poppe, Josep Puig, Mar Castellanos, Sung I Sohn, Seong H Ahn, Ana Calleja, Albert Jin, Talip Asil, Negar Asdaghi, Thalia S Field, Shelagh Coutts, Michael D Hill, Andrew M Demchuk, Mayank Goyal, Bijoy K Menon
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe Alberta Stroke Program Early CT Score (ASPECTS) is a systematic method of assessing the extent of early ischemic change on non-contrast computed tomography in patients with acute ischemic stroke. Our objective was to validate an automated ASPECTS scoring method we recently developed on a large data set.Materials and methodsWe retrospectively collected 602 acute ischemic stroke patients’ non-contrast computed tomography scans. Expert ASPECTS readings on non-contrast computed tomography were compared to automated ASPECTS. Statistical analyses on the total ASPECTS, region level ASPECTS, and dichotomized ASPECTS (≤4 vs.>4) score were conducted.ResultsIn total, 602 scans were evaluated and 6020 (602 × 10) ASPECTS regions were scored. Median time from stroke onset to computed tomography was 114 min (interquartile range: 73–183 min). Total ASPECTS for the 602 patients generated by the automated method agreed well with expert readings (intraclass correlation coefficient): 0.65 (95% confidence interval (CI): 0.60–0.69). Region level analysis showed that the automated method yielded accuracy of 81.25%, sensitivity of 61.13% (95% CI: 58.4%–63.8%), specificity of 86.56% (95% CI: 85.6%–87.5%), and area under curve of 0.74 (95% CI: 0.73–0.75). For dichotomized ASPECTS (≤4 vs.>4), the automated method demonstrated sensitivity 97.21% (95% CI: 95.4%–98.4%), specificity 57.81% (95% CI: 44.8%–70.1%), accuracy 93.02%, and area under the curve of 0.78 (95% CI: 0.74–0.81). For each individual region (M1–6, lentiform, insula, and caudate), the automated method demonstrated acceptable performance.ConclusionThe automated system we developed approached the stroke expert in performance when scoring ASPECTS on non-contrast computed tomography scans of acute ischemic stroke patients.
      Citation: International Journal of Stroke
      PubDate: 2019-12-19T06:06:53Z
      DOI: 10.1177/1747493019895702
  • Prior stroke and transient ischemic attack as risk factors for subsequent
           stroke in atrial fibrillation patients: A report from the GARFIELD-AF
    • Authors: Werner Hacke, Jean-Pierre Bassand, Saverio Virdone, A John Camm, David A Fitzmaurice, Keith AA Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Karen S Pieper, Alexander GG Turpie, Martin van Eickels, Freek WA Verheugt, Ajay K Kakkar
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIt is not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event.Research questionTo characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation.Study design and methodsThis study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians’ assessment. Patients’ one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression.ResultsAt enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12–1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01–1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15–1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80–2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11–1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10–1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83–2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone.InterpretationA history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor.Clinical trial registration: NCT01090362.
      Citation: International Journal of Stroke
      PubDate: 2019-12-18T07:18:35Z
      DOI: 10.1177/1747493019891516
  • Normal-appearing white matter microstructural injury is associated with
           white matter hyperintensity burden in acute ischemic stroke
    • Authors: Mark R Etherton, Ona Wu, Anne-Katrin Giese, Natalia S Rost
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundWhite matter hyperintensity of presumed vascular origin is a risk factor for poor stroke outcomes. In patients with acute ischemic stroke, however, the in vivo mechanisms of white matter microstructural injury are less clear.AimsTo characterize the directional diffusivity components in normal-appearing white matter and white matter hyperintensity in acute ischemic stroke patients.MethodsA retrospective analysis was performed on a cohort of patients with acute ischemic stroke and brain magnetic resonance imaging with diffusion tensor imaging sequences acquired within 48 h of admission. White matter hyperintensity volume was measured in a semi-automated manner. Median fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter and white matter hyperintensity in the hemisphere contralateral to the acute infarct. Linear regression analysis was performed to evaluate predictors of white matter hyperintensity volume and normal-appearing white matter diffusivity metrics.ResultsIn 319 patients, mean age was 64.9 ± 15.9 years. White matter hyperintensity volume was 6.33 cm3 (interquartile range 3.0–12.6 cm3). Axial and radial diffusivity were significantly increased in white matter hyperintensity compared to normal-appearing white matter. In multivariable linear regression, age (β = 0.20, P = 0.003) and normal-appearing white matter axial diffusivity (β = 37.9, P 
      Citation: International Journal of Stroke
      PubDate: 2019-12-18T07:18:35Z
      DOI: 10.1177/1747493019895707
  • Semi-automatic measurement of intracranial hemorrhage growth on
           non-contrast CT
    • Authors: Kevin J Chung, Hulin Kuang, Alyssa Federico, Hyun Seok Choi, Linda Kasickova, Abdulaziz Sulaiman Al Sultan, MacKenzie Horn, Mark Crowther, Stuart J Connolly, Patrick Yue, John T Curnutte, Andrew M Demchuk, Bijoy K Menon, Wu Qiu
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundManual segmentations of intracranial hemorrhage on non-contrast CT images are the gold-standard in measuring hematoma growth but are prone to rater variability.AimsWe demonstrate that a convex optimization-based interactive segmentation approach can accurately and reliably measure intracranial hemorrhage growth.MethodsBaseline and 16-h follow-up head non-contrast CT images of 46 subjects presenting with intracranial hemorrhage were selected randomly from the ANNEXA-4 trial imaging database. Three users semi-automatically segmented intracranial hemorrhage to measure hematoma volume for each timepoint using our proposed method. Segmentation accuracy was quantitatively evaluated compared to manual segmentations by using Dice similarity coefficient, Pearson correlation, and Bland–Altman analysis. Intra- and inter-rater reliability of the Dice similarity coefficient and intracranial hemorrhage volumes and volume change were assessed by the intraclass correlation coefficient and minimum detectable change.ResultsAmong the three users, the mean Dice similarity coefficient, Pearson correlation, and mean difference ranged from 76.79% to 79.76%, 0.970 to 0.980 (p 
      Citation: International Journal of Stroke
      PubDate: 2019-12-18T05:27:06Z
      DOI: 10.1177/1747493019895704
  • Onset-to-door time in patients with driving-related ischemic stroke
    • Authors: Joji Inamasu, Kazuhiro Tomiyasu, Masashi Nakatsukasa, Shunsuke Nakae
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-12-18T05:27:05Z
      DOI: 10.1177/1747493019895668
  • Randomization of endovascular treatment with stent-retriever and/or
           thromboaspiration versus best medical therapy in acute ischemic stroke due
           to large vessel occlusion trial: Rationale and design
    • Authors: Raul G Nogueira, Fabricio O Lima, Octávio M Pontes-Neto, Gisele S Silva, Francisco José Mont’Alverne, Daniel G Abud, Michel Frudit, Paulo Passos, Diogo C Haussen, Guilherme Dabus, Gabriel R de Freitas, Jamary Oliveira-Filho, Daniel C Bezerra, David S Liebeskind, Mario B Wagner, José EF Passos, Carlos A Molina, Joseph Broderick, Jeffrey L Saver, Sheila O Martins
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundRESILIENT is a prospective, multicenter, randomized phase III trial to test the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country.MethodsSubjects must fulfill the following main inclusion criteria: symptom onset ≤8 h, age ≥18 years, baseline NIHSS ≥8, evidence of intracranial ICA or proximal MCA (M1 segment) occlusion, ASPECTS ≥6 on CT or>5 on DWI-MRI and be either ineligible for or unresponsive to intravenous alteplase. The primary end-point is the distribution of disability levels (on the modified Rankin Scale, mRS) at 90 days under the intention-to-treat principle.RandomizationRandomization is performed under a minimization process using age, baseline NIHSS, intravenous alteplase use, occlusion site and center.DesignThe trial is designed with an expectation of a 10% difference in the proportion of favorable outcome (mRS 0–2 at 90 days) common odds ratio of 1.615.Primary outcomeProjected sample size is 690 subjects with pre-planned interim analyses at 174, 346, and 518 subjects.Secondary outcomesSecondary end-points include: 90-day functional independence (mRS ≤2), mRS shift stratified for treatment with IV rt-PA at 90 days, infarct volume on 24 h CT or MRI, early dramatic response (NIHSS 0–2 or improvement ≥8 points) at 24 h, vessel recanalization evaluated by CTA or MRA at 24 h, and the post-procedure rate of successful reperfusion (defined as a modified Treatment in Cerebral Infarction 2b or greater). Safety variables are mortality at 90 days, symptomatic intracranial hemorrhage at 24 h and procedure-related complications.
      Citation: International Journal of Stroke
      PubDate: 2019-12-03T06:17:50Z
      DOI: 10.1177/1747493019890700
  • Comparing mismatch strategies for patients being considered for ischemic
           stroke tenecteplase trials
    • Authors: Andrew Bivard, Xuya Huang, Christopher R Levi, Bruce CV Campbell, Bharath K Cheripelli, Chushuang Chen, Dheeraj Kalladka, Fiona C Moreton, Ian Ford, Stephen M Davis, Geoffrey A Donnan, Keith W Muir, Mark W Parsons
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundCurrently there are multiple variations of imaging-based patient selection mismatch methods in ischemic stroke. In the present study, we sought to compare the two most common mismatch methods and identify if there were different effects on the outcome of a randomized clinical trial depending on the mismatch method used.AimsInvestigate the effect of clinical and imaging-based mismatch criteria on patient outcomes of a pooled cohort from randomized trials of intravenous tenecteplase versus alteplase.MethodsBaseline clinical and imaging scores were used to categorize patients as meeting either the DAWN mismatch (baseline NIHSS ≥ 10, and age cut-offs for ischemic core volume) or DEFUSE 2 mismatch criteria (mismatch volume > 15 mL, mismatch ratio > 1.8 and ischemic core 
      Citation: International Journal of Stroke
      PubDate: 2019-11-05T06:14:54Z
      DOI: 10.1177/1747493019884529
  • Long-term (>10-year) clinical follow-up after young embolic stroke/TIA of
           undetermined source

         This is an Open Access Article Open Access Article

    • Authors: M Nassif, ME Annink, H Yang, TCD Rettig, YBWEM Roos, RBA van den Brink, JGP Tijssen, BJM Mulder, RJ de Winter, BJ Bouma
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundTo date, the pathophysiology of first-ever and recurrent stroke/TIA still remains unclear in young patients with embolic stroke/TIA of undetermined source (ESUS). Clinical studies with long-term follow-up in young ESUS patients are necessary to investigate the underlying pathophysiology of first-ever and recurrent stroke/TIA in this patient population, in particular the role of new-onset atrial fibrillation.AimsOur aim was to study the long-term (>10-year) clinical outcome of young patients (
      Citation: International Journal of Stroke
      PubDate: 2019-11-04T05:10:32Z
      DOI: 10.1177/1747493019884520
  • Histological stroke clot analysis after thrombectomy: Technical aspects
           and recommendations
    • Authors: S Staessens, S Fitzgerald, T Andersson, F Clarençon, F Denorme, MJ Gounis, W Hacke, DS Liebeskind, I Szikora, ACGM van Es, W Brinjikji, KM Doyle, SF De Meyer
      Abstract: International Journal of Stroke, Ahead of Print.
      The recent advent of endovascular procedures has created the unique opportunity to collect and analyze thrombi removed from cerebral arteries, instigating a novel subfield in stroke research. Insights into thrombus characteristics and composition could play an important role in ongoing efforts to improve acute ischemic stroke therapy. An increasing number of centers are collecting stroke thrombi. This paper aims at providing guiding information on thrombus handling, procedures, and analysis in order to facilitate and standardize this emerging research field.
      Citation: International Journal of Stroke
      PubDate: 2019-11-04T05:10:31Z
      DOI: 10.1177/1747493019884527
  • Direct Intra-arterial thrombectomy in order to Revascularize AIS patients
           with large vessel occlusion Efficiently in Chinese Tertiary hospitals: A
           Multicenter randomized clinical Trial (DIRECT-MT)—Protocol
    • Authors: Pengfei Yang, Kilian M Treurniet, Lei Zhang, Yongwei Zhang, Zifu Li, Pengfei Xing, Yongxin Zhang, Ping Zhang, Hao Wang, Bo Hong, Diederik WJ Dippel, Yvo BWEM Roos, Charles BLM Majoie, Benqiang Deng, Jianmin Liu
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleIntravenous thrombolysis combined with mechanical thrombectomy (MT) has been proven safe and clinical effective in patients with acute ischemic stroke of anterior circulation large vessel occlusion. However, despite reperfusion, a considerable proportion of patients do not recover. Incidence of symptomatic intracerebral hemorrhage was similar between patients treated with the combination of intravenous thrombolysis and MT, as compared to intravenous thrombolysis alone, suggesting that this complication should be attributed to pre-treatment with intravenous thrombolysis. Conversely, intravenous thrombolysis may be beneficial in patients with small clots occluding intracranial arteries with underlying intracranial atherosclerotic disease, not accessible for MT.AimTo assess whether direct MT is non-inferior compared to combined intravenous thrombolysis plus MT in patients with AIS due to an anterior circulation large vessel occlusion, and to assess treatment effect modification by presence of intracranial atherosclerotic disease.Sample sizeAim to randomize 636 patients 1:1 to receive direct MT (intervention) or combined intravenous thrombolysis plus MT (control).DesignThis is a multicenter, prospective, open label parallel group trial with blinded outcome assessment (PROBE design) assessing non-inferiority of direct MT compared to combined intravenous thrombolysis plus MT.OutcomesThe primary outcome is the score on the modified Rankin Scale assessed blindly at 90 (±14) days. An common odds ratio, adjusted for the prognostic factors (age, NIHSS, collateral score), representing the shift on the 6-category mRS scale measured at three months, estimated with ordinal logistic regression, will be the primary effect parameter. Non-inferiority is established if the lower boundary of the 95% confidence interval does not cross 0.8.DiscussionDIRECT-MT could result in improved therapeutic efficiency and cost reduction in treatment of anterior circulation large vessel occlusion stroke.
      Citation: International Journal of Stroke
      PubDate: 2019-10-30T01:36:22Z
      DOI: 10.1177/1747493019882837
  • Elevated early lesion water uptake in acute stroke predicts poor outcome
           despite successful recanalization – When “tissue clock” and “time
           clock” are desynchronized
    • Authors: Jawed Nawabi, Fabian Flottmann, Andre Kemmling, Helge Kniep, Hannes Leischner, Peter Sporns, Gerhard Schön, Uta Hanning, Götz Thomalla, Jens Fiehler, Gabriel Broocks
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIschemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction.AimsWe hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization.MethodsAcute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6.ResultsSeventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p 
      Citation: International Journal of Stroke
      PubDate: 2019-10-26T01:24:47Z
      DOI: 10.1177/1747493019884522
  • Thrombolysis in elderly stroke patients in Italy (TESPI) trial and updated
           meta-analysis of randomized controlled trials
    • Authors: Svetlana Lorenzano, Annarita Vestri, Paolo Bovi, Manuel Cappellari, Paolo Stanzione, Domenico Samà, Maddalena Bruscoli, Milena Cavazzuti, Andrea Zini, Maurizia Rasura, Mario Beccia, Giancarlo Comi, Maria Sessa, Carlo Gandolfo, Maurizio Balestrino, Giancarlo Agnelli, Valeria Caso, Piercarlo Gerbino Promis, Claudio Pozzessere, Sabrina Anticoli, Francesco Perini, Michela Marcon, Annalisa Vinattieri, Alba Caruso, Mauro Magoni, Mauro Furlan, Giovanni Orlandi, Vincenzo Di Lazzaro, Mariarosaria Valente, Patrizia Nencini, Danilo Toni
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundSince its approval, the use of alteplase had been limited to patients aged ≤80 years.AimsTESPI trial had been designed to evaluate whether alteplase treatment within 3 h in patients with acute ischemic stroke aged>80 years resulted in favorable benefit/risk ratio compared with standard care. The meta-analysis of randomized controlled trials was updated to put findings in the context of all available evidence.MethodsTESPI was a multicenter, open-label with blinded outcome evaluation, randomized, controlled trial. Main clinical endpoints were 90-day favorable functional outcome (mRS score 0–2) and mortality and symptomatic intracerebral hemorrhage. The trial was prematurely terminated for ethical reasons after publication of IST-3 trial which provided evidence of treatment benefit in elderly.ResultsOf the planned 600 patients, 191 (88 assigned to alteplase) were enrolled. Overall, 24/83 (28.9%) alteplase patients had a favorable outcome compared to 22/95 (23.2%) controls (non-significant absolute difference of 5.7% for alteplase; OR 1.35, 95% CI 0.69–2.64, P = 0.381). Rates of death were non-significantly lower in the alteplase patients (18.1% vs. 26.5%); rates of symptomatic intracerebral hemorrhage were similar between the two groups (5.9% vs. 5.1%). The updated meta-analysis showed consistent results with prior estimates and add weights.ConclusionsThe effects of alteplase observed in this interrupted trial did not reach statistical significance, probably for the small numbers, but are consistent with and add weight to the sum total of the randomized evidence demonstrating that alteplase is beneficial in patients with acute ischemic stroke aged over 80 years, particularly if given within 3 h.
      Citation: International Journal of Stroke
      PubDate: 2019-10-26T01:24:47Z
      DOI: 10.1177/1747493019884525
  • National trends in outcomes of ischemic stroke and prognostic influence of
           stroke center capability in Japan, 2010–2016
    • Authors: Akiko Kada, Kuniaki Ogasawara, Takanari Kitazono, Kunihiro Nishimura, Nobuyuki Sakai, Daisuke Onozuka, Yoshiaki Shiokawa, Shigeru Miyachi, Izumi Nagata, Kazunori Toyoda, Yoichiro Hashimoto, Yasuhiro Hasegawa, Haruhiko Hoshino, Shinichi Yoshimura, Michiyasu Suzuki, Akira Tsujino, Shinya Matsuda, Ryota Kurogi, Ai Kurogi, Nice Ren, Ataru Nishimura, Koichi Arimura, Akihito Hagihara, Teiji Tominaga, Takamasa Kayama, Hajime Arai, Norihiro Suzuki, Susumu Miyamoto, Akira Ogawa, Koji Iihara
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundLimited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists.AimsTo examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan.MethodsThis retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models.ResultsOver time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively).ConclusionsThis nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.
      Citation: International Journal of Stroke
      PubDate: 2019-10-26T01:12:59Z
      DOI: 10.1177/1747493019884526
  • Measuring stroke and transient ischemic attack burden in New Zealand:
    • Authors: Valery L Feigin, Rita Krishnamurthi, Suzanne Barker-Collo, P Alan Barber, Yogini Rathnasabapathy, Braden Te Ao, Priya Parmar, Susan Mahon, Bronwyn Tunnage, Andrew Swain, Bruce Arroll, Hinemoa Elder, El-Shadan Tautolo, Varsha Parag, Craig Anderson, Derrick Bennett, Amanda G Thrift, Dominique A Cadilhac, Paul Brown, Annemarei Ranta, Jeroen Douwes
      Abstract: International Journal of Stroke, Ahead of Print.
      Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion: In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an “ideal” population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations.
      Citation: International Journal of Stroke
      PubDate: 2019-10-25T05:02:14Z
      DOI: 10.1177/1747493019884528
  • Characteristics and management of stroke in Korea: 2014–2018 data
           from Korean Stroke Registry
    • Authors: Han-Yeong Jeong, Keun-Hwa Jung, Heejung Mo, Chan-Hyuk Lee, Tae Jung Kim, Jong-Moo Park, MiSun Oh, Ji Sung Lee, Beom Joon Kim, Joon-Tae Kim, Jinkwon Kim, Woo-Keun Seo, Jun Lee, Jae-Kwan Cha, Sang-Bae Ko, Hee-Joon Bae, Byung-Woo Yoon
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundLifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population.AimsWe aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time.MethodsThis study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis.ResultsA total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060–1.131), p 
      Citation: International Journal of Stroke
      PubDate: 2019-10-23T05:25:08Z
      DOI: 10.1177/1747493019884517
  • Regional, sex, and age differences in diagnostic testing among
           participants in the NAVIGATE-ESUS trial
    • Authors: Antonio Arauz, Fabiola Serrano, Lesly A Pearce, Scott E Kasner, Sebastian F Ameriso, Danilo Toni, Daniel Bereczki, James Siegler, Angélica Ruiz-Franco, Carlos Cantú-Brito, Anna Czlonkowska, Wilfried Lang, Scott D Berkowitz, Hardi Mundl, Robert G Hart
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimThe diagnosis of embolic stroke of undetermined source (ESUS) is based on excluding other more likely stroke etiologies, and therefore diagnostic testing plays an especially crucial role. Our objective was to compare the diagnostic testing by region, sex, and age among the participants of NAVIGATE-ESUS trial.MethodsParticipants were grouped according to five global regions (North America, Latin America, Western Europe, Eastern Europe and East Asia), age (75 years), and sex. Frequencies of each diagnostic test within areas of echocardiography, cardiac rhythm monitoring, and arterial imaging were described and compared across groups. A multivariable logistic regression model for each diagnostic test was fit to assess the independent influence of each of region, age, and sex and likelihood of testing.ResultsWe included 6985 patients in the analysis (918 from North America; 746 from Latin America; 2853 from Western Europe; 1118 from Eastern Europe; 1350 from East Asia). Average age (highest in Western Europe (69 years), lowest in Eastern Europe (65 years)), % females (highest in Latin America (44%) and lowest in East Asia (31%)), and use of each diagnostic test varied significantly across regions. Region, but not sex, was independently associated with use of each diagnostic test examined. Transesophageal echocardiography and either CT or MR angiogram were more often used in younger patients.ConclusionDiagnostic testing differed by region, and less frequently by age, but not by sex. Our findings reflect the existing variations in global practice in diagnostic testing in ESUS patients.
      Citation: International Journal of Stroke
      PubDate: 2019-10-21T05:38:48Z
      DOI: 10.1177/1747493019884523
  • Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital
           stroke registry
    • Authors: F Abass Cisse, C Damien, M Haba, ML Touré, M Barry, ABA Djibo, AK Bah, FM Soumah, G Naeije
      Abstract: International Journal of Stroke, Ahead of Print.
      Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.
      Citation: International Journal of Stroke
      PubDate: 2019-10-21T05:38:47Z
      DOI: 10.1177/1747493019884521
  • Fluoxetine for stroke recovery: Meta-analysis of randomized controlled
    • Authors: Gillian E Mead, Lynn Legg, Russel Tilney, Cheng Fang Hsieh, Simiao Wu, Erik Lundström, Ann Sofie Rudberg, Mansur Kutlubaev, Martin S Dennis, Babak Soleimani, Amanda Barugh, Maree L Hackett, Graeme J Hankey
      Abstract: International Journal of Stroke, Ahead of Print.
      ObjectiveTo determine whether fluoxetine, at any dose, given within the first year after stroke to patients who did not have to have mood disorders at randomization reduced disability, dependency, neurological deficits and fatigue; improved motor function, mood, and cognition at the end of treatment and follow-up, with the same number or fewer adverse effects.MethodsSearches (from 2012) in July 2018 included databases, trials registers, reference lists, and contact with experts. Co-primary outcomes were dependence and disability. Dichotomous data were synthesized using risk ratios (RR) and continuous data using standardized mean differences (SMD). Quality was appraised using Cochrane risk of bias methods. Sensitivity analyses explored influence of study quality.ResultsThe searches identified 3414 references of which 499 full texts were assessed for eligibility. Six new completed RCTs (n = 3710) were eligible, and were added to the seven trials identified in a 2012 Cochrane review (total: 13 trials, n = 4145). There was no difference in the proportion independent (3 trials, n = 3249, 36.6% fluoxetine vs. 36.7% control; RR 1.00, 95% confidence interval 0.91 to 1.09, p = 0.99, I2 = 78%) nor in disability (7 trials n = 3404, SMD 0.05, −0.02 to 0.12 p = 0.15, I2 = 81%) at end of treatment. Fluoxetine was associated with better neurological scores and less depression. Among the four (n = 3283) high-quality RCTs, the only difference between groups was lower depression scores with fluoxetine.ConclusionThis class I evidence demonstrates that fluoxetine does not reduce disability and dependency after stroke but improves depression.
      Citation: International Journal of Stroke
      PubDate: 2019-10-17T08:03:40Z
      DOI: 10.1177/1747493019879655
  • Stroke in the Middle-East and North Africa: A 2-year prospective
           observational study of intravenous thrombolysis treatment in the region.
           Results from the SITS-MENA Registry
    • Authors: S Al-Rukn, M Mazya, N Akhtar, H Hashim, B Mansouri, B Faouzi, H Aref, H Abdulrahman, S Kesraoui, F Hentati, S Gebelly, N Ahmed, N Wahlgren, F Abd-Allah, M Almekhlafi, T Moreira
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and methodsIntravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry.ResultsOf 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p 
      Citation: International Journal of Stroke
      PubDate: 2019-10-09T05:54:56Z
      DOI: 10.1177/1747493019874729
  • National trends in hospital admission, case fatality, and sex differences
           in atrial fibrillation-related strokes
    • Authors: Gordon AE Jewett, M Patrice Lindsay, Cristina Goia, Brandon Zagorski, Noreen Kamal, Moira K Kapral, Andrew M Demchuk, Michael D Hill, Amy YX Yu
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimAtrial fibrillation is associated with increased risk of ischemic stroke and its global prevalence is increasing. We aimed to describe the contemporary temporal trends in hospital admissions, case fatality rate, as well as sex differences in atrial fibrillation-related stroke in Canada.MethodsWe conducted a retrospective cohort study using Canadian national administrative data to identify admissions to hospital for stroke with comorbid atrial fibrillation between 1 April 2007 and 31 March 2016. We determined temporal trends in the crude and the age- and sex-standardized admission and case fatality rates. We also evaluated for any sex differences in these outcomes.ResultsThere were 222,100 admissions to hospital for ischemic (n = 182,990) or hemorrhagic (n = 39,110) stroke. Comorbid atrial fibrillation was present in 20.2% of admissions for ischemic strokes and 10.1% for hemorrhagic strokes. Over the study period, the age–sex adjusted proportion of admissions with atrial fibrillation increased from 16.3% to 20.5% (p = 0.02) for ischemic stroke and was stable for hemorrhagic stroke. In-hospital case fatality rate decreased for ischemic stroke with and without comorbid atrial fibrillation. Women aged 65 years and older with ischemic stroke were more likely to have comorbid atrial fibrillation compared to men, while this association was reversed in younger women. There were no sex differences in the case fatality rate for people with atrial fibrillation-related ischemic stroke.ConclusionAtrial fibrillation is present in an increasing proportion of people hospitalized in Canada with ischemic stroke and disproportionately affects older women. Renewed focus is needed on atrial fibrillation-related stroke prevention with particular attention to sex disparities.
      Citation: International Journal of Stroke
      PubDate: 2019-10-09T05:54:56Z
      DOI: 10.1177/1747493019881349
  • Emotions after stroke: A narrative update
    • Authors: José M Ferro, Ana C Santos
      Abstract: International Journal of Stroke, Ahead of Print.
      AimIn this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke.MethodsWe searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance.Summary of reviewThe emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing.ConclusionOur current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.
      Citation: International Journal of Stroke
      PubDate: 2019-10-04T05:39:43Z
      DOI: 10.1177/1747493019879662
  • Remote ischemic conditioning for acute moderate ischemic stroke (RICAMIS):
           Rationale and design
    • Authors: Xiao-Qiu Li, Lin Tao, Zhong-He Zhou, Yu Cui, Hui-Sheng Chen
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleA large number of basic and clinical studies have proved that remote ischemic conditioning has neuroprotective effect. For example, remote ischemic conditioning showed a neuroprotective role in cerebral ischemia-reperfusion injury model. Recent clinical studies suggested that remote ischemic conditioning may improve neurological function and reduce the risk of recurrence in ischemic stroke patients. However, there is a lack of convincing evidence for the neuroprotective effect of remote ischemic conditioning on ischemic stroke, which deserves further study.AimTo explore the efficacy and safety of remote ischemic conditioning for acute moderate ischemic stroke.Sample size estimatesA maximum of 1800 subjects are required to test the superiority hypothesis with 80% power according to a one-sided 0.025 level of significance, stratified by gender, age, time from onset to treatment, National Institutes of Health Stroke Scale (6–10 vs. 11–16), degree of responsible vessel stenosis, location of stenosis, and stroke etiology.Methods and designRemote Ischemic Conditioning for Acute Moderate Ischemic Stroke is a prospective, random, open label, blinded endpoint and multi-center study. The subjects are divided into experimental group and control group randomly. The experimental group was treated with remote ischemic conditioning twice daily with 200 mmHg pressure for 10–14 days besides guideline-based therapy. The control group was treated according to the guidelines.Study outcomeThe primary efficacy endpoint is favorable functional outcome, defined as modified Rankin Scale 0–1 at 90 days post-randomization.
      Citation: International Journal of Stroke
      PubDate: 2019-10-04T05:39:42Z
      DOI: 10.1177/1747493019879651
  • Overview of endovascular thrombectomy accessibility gap for acute ischemic
           stroke in Asia: A multi-national survey
    • Authors: Anderson Chun On Tsang, I-Hsiao Yang, Emanuele Orru, Quang-Anh Nguyen, Roselyn V Pamatmat, Gorky Medhi, Yue Wan, Song Huang
      Abstract: International Journal of Stroke, Ahead of Print.
      Endovascular thrombectomy revolutionized the treatment of acute ischemic stroke. Nevertheless, access to endovascular thrombectomy is limited in many parts of the world. Asia holds 60% of the world’s population and its countries carry some of the highest stroke disease burden. To understand the availability of endovascular thrombectomy and intravenous thrombolysis in this region, we interviewed stroke neurologists and neuro-interventionists of 19 Asian countries, and found a large disparity in access to endovascular thrombectomy and intravenous thrombolysis between high- and low-income countries. Lack of neuro-interventionists, comprehensive stroke units, stroke triage systems and high treatment cost are the major obstacles to wider accessibility of endovascular thrombectomy, especially among developing countries. The potential solutions to provide equitable access to stroke revascularization therapy are discussed.
      Citation: International Journal of Stroke
      PubDate: 2019-10-04T05:39:42Z
      DOI: 10.1177/1747493019881345
  • e-ASPECTS derived acute ischemic volumes on non-contrast-enhanced computed
           tomography images
    • Authors: Simon Nagel, Olivier Joly, Johannes Pfaff, Panagiotis Papanagiotou, Klaus Fassbender, Wolfgang Reith, Markus A Möhlenbruch, Christian Herweh, Iris Q Grunwald
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purposeValidation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT).Materials and methodsData from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed.ResultsWe included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p 
      Citation: International Journal of Stroke
      PubDate: 2019-10-01T06:58:05Z
      DOI: 10.1177/1747493019879661
  • Determining the optimal dose of tenecteplase before endovascular therapy
           for ischemic stroke (EXTEND-IA TNK Part 2): A multicenter, randomized,
           controlled study
    • Authors: Bruce CV Campbell, Peter J Mitchell, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Bernard Yan, Vincent Thijs, Patricia M Desmond, Mark W Parsons, Geoffrey A Donnan, Stephen M Davis
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and hypothesisIntravenous thrombolysis with tenecteplase is more effective than alteplase in achieving substantial reperfusion at initial angiographic assessment and improves functional outcome. However, the optimal dose of tenecteplase remains uncertain. We hypothesized that 0.40 mg/kg tenecteplase is superior to 0.25 mg/kg tenecteplase in achieving reperfusion at initial angiogram, when administered within 4.5 h of ischemic stroke onset, in patients planned to undergo endovascular therapy.Study designEXTEND-IA TNK part 2 is an investigator-initiated, phase II, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Eligibility requires a diagnosis of ischemic stroke within 4.5 h of stroke onset, pre-stroke modified Rankin Scale (mRS)≤3 (no upper age limit), absence of contraindications to intravenous thrombolysis, and large vessel occlusion (internal carotid, basilar, or middle cerebral artery) on multimodal CT. Patients are randomized to IV tenecteplase at either 0.40 mg/kg (max 40 mg) or 0.25 mg/kg (max 25 mg) prior to thrombectomy.Study outcomesThe primary outcome measure is reperfusion on the initial catheter angiogram, assessed as modified Treatment In Cerebral Infarction (mTICI) 2b/3, or the absence of retrievable intracranial thrombus. Secondary outcomes include mRS at day 90 and early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) by ≥8 points or reaching 0–1) at day 3. Safety outcomes are death and symptomatic intracerebral hemorrhage.Trial registration: NCT03340493
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T08:27:14Z
      DOI: 10.1177/1747493019879652
  • A pragmatic, multi-centered, stepped wedge, cluster randomized controlled
           trial pilot of the clinical and cost effectiveness of a complex Stroke
           Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with
           usual oral healthcare in stroke wards

         This is an Open Access Article Open Access Article

    • Authors: Marian C Brady, David J Stott, Christopher J Weir, Campbell Chalmers, Petrina Sweeney, John Barr, Alex Pollock, Naomi Bowers, Heather Gray, Brenda Jean Bain, Marissa Collins, Catriona Keerie, Peter Langhorne
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundPatients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life.AimsWe piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings.MethodsScottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque.ResultsWe screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42).ConclusionsOur stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect.Trial RegistrationNCT01954212.
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T07:01:37Z
      DOI: 10.1177/1747493019871824
  • Granulocyte colony-stimulating factor and stromal cell-derived factor-1
           combination therapy: A more effective treatment for cerebral ischemic
    • Authors: Ming-Li Wang, Li-Xiang Zhang, Jun-Jie Wei, Lv-Li Li, Wei-Zhang Zhong, Xin-Jing Lin, Jin-ou Zheng, Xiao-Feng Li
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundDrugs that promote angiogenesis include statins, recombinant human granulocyte colony-stimulating factor, and stromal cell-derived factor-1. Low doses of atorvastatin could significantly increase the vascular expressions of endothelial growth factor, and the number of peripheral blood endothelial progenitor cells (EPCs), thus improving angiogenesis and local blood flow. G-CSF is an EPC-mobilization agent used in ischemia studies for targeting angiogenesis after cerebral ischemia via EPCs. In previous clinical trials, consistent conclusions have not been reached about the effectiveness of G-CSF on ischemic stroke. Therefore, the therapeutic effect of G-CSF and its combination with other medicines need further experimental verification. It is known that atorvastatin, rhG-CSF, and SDF-1 are considered the most promising neuroprotective candidates, but a comprehensive comparison of their effects is lacking.AimsTo compare the effects of atorvastatin, stromal cell-derived factor-1, and recombinant human granulocyte colony-stimulating factor on ischemic stroke.MethodsAdult male Sprague-Dawley rats were randomly allocated to three groups: normal, sham-operated, and middle cerebral artery occlusion operated. Middle cerebral artery occlusion operated rats were further allocated into saline, atorvastatin, recombinant human granulocyte colony-stimulating factor, and recombinant human granulocyte colony-stimulating factor + stromal cell-derived factor-1 groups. Neurological function evaluation, cerebral infarction and the blood–brain barrier integrity analysis, identification of angiogenic factors, assessment of angiogenesis, expression of growth-associated protein-43, neuroglobin, glial cell-derived neurotrophic factor, and cleaved caspase 3, were performed.ResultsCompared with atorvastatin or recombinant human granulocyte colony-stimulating factor alone, recombinant human granulocyte colony-stimulating factor + stromal cell-derived factor-1 treatment improved neurological performance, reduced cerebral infarction and blood–brain barrier disruption after stroke, and increased the content of stromal cell-derived factor-1, vascular endothelial growth factor, monocyte chemotactic protein 1, and basic fibroblast growth factor in peripheral blood. In addition, recombinant human granulocyte colony-stimulating factor + stromal cell-derived factor-1 promoted greater angiogenesis than atorvastatin or recombinant human granulocyte colony-stimulating factor alone and increased the expression of growth-associated protein-43, neuroglobin, and glial cell-derived neurotrophic factor, while decreasing the levels of cleaved caspase 3 in the brain after ischemic stroke.ConclusionsCombination therapy with recombinant human granulocyte colony-stimulating factor and stromal cell-derived factor-1 is more effective than atorvastatin or recombinant human granulocyte colony-stimulating factor alone in protecting against stroke-induced damage and could be an optimal therapeutic strategy for stroke.
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T07:01:36Z
      DOI: 10.1177/1747493019879666
  • Costs of bleeding on long-term antiplatelet treatment without routine
           co-prescription of proton-pump inhibitors
    • Authors: Ramon Luengo-Fernandez, Linxin Li, Peter M Rothwell
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundLong-term antiplatelet treatment is associated with major bleeding.AimsTo determine the costs associated with major bleeding in patients treated with aspirin-based antiplatelet treatment for secondary prevention of vascular events without routine prescription of proton-pump inhibitors and to estimate the likely long-term savings from routine co-prescription.MethodsIn a prospective population-based cohort study of TIA, ischemic stroke, and MI treated with antiplatelet drugs, we evaluated hospital care costs associated with bleed management during 10-year follow-up. Bleeding-associated costs were averaged across all patients. For upper GI-bleeds, mean costs were compared with the cost of routine co-prescription of proton-pump inhibitor.ResultsAmong 3166 patients on antiplatelet therapy with 405 first bleeding events, the average cost of major bleeding was $13,093 (S.D. 20,501), with similar costs for upper GI bleeds and intracranial bleeds (p = 0.235). However, total costs among the 3166 patients were higher for upper GI bleeds ($1,158,385 vs. $740,123). Averaged across all patients, the 10-year cost of major bleeding was $838 (95%CI: 680–1007), $411 due to upper GI bleeding, the cost of which increased from $175 in those aged
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T07:01:35Z
      DOI: 10.1177/1747493019879658
  • Organization of Stroke Care in Pakistan
    • Authors: Arsalan Anwar, Sidra Saleem, Alifiya Aamir, Mufaddal Diwan
      Abstract: International Journal of Stroke, Ahead of Print.
      In Pakistan, stroke is one of the major contributors to the health problem. The increasing incidence of stroke and lack of infrastructure in both urban and rural areas requires immediate attention. Multiple societies and groups have been established to highlight the growing problem, but necessary steps must be taken at the government level to improve and design a better stroke care system in the country.
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T07:01:35Z
      DOI: 10.1177/1747493019879663
  • Mechanical thrombectomy in patients with acute ischemic stroke: A
           cost-effectiveness and value of implementation analysis
    • Authors: Robert Heggie, Olivia Wu, Phil White, Gary A Ford, Joanna Wardlaw, Martin M Brown, Andrew Clifton, Keith W Muir
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundRecent clinical trials have demonstrated the efficacy of mechanical thrombectomy in acute ischemic stroke.AimsTo determine the cost-effectiveness, value of future research, and value of implementation of mechanical thrombectomy.MethodsUsing UK clinical and cost data from the Pragmatic Ischemic Stroke Thrombectomy Evaluation (PISTE) trial, we estimated the cost-effectiveness of mechanical thrombectomy over time horizons of 90-days and lifetime, based on a decision-analytic model, using all existing evidence. We performed a meta-analysis of seven clinical trials to estimate treatment effects. We used sensitivity analysis to address uncertainty. Value of implementation analysis was used to estimate the potential value of additional implementation activities to support routine delivery of mechanical thrombectomy.ResultsOver the trial period (90 days), compared with best medical care alone, mechanical thrombectomy incurred an incremental cost of £5207 and 0.025 gain in QALY (incremental cost-effectiveness ratio (ICER) £205,279), which would not be considered cost-effective. However, mechanical thrombectomy was shown to be cost-effective over a lifetime horizon, with an ICER of £3466 per QALY gained. The expected value of perfect information per patient eligible for mechanical thrombectomy in the UK is estimated at £3178. The expected value of full implementation of mechanical thrombectomy is estimated at £1.3 billion over five years.ConclusionMechanical thrombectomy was cost-effective compared with best medical care alone over a patient’s lifetime. On the assumption of 30% implementation being achieved throughout the UK healthcare system, we estimate that the population health benefits obtained from this treatment are greater than the cost of implementation.Trial registrationNCT01745692.
      Citation: International Journal of Stroke
      PubDate: 2019-09-30T07:01:34Z
      DOI: 10.1177/1747493019879656
  • Special topic section: linkages among cerebrovascular, cardiovascular, and
           cognitive disorders: Preventing dementia by preventing stroke: The Berlin
    • Authors: Vladimir Hachinski, Karl Einhäupl, Detlev Ganten, Suvarna Alladi, Carol Brayne, Blossom C. M. Stephan, Melanie D. Sweeney, Berislav Zlokovic, Yasser Iturria-Medina, Costantino Iadecola, Nozomi Nishimura, Chris B. Schaffer, Shawn N. Whitehead, Sandra E. Black, Leif Østergaard, Joanna Wardlaw, Steven Greenberg, Leif Friberg, Bo Norrving, Brian Rowe, Yves Joanette, Werner Hacke, Lewis Kuller, Martin Dichgans, Matthias Endres, Zaven S. Khachaturian
      Abstract: International Journal of Stroke, Ahead of Print.
      The incidence of stroke and dementia are diverging across the world, rising for those in low-and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action.© 2019 the Alzheimer’s Association and the World Stroke Organisation. Published by Elsevier Inc. All rights reserved.
      Citation: International Journal of Stroke
      PubDate: 2019-09-23T04:39:39Z
      DOI: 10.1177/1747493019871915
  • The emerging value of serum D-dimer measurement in the work-up and
           management of ischemic stroke
    • Authors: Tomoyuki Ohara, Mehdi Farhoudi, Oh Young Bang, Masatoshi Koga, Andrew M Demchuk
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundElevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases.AimsTo outline the clinical utility of D-dimer in work-up and management of ischemic stroke.SummaryD-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies.ConclusionAccumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.
      Citation: International Journal of Stroke
      PubDate: 2019-09-20T05:44:57Z
      DOI: 10.1177/1747493019876538
  • Atrial cardiopathy and stroke mortality in the general population
    • Authors: Muhammad I Ahmad, Matthew J Singleton, Prashant D Bhave, Hooman Kamel, Elsayed Z Soliman
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundPrior studies examining the link between atrial cardiopathy and stroke risk have focused mainly on non-fatal stroke.AimsTo examine the association between atrial cardiopathy and stroke mortality.MethodsThis analysis included 8028 participants (60.0 ± 13.4 years, 51.9% women, 49.8% white) from the Third National Health and Nutrition Examination (NHANES III) Survey. Atrial cardiopathy was defined as abnormal deep terminal negativity of the P wave in V1 (DTNPV1 = negative p-wave in V1
      Citation: International Journal of Stroke
      PubDate: 2019-09-18T03:05:38Z
      DOI: 10.1177/1747493019876543
  • Impact of intravenous thrombolysis on functional outcome in patients with
           mild ischemic stroke without large vessel occlusion or rapidly improving
    • Authors: Marcellina Isabelle Haeberlin, Ulrike Held, Ralf W Baumgartner, Dimitrios Georgiadis, Philipp O Valko
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundOptimal treatment strategy in patients with mild ischemic stroke remains uncertain. While functional dependency or death has been reported in up to one-third of non-thrombolyzed mild ischemic stroke patients, intravenous thrombolysis is currently not recommended in this patient group. Emerging evidence suggests two risk factors—rapid early improvement and large vessel occlusion—as main associates of unfavorable outcome in mild ischemic stroke patients not undergoing intravenous thrombolysis.AimsTo analyze natural course as well as safety and three-month outcome of intravenous thrombolysis in mild ischemic stroke without rapid early improvement or large vessel occlusion.MethodsMild ischemic stroke was defined by a National Institute of Health Stroke Scale score ≤6. We used the modified Rankin Scale (mRS) to compare three-month functional outcome in 370 consecutive mild ischemic stroke patients without early rapid improvement and without large vessel occlusion, who either underwent intravenous thrombolysis (n = 108) or received best medical treatment (n = 262).ResultsFavorable outcome (mRS ≤ 1) was common in both groups (intravenous thrombolysis: 91%; no intravenous thrombolysis: 90%). Although intravenous thrombolysis use was independently associated with a higher risk of asymptomatic hemorrhagic transformation (OR = 4.62, p = 0.002), intravenous thrombolysis appeared as an independent predictor of mRS = 0 at three months (OR = 3.33, p 
      Citation: International Journal of Stroke
      PubDate: 2019-09-13T01:10:13Z
      DOI: 10.1177/1747493019874719
  • Clinical and neuroimaging criteria to improve the workflow in transfers
           for endovascular treatment evaluation
    • Authors: Manuel Requena, Marta Olivé-Gadea, Sandra Boned, Anna Ramos, Pere Cardona, Xabier Urra, Joaquín Serena, Yolanda Silva, Francisco Purroy, Xavier Ustrell, Sonia Abilleira, Alejandro Tomasello, Natalia Perez de la Ossa, Carlos A Molina, Marc Ribo, Marta Rubiera
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundTransfer protocols from primary to comprehensive stroke centers are crucial for endovascular treatment success.AimTo evaluate clinical and neuroimaging data of transferred patients and their likelihood of presenting a large infarct core at comprehensive stroke center arrival.MethodsRetrospective analysis of population-based mandatory prospective registry of acute stroke patients evaluated for endovascular treatment. Consecutive patients evaluated at primary stroke center with suspected large vessel occlusion and PSC-ASPECTS ≥ 6 transferred to a comprehensive stroke center were included. PSC and CSC-ASPECTS, time-metrics, and clinical data were analyzed.ResultsDuring 28 months, 1185 endovascular treatment candidates were transferred from PC to comprehensive stroke center in our public stroke network, 477 had an anterior circulation syndrome and available neuroimaging information and were included. Median baseline NIHSS was 13 (8–19). On arrival to comprehensive stroke center, large vessel occlusion was confirmed in 60.2% patients, and 41.2% received endovascular treatment. Median interfacility ASPECTS decay was 1 (0–2) after a median of 150.7 (SD 101) min between both CT-acquisitions. A logistic regression analysis adjusted by age, time from symptoms to PC-CT, and time from PC-CT to CSC-CT showed that only a baseline NIHSS and PSC-ASPECTS independently predicted a CSC-ASPECTS 
      Citation: International Journal of Stroke
      PubDate: 2019-09-11T04:50:19Z
      DOI: 10.1177/1747493019874725
  • Adverse effects of pre-existing cerebral small vessel disease on cognitive
           improvement after carotid endarterectomy
    • Authors: Jun Yoshida, Fumio Yamashita, Makoto Sasaki, Kunihiro Yoshioka, Shunrou Fujiwara, Masakazu Kobayashi, Kenji Yoshida, Yoshitaka Kubo, Kuniaki Ogasawara
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAlthough patients with improved cognition after carotid endarterectomy usually exhibit postoperative restoration of cerebral blood flow, less than half of patients with such cerebral blood flow change have postoperatively improved cognition. Cerebral small vessel disease on magnetic resonance imaging is associated with irreversible cognitive impairment.AimsThe purpose of the present prospective study was to determine whether pre-existing cerebral small vessel disease affects cognitive improvement after carotid endarterectomy.MethodsBrain MR imaging was performed preoperatively, and the number or grade of each cerebral small vessel disease was determined in 80 patients undergoing carotid endarterectomy for ipsilateral internal carotid artery stenosis (≥70%). The volume of white matter hyperintensities relative to the intracranial volume was also calculated. Brain perfusion single-photon emission computed tomography and neuropsychological testing were performed preoperatively and two months postoperatively. Based on these data, a postoperative increase in cerebral blood flow and postoperative improved cognition, respectively, were determined.ResultsLogistic regression analysis using the sequential backward elimination approach revealed that a postoperative increase in cerebral blood flow (95% confidence interval [CI], 10.74–3730.00; P = 0.0004) and the relative volume of white matter hyperintensities (95% CI, 0.01–0.63; P = 0.0314) were significantly associated with postoperative improved cognition. Although eight of nine patients with postoperative improved cognition exhibited both a relative volume of white matter hyperintensities
      Citation: International Journal of Stroke
      PubDate: 2019-09-10T04:23:48Z
      DOI: 10.1177/1747493019874732
  • Feasibility of improving cerebral autoregulation in acute intracerebral
           hemorrhage (BREATHE-ICH) study: Results from an experimental
           interventional study
    • Authors: Jatinder S Minhas, Ronney B Panerai, David Swienton, Thompson G Robinson
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundCerebral autoregulation is impaired in a multitude of neurological conditions. Increasingly, clinical studies are correlating the nature of this impairment with prognostic markers. In acute intracerebral hemorrhage, impairment of cerebral autoregulation has been associated with worsening clinical outcomes including poorer Glasgow Coma Score and larger hematoma volume. Hypocapnia has been shown to improve cerebral autoregulation despite concerns over hypoperfusion and consequent ischemic risks, and it is therefore hypothesized that hypocapnia (via hyperventilation) in acute intracerebral hemorrhage may improve cerebral autoregulation and consequently clinical outcome.AimsTo assess the feasibility and acceptability of the first cerebral autoregulation-targeted intervention in acute intracerebral hemorrhage utilizing a simple bed-side hyperventilatory maneuver.MethodsTwelve patients with acute intracerebral hemorrhage within 48 h of onset were enrolled. The experimental setup measured cerebral blood flow velocity (transcranial Doppler), blood pressure (Finometer), and end-tidal CO2 (EtCO2, capnography) at baseline, and in response to hypocapnia (−5 mmHg below baseline) achieved via a 90-s hyperventilatory maneuver. Cerebral autoregulation was evaluated with transfer function analysis and autoregulatory index calculations.ResultsWe observed tolerance to the protocol in a cohort of mild (National Institutes of Health Scale 4) supratentorial intracerebral hemorrhage patients with small volume hematomas without intraventricular extension. Importantly, a significant difference was noted between ipsilateral autoregulatory index at baseline 4.8 (1.7) and autoregulatory index during hypocapnic intervention 7.0 (0.8) (p = 0.0004), reflecting improved cerebral autoregulation, though a dose-dependent effect of EtCO2 on autoregulatory index was not observed.ConclusionsIn this small study, there was no observed effect on 14-day death and disability in recruited participants. This is the first report of improvement in cerebral autoregulation in acute intracerebral hemorrhage using a non-invasive interventional maneuver, through induction of hypocapnia via Identifier: NCT03324321URL:
      Citation: International Journal of Stroke
      PubDate: 2019-09-10T04:23:46Z
      DOI: 10.1177/1747493019873690
  • Statin-based therapy for primary and secondary prevention of ischemic
           stroke: A meta-analysis and critical overview
    • Authors: Haralampos Milionis, George Ntaios, Eleni Korompoki, Konstantinos Vemmos, Patrik Michel
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsTo reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents.MethodsEnglish literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots.ResultsFour primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60–0.82; p 
      Citation: International Journal of Stroke
      PubDate: 2019-09-07T05:09:49Z
      DOI: 10.1177/1747493019873594
  • Comparison of MRI IVIM and MR perfusion imaging in acute ischemic stroke
           due to large vessel occlusion
    • Authors: Guangming Zhu, Christian Federau, Max Wintermark, Hui Chen, David G Marcellus, Blake W Martin, Jeremy J Heit
      Abstract: International Journal of Stroke, Ahead of Print.
      PurposeIntravoxel incoherent motion is a diffusion-weighted imaging magnetic resonance imaging technique that measures microvascular perfusion from a multi-b value sequence. Intravoxel incoherent motion microvascular perfusion has not been directly compared to conventional dynamic susceptibility contrast perfusion-weighted imaging in the context of acute ischemic stroke. We determined the degree of correlation between perfusion-weighted imaging and intravoxel incoherent motion parameter maps in patients with acute ischemic stroke.MethodsWe performed a retrospective cohort study of acute ischemic stroke patients undergoing thrombectomy treatment triage by magnetic resonance imaging. Intravoxel incoherent motion perfusion fraction maps were derived using two-step voxel-by-voxel post-processing. Ischemic core, penumbra, non-ischemia, and contralateral hemisphere were delineated based upon diffusion-weighted imaging and perfusion-weighted imaging using a Tmax>6 s threshold. Signal intensity within different brain compartments were measured on intravoxel incoherent motion (IVIM f, IVIM D*, IVIM fD*) parametric maps and compared the differences using one-way ANOVA. Ischemic volumes were measured on perfusion-weighted imaging and intravoxel incoherent motion parametric maps. Bland–Altman analysis and voxel-based volumetric comparison were used to determine the agreements among ischemic volumes of perfusion-weighted imaging and intravoxel incoherent motion perfusion parameters. Inter-rater reliability on intravoxel incoherent motion maps was also assessed. Significance level was set at α 
      Citation: International Journal of Stroke
      PubDate: 2019-09-04T01:32:22Z
      DOI: 10.1177/1747493019873515
  • Endovascular versus medical therapy for large-vessel anterior occlusive
           stroke presenting with mild symptoms
    • Authors: Dylan N Wolman, David G Marcellus, Maarten G Lansberg, Gregory Albers, Adrien Guenego, Michael P Marks, Robert L Dodd, Huy M Do, Max Wintermark, Blake W Martin, Jeremy J Heit
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAcute ischemic stroke patients with a large-vessel occlusion but mild symptoms (NIHSS ≤ 6) pose a treatment dilemma between medical management and endovascular thrombectomy.AimsTo evaluate the differences in clinical outcomes of endovascular thrombectomy-eligible patients with target-mismatch perfusion profiles who undergo either medical management or endovascular thrombectomy.MethodsForty-seven patients with acute ischemic stroke due to large-vessel occlusion, NIHSS ≤ 6, and a target-mismatch perfusion imaging profile were included. Patients underwent medical management or endovascular thrombectomy following treating neurointerventionalist and neurologist consensus. The primary outcome measure was NIHSS shift. Secondary outcome measures were symptomatic intracranial hemorrhage, in-hospital mortality, and 90-day mRS scores. The primary intention-to-treat and as-treated analyses were compared to determine the impact of crossover patient allocation on study outcome measures.ResultsForty-seven patients were included. Thirty underwent medical management (64%) and 17 underwent endovascular thrombectomy (36%). Three medical management patients underwent endovascular thrombectomy due to early clinical deterioration. Presentation NIHSS (P = 0.82), NIHSS shift (P = 0.62), and 90-day functional independence (mRS 0–2; P = 0.25) were similar between groups. Endovascular thrombectomy patients demonstrated an increased overall rate of intracranial hemorrhage (35.3% vs. 10.0%; P = 0.04), but symptomatic intracranial hemorrhage was similar between groups (P = 0.25). In-hospital mortality was similar between groups (P = 0.46), though all two deaths in the medical management group occurred among crossover patients. Endovascular thrombectomy patients demonstrated a longer length of stay (7.6 ± 7.2 vs. 4.3 ± 3.9 days; P = 0.04) and a higher frequency of unfavorable discharge to a skilled-nursing facility (P = 0.03) rather than home (P = 0.05).ConclusionsEndovascular thrombectomy may pose an unfavorable risk-benefit profile over medical management for endovascular thrombectomy-eligible acute ischemic stroke patients with mild symptoms, which warrants a randomized trial in this subpopulation.
      Citation: International Journal of Stroke
      PubDate: 2019-08-31T11:24:45Z
      DOI: 10.1177/1747493019873510
  • System-integrated technology-enabled model of care (SINEMA) to improve the
           health of stroke patients in rural China: Statistical analysis plan for a
           cluster-randomized controlled trial
    • Authors: Enying Gong, Lijing L Yan, Kara McCormack, John A Gallis, Janet Prvu Bettger, Elizabeth L Turner
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe system-integrated technology-enabled model of care (SINEMA) trial aimed to evaluate the effectiveness of a community-based multi-component intervention for secondary prevention of stroke in rural China.ObjectiveTo present the detailed statistical analysis plan for the trial prior to database locking and data analysis.MethodsThe detailed analysis plan outlines primary and secondary outcome measures, describes the over-arching data analysis principles to be adopted as well as more detailed descriptions of specific analytical approaches for effectiveness analyses, as well strategies to handle missing outcome data.DiscussionPublication of the statistical analysis plan increases the transparency of the data analysis procedure and reduces potential bias in trial reporting.Trial registrationThe trial was registered with (NCT03185858).
      Citation: International Journal of Stroke
      PubDate: 2019-08-29T05:27:30Z
      DOI: 10.1177/1747493019869707
  • Computed tomography perfusion in stroke mimics
    • Authors: James E Siegler, Jon Rosenberg, Daniel Cristancho, Andrew Olsen, Johannes Pulst-Korenberg, Lindsay Raab, Brett Cucchiara, Steven R Messé
      Abstract: International Journal of Stroke, Ahead of Print.
      ObjectiveTo describe the prevalence and patterns of abnormal findings on automated computed tomography perfusion in patients with stroke mimic.MethodsWe reviewed a retrospective multi-site cohort of consecutive patients undergoing computed tomography perfusion for suspected acute ischemic stroke within 24 h from last normal (June 2017 to December 2017). The primary outcome was the diagnosis of stroke mimic. Hypoperfusion abnormalities on iSchemaView RAPID automated computed tomography perfusion were compared between patients with stroke/transient ischemic attack and stroke mimic using mixed-effects multivariable logistic regression, focusing on absence of perfusion abnormalities and discordance with clinical symptoms and computed tomography angiography findings.ResultsOf 410 consecutive patients who underwent computed tomography perfusion, 348 met inclusion criteria (178 (51%) stroke, 19 (6%) transient ischemic attack, and 151 (43%) mimic). Time-to-maximum of the tissue residue function (Tmax>6s) abnormalities were seen in 42 (28%) patients with stroke mimic and 122 (62%) patients with stroke/transient ischemic attack (p 
      Citation: International Journal of Stroke
      PubDate: 2019-08-14T08:44:23Z
      DOI: 10.1177/1747493019869702
  • Distribution and current problems of acute endovascular therapy for large
           artery occlusion from a two-year national survey in Japan
    • Authors: Toshinori Takagi, Shinichi Yoshimura, Nobuyuki Sakai, Koji Iihara, Hidenori Oishi, Masaru Hirohata, Yuji Matsumaru, Yasushi Matsumoto, Hiroshi Yamagami, Bijoy K Menon, Mohammed Almekhlafi, Jessalyn K Holodinsky, Noreen Kamal, Michael D Hill, Mayank Goyal
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundEndovascular treatment is recommended in clinical practice in Japan. However, its utilization and comprehensiveness are less well described.AimsTo report endovascular treatment utilization and overall geographical coverage in Japan and to analyze regional differences in the number of endovascular treatments, specialists, and endovascular treatment-capable hospitals.MethodsA national survey of members of the Japanese Society for NeuroEndovascular Therapy (JSNET) was conducted in 2017 and 2018. The total number of endovascular treatment cases per year was estimated, and the number of endovascular treatment cases per 100,000 people was calculated using the 2015 census. The distribution of treatment hospitals and JSNET specialists was mapped and the population coverage rate was determined.ResultsThe total number of endovascular treatment cases in Japan increased by 34.5% from 2016 (7702) to 2017 (10,360). The number of endovascular treatment-capable hospitals in Japan increased from 597 in 2016 to 693 in 2017, with an average annual caseload of 14.9 in 2017. The number of JSNET specialists per hospital decreased from 1.81 in 2016 to 1.76 in 2017 because of the increase in endovascular treatment-capable hospitals. Only 50 (7.2%) hospitals had > 40 endovascular treatment cases annually. The majority (97.7%) of the Japanese population lives within a 60-min drive of any endovascular treatment-capable hospital. However, only 70.4% live within a 60-min drive of a high-volume center (>40 cases annually).ConclusionsUtilization of endovascular treatment in Japan is increasing; however, the number of cases per hospital remains low, as is the number of specialists per endovascular treatment-capable hospital. Increased number of specialists and centralization of endovascular treatment services may improve patient outcomes.
      Citation: International Journal of Stroke
      PubDate: 2019-08-14T08:44:23Z
      DOI: 10.1177/1747493019869706
  • Comparison of T2*GRE and DSC-PWI for hemorrhage detection in acute
           ischemic stroke patients: Pooled analysis of the EPITHET, DEFUSE 2, and
           SENSE 3 stroke studies
    • Authors: Shalini A Amukotuwa, Nancy J Fischbein, Gregory W Albers, Stephen Davis, Geoffrey A Donnan, Jalal B Andre, Roland Bammer
      Abstract: International Journal of Stroke, Ahead of Print.
      AimsThe objective of this study was to compare the diagnostic performance of the baseline pre-contrast images of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) with conventional T2*gradient recalled echo (GRE) imaging for detection of hemorrhage in acute ischemic stroke patients.Material and methodsT2*GRE and DSC-PWI from 393 magnetic resonance imaging scans from 221 patients enrolled in three prospective stroke studies were independently evaluated by two readers blinded to clinical and other imaging data. Agreement between T2*GRE and DSC-PWI for the presence of hemorrhage, and acute hemorrhagic transformation, was assessed using the kappa statistic. Inter-reader agreement was also assessed using the kappa statistic.ResultsAgreement between the baseline images of DSC-PWI and T2*GRE regarding the presence of hemorrhage was almost perfect (kreader 1 : 0.90, 95% confidence interval 0.86–0.95 and kreader 2 : 0.91, 95% confidence interval 0.87–0.96). Agreement between the sequences was still higher for detection of acute hemorrhagic transformation (kreader 1 : 0.94, 95% confidence interval 0.91–0.98 and kreader 2 : 0.95, 95% confidence interval 0.92–0.98). Inter-reader agreement for detection of hemorrhage was also almost perfect for both T2*GRE (k: 0.95, 95% confidence interval 0.91–0.98) and DSC-PWI (k: 0.96, 95% confidence interval 0.93–0.99). Acute hemorrhagic transformation detected on T2*GRE was missed on DSC-PWI by one or both readers in 5/393 (1.3%) scans.ConclusionThe almost perfect statistical agreement between DSC-PWI and conventional T2*GRE suggests that DSC-PWI is sufficient for hemorrhage screening prior to thrombolysis in stroke patients. T2*GRE can therefore be omitted when DSC-PWI is included, thereby shortening the acute ischemic stroke magnetic resonance imaging protocol and expediting treatment.Trial registration: Identifier: NCT02586415.
      Citation: International Journal of Stroke
      PubDate: 2019-07-11T05:03:36Z
      DOI: 10.1177/1747493019858781
  • Informal caregivers in stroke: Life impact, support, and psychological
           well-being—A Swedish Stroke Register (Riksstroke) study
    • Authors: Stefan Sennfält, Teresa Ullberg
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundInformal caregivers provide a large amount of day-to-day assistance and are crucial for the ability of survivors to recover and adapt to life after stroke.AimThe development of caregiver support programs is limited by lack of large long-term follow-up studies. We present a comprehensive study of Swedish stroke caregivers' life situation in relation to degree of functional dependency of the survivor.Patients and methodsIn 2016, the Swedish Stroke Register, Riksstroke, conducted a long-term follow-up survey on caregivers to patients with stroke three and five years earlier. Items on psychological well-being were adapted from the 36-item short-form health survey and poor outcome was defined using the 36-item short-form health survey reference material. Survivor degree of dependency was indicated by the caregiver as independent, partially dependent, or completely dependent.ResultsA total of 5063 community dwelling dyads were included: 56.5% of survivors were independent, 33.4% partially dependent, and 10.1% completely dependent. Caregiver life impact, need of support, and proportion of poor psychological well-being increased incrementally with survivor degree of dependency. In the completely dependent group where 41.1% of survivors could not be left unattended for more than 1 h, 23.7% of caregivers expressed unmet need of caregiver support; 51.4% reported poor psychological well-being compared to 19.3% in the independent group.ConclusionThe caregiver situation varies greatly with degree of survivor dependency which makes generalizations of caregiver needs difficult. Our results emphasize the need for integrating support aimed specifically at caregivers to survivors of stroke with a large degree of dependency.
      Citation: International Journal of Stroke
      PubDate: 2019-06-25T05:14:14Z
      DOI: 10.1177/1747493019858776
  • Dysphagia screening and risks of pneumonia and adverse outcomes after
           acute stroke: An international multicenter study
    • Authors: Menglu Ouyang, Elizabeth Boaden, Hisatomi Arima, Pablo M Lavados, Laurent Billot, Maree L Hackett, Verónica V Olavarría, Paula Muñoz-Venturelli, Lili Song, Kris Rogers, Sandy Middleton, Octavio M Pontes-Neto, Tsong-Hai Lee, Caroline Watkins, Thompson Robinson, Craig S Anderson
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundDysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice.AimsTo determine associations between a “brief” screen and “detailed” assessment of dysphagia on clinical outcomes in acute stroke patients.MethodsA prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3–6) at 90 days.ResultsOverall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to “screen-pass” patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18–4.10) and death or disability (aOR = 1.66, 95% CI = 1.41–1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72–9.54).ConclusionsFailing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.
      Citation: International Journal of Stroke
      PubDate: 2019-06-22T05:16:54Z
      DOI: 10.1177/1747493019858778
  • Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue
           following Stroke, 6th edition update 2019
    • Authors: Krista L Lanctôt, M Patrice Lindsay, Eric E Smith, Demetrios J Sahlas, Norine Foley, Gord Gubitz, Melissa Austin, Kristyn Ball, Sanjit Bhogal, Treena Blake, Nathan Herrmann, David Hogan, Aisha Khan, Stewart Longman, Andrea King, Carol Leonard, Tricia Shoniker, Trudy Taylor, Moira Teed, Andrea de Jong, Anita Mountain, Leanne K Casaubon, Dar Dowlatshahi, Richard H Swartz
      Abstract: International Journal of Stroke, Ahead of Print.
      The 2019 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Mood, Cognition and Fatigue following Stroke is a comprehensive set of evidence-based guidelines addressing three important issues that can negatively impact the lives of people who have had a stroke. These include post-stroke depression and anxiety, vascular cognitive impairment, and post-stroke fatigue. Following stroke, approximately 20% to 50% of all persons may be affected by at least one of these conditions. There may also be overlap between conditions, particularly fatigue and depression. If not recognized and treated in a timely matter, these conditions can lead to worse long-term outcomes. The theme of this edition of the CSBPR is Partnerships and Collaborations, which stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care to optimize recovery and outcomes. Accordingly, these recommendations place strong emphasis on the importance of timely screening and assessments, and timely and adequate initiation of treatment across care settings. Ideally, when screening is suggestive of a mood or cognition issue, patients and families should be referred for in-depth assessment by healthcare providers with expertise in these areas. As the complexity of patients treated for stroke increases, continuity of care and strong communication among healthcare professionals, and between members of the healthcare team and the patient and their family is an even bigger imperative, as stressed throughout the recommendations, as they are critical elements to ensure smooth transitions from acute care to active rehabilitation and reintegration into their community.
      Citation: International Journal of Stroke
      PubDate: 2019-06-21T08:52:48Z
      DOI: 10.1177/1747493019847334
  • High prevalence of stroke and uncontrolled associated risk factors are
           major public health challenges in rural northeast China: A
           population-based study
    • Authors: Liying Xing, Li Jing, Yuanmeng Tian, Shiwei Liu, Min Lin, Zhi Du, Guocheng Ren, Qun Sun, Lei Shi, Dong Dai, Shuang Liu
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-05-16T01:48:18Z
      DOI: 10.1177/1747493019851280
  • Thrombolysis related symptomatic intracranial hemorrhage in estimated
           versus measured body weight
    • Authors: T Truc My Nguyen, Stephanie IW van de Stadt, Adrien E Groot, Marieke JH Wermer, Heleen M den Hertog, Hanneke M Droste, Erik W van Zwet, Sander M van Schaik, Jonathan M Coutinho, Nyika D Kruyt
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-05-16T01:48:17Z
      DOI: 10.1177/1747493019851285
  • Left ventricular wall motion abnormality is associated with cryptogenic
    • Authors: Jeong-Yoon Choi, Jaehyung Cha, Jin-Man Jung, Woo-Keun Seo, Kyungmi Oh, Kyung-Hee Cho, Sungwook Yu
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-04-13T07:10:12Z
      DOI: 10.1177/1747493019834181
  • Long-term stroke incidence in proximal thoracic aorta aneurysm survivors
    • Authors: Jin-Yi Hsu, Yuan-Chih Su, Jen-Hung Wang, Boon Lead Tee
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-04-03T05:27:25Z
      DOI: 10.1177/1747493019840944
  • Measuring the effects of listening for leisure on outcome after stroke
           (MELLO): A pilot randomized controlled trial of mindful music listening
    • Authors: Satu Baylan, Caroline Haig, Maxine MacDonald, Ciara Stiles, Jake Easto, Meigan Thomson, Breda Cullen, Terence J Quinn, David Stott, Stewart W Mercer, Niall M Broomfield, Heather Murray, Jonathan J Evans
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-04-03T05:27:25Z
      DOI: 10.1177/1747493019841250
  • Comprehensive assessment of disability post-stroke using the newly
           developed miFUNCTION scale
    • Authors: Charlotte Zerna, Tyler Burley, Theresa L Green, Sean P Dukelow, Andrew M Demchuk, Michael D Hill
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-03-28T01:46:29Z
      DOI: 10.1177/1747493019840933
  • IER-START nomogram for prediction of three-month unfavorable outcome after
           thrombectomy for stroke
    • Authors: Manuel Cappellari, Salvatore Mangiafico, Valentina Saia, Giovanni Pracucci, Sergio Nappini, Patrizia Nencini, Daniel Konda, Fabrizio Sallustio, Stefano Vallone, Andrea Zini, Sandra Bracco, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Antonio Pitrone, Francesco Grillo, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Chiara Comelli, Enrica Duc, Alessio Comai, Enrica Franchini, Mirco Cosottini, Michelangelo Mancuso, Simone Peschillo, Manuela De Michele, Andrea Giorgianni, Maria Luisa Delodovici, Elvis Lafe, Maria F Denaro, Nicola Burdi, Saverio Internò, Nicola Cavasin, Adriana Critelli, Luigi Chiumarulo, Marco Petruzzellis, Marco Doddi, Antonio Carolei, William Auteri, Alfredo Petrone, Riccardo Padolecchia, Tiziana Tassinari, Marco Pavia, Paolo Invernizzi, Gianni Turcato, Stefano Forlivesi, Elisa Francesca Maria Ciceri, Bruno Bonetti, Domenico Inzitari, Danilo Toni
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.AimsWe aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy
      Citation: International Journal of Stroke
      PubDate: 2019-03-25T09:04:07Z
      DOI: 10.1177/1747493019837756
  • Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy
           compared to best medical treatment: One-year interim results of SPACE-2

         This is an Open Access Article Open Access Article

    • Authors: T Reiff, HH Eckstein, U Mansmann, O Jansen, G Fraedrich, H Mudra, D Böckler, M Böhm, H Brückmann, ES Debus, J Fiehler, W Lang, K Mathias, EB Ringelstein, J Schmidli, R Stingele, R Zahn, T Zeller, A Hetzel, U Bodechtel, A Binder, J Glahn, W Hacke, PA Ringleb
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-03-15T10:39:42Z
      DOI: 10.1177/1747493019833017
  • Ligature-induced periodontitis induces systemic inflammation but does not
           alter acute outcome after stroke in mice
    • Authors: Conor O'Boyle, Michael J Haley, Eloise Lemarchand, Craig J Smith, Stuart M Allan, Joanne E Konkel, Catherine B Lawrence
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-22T04:29:33Z
      DOI: 10.1177/1747493019834191
  • Chest infection within 30 days of acute stroke, associated factors,
           survival and the benefits of stroke unit care: Analysis using linked data
           from the Australian Stroke Clinical Registry
    • Authors: Chantelle Chapman, Dominique A Cadilhac, Prue Morgan, Monique F Kilkenny, Rohan Grimley, Vijaya Sundararajan, Tara Purvis, Trisha Johnston, Natasha A Lannin, Nadine E Andrew
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-21T04:15:07Z
      DOI: 10.1177/1747493019833008
  • ICARUSS: An effective model for risk factor management in stroke survivors
    • Authors: Jacques Joubert, Stephen M Davis, Geoffrey A Donnan, Christopher Levi, Graeme Gonzales, Lynette Joubert, Graeme J Hankey
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-20T03:31:53Z
      DOI: 10.1177/1747493019830582
  • Utility-weighted modified Rankin Scale: Still too crude to be a truly
           patient-centric primary outcome measure'
    • Authors: Venesha Rethnam, Julie Bernhardt, Helen Dewey, Marj Moodie, Hannah Johns, Lan Gao, Janice Collier, Fiona Ellery, Leonid Churilov
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-12T04:10:25Z
      DOI: 10.1177/1747493019830583
  • Transient ischemic attack: Incidence and early risk of stroke in northern
           Portugal from 1998–2000 to 2009–2011
    • Authors: Rui Felgueiras, Rui Magalhães, Mário R Silva, Maria C Silva, Manuel Correia
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-08T11:23:47Z
      DOI: 10.1177/1747493019830322
  • Approval of Stroke and Cardiovascular Disease Control Act in Japan:
           Comprehensive nationwide approach for prevention, treatment, and
           patients’ support
    • Authors: Hirofumi Nakayama, Kazuo Minematsu, Takenori Yamaguchi, Susumu Miyamoto, Mitsuaki Isobe, Issei Komuro, Yoshio Yazaki
      First page: 7
      Abstract: International Journal of Stroke, Ahead of Print.
      The Stroke and Cardiovascular Disease Control Act was enacted in Japan in December 2018. This law has become the first ever legislative countermeasure against stroke and cardiovascular disease in Japan. The government shall make a “Basic Plan to Promote Stroke and Cardiovascular Disease Control Programs” with input from a council consisted of stakeholders. In accordance with the government plan, each prefecture shall make a prefectural plan. Both government and prefectural plans will be reviewed at least every six years. A nationwide approach is expected to contribute to reducing the burden of disease and to prolong healthy life expectancy.
      Citation: International Journal of Stroke
      PubDate: 2019-09-04T01:32:23Z
      DOI: 10.1177/1747493019873549
  • Aspirin for primary prevention of stroke in individuals without
           cardiovascular disease—A meta-analysis
    • Authors: Conor Judge, Sarah Ruttledge, Robert Murphy, Elaine Loughlin, Sarah Gorey, Maria Costello, Aoife Nolan, John Ferguson, Martin O Halloran, Michelle O'Canavan, Martin J O'Donnell
      First page: 9
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe benefits of aspirin for primary prevention of stroke are uncertain.MethodsWe performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease.Summary of review resultsAmong 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention.ConclusionOur meta-analysis reports no benefit of aspirin for primary stroke prevention.
      Citation: International Journal of Stroke
      PubDate: 2019-06-25T05:14:15Z
      DOI: 10.1177/1747493019858780
  • Stroke epidemiology and stroke policies in China from 1980 to 2017: A
           systematic review and meta-analysis
    • Authors: Sophia Hu, Bijun Cui, Michael Mlynash, Xin Zhang, Kala M Mehta, Maarten G Lansberg
      First page: 18
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundStroke is the leading cause of death and years of life lost in China, and this problem is growing because stroke risk factors such as hypertension and hypercholesteremia have been on the rise as China experiences the demographic transition. The Chinese government has created public health initiatives in the form of guidelines, policies and programs to combat this problem, but the dissemination and effectiveness of these policies are not well known.AimsThe aim of this study was to determine trends in stroke incidence, prevalence, and stroke-related mortality in China and to report these trends in the context of stroke initiatives that have been enacted by the Chinese government.Summary of reviewWe systematically reviewed articles on stroke rates and stroke initiatives from 1980 to 2017. A meta-regression including 11 studies showed that stroke incidence remained stable at 128.3 per 100,000 per year from 1980 to 2005 and has increased by 21.3 per 100,000 per year since then to 298.7 per 100,000 per year in 2013. A meta-regression including seven studies demonstrated a gradual decline in stroke-related mortality by 6.5 per 100,000 per year since 1980 (a decline from 369.2 in 1980 to 154.7 per 100,000 per year in 2013). Average stroke prevalence was 898.4 per 100,000 over the entire time-period. Limitations included heterogeneity between the studies. We identified 12 stroke initiatives, the first of which was enacted in 2006.ConclusionsDespite numerous public health initiatives aimed at combating stroke that started in 2006, stroke incidence in China has increased over the last decade, likely as a result of aging and urbanization of the Chinese population.
      Citation: International Journal of Stroke
      PubDate: 2019-09-23T04:40:13Z
      DOI: 10.1177/1747493019873562
  • Who will benefit more from low-dose alteplase in acute ischemic
    • Authors: Xia Wang, Keon-Joo Lee, Tom J Moullaali, Beom Joon Kim, Qiang Li, Hee-Joon Bae, Cheryl Carcel, Candice Delcourt, Hisatomi Arima, Shoichiro Sato, Thompson G Robinson, Lili Song, Guofang Chen, Jie Yang, John Chalmers, Craig S Anderson, Richard Lindley, Mark Woodward
      First page: 39
      Abstract: International Journal of Stroke, Ahead of Print.
      ObjectivesControversy persists over the benefits of low-dose versus standard-dose intravenous alteplase for the treatment of acute ischemic stroke. We sought to determine individual patient factors that contribute to the risk–benefit balance of low-dose alteplase treatment.MethodsObservational study using data from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, randomized, open-label, blinded-endpoint trial that assessed low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) intravenous alteplase in acute ischemic stroke patients. Logistic regression models were used to estimate the benefit of good functional outcome (scores 0 or 1 on the modified Rankin scale at 90 days) and risk (symptomatic intracerebral hemorrhage), under both regimens for individual patients. The net advantage for low-dose, relative to standard-dose, alteplase was calculated by dividing excess benefit by excess risk according to a combination of patient characteristics. The algorithms were externally validated in a nationwide acute stroke registry database in South Korea.ResultsPatients with an estimated net advantage from low-dose alteplase, compared with without, were younger (mean age of 66 vs. 75 years), had lower systolic blood pressure (148 vs. 160 mm Hg), lower National Institute of Health Stroke Scale score (median of 8 vs. 16), and no atrial fibrillation (10.3% vs. 97.4%), diabetes mellitus (19.2% vs. 22.4%), or premorbid symptoms (defined by modified Rankin scale = 1) (16.3% vs. 37.8%).ConclusionUse of low-dose alteplase may be preferable in acute ischemic stroke patients with a combination of favorable characteristics, including younger age, lower systolic blood pressure, mild neurological impairment, and no atrial fibrillation, diabetes mellitus, or premorbid symptoms.
      Citation: International Journal of Stroke
      PubDate: 2019-06-22T05:16:52Z
      DOI: 10.1177/1747493019858775
  • Cortical thickness, white matter hyperintensities, and cognition after
    • Authors: David Alexander Dickie, Kirstyn Gardner, Annika Wagener, Annick Wyss, Francesco Arba, Joanna M Wardlaw, Jesse Dawson
      First page: 46
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-05-15T05:23:58Z
      DOI: 10.1177/1747493019851291
  • Validation and iteration of CT perfusion defined malignant profile
           thresholds for acute ischemic stroke
    • Authors: Kevin J Keenan, Soren Christensen, Manabu Inoue, Michael Mlynash, Gregory W Albers, Wade S Smith
      First page: 55
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-22T04:29:27Z
      DOI: 10.1177/1747493019832987
  • Burden of large vessel occlusion stroke and the service gap of
           thrombectomy: A population-based study using a territory-wide public
           hospital system registry
    • Authors: Anderson C.O. Tsang, Jia You, Lai Fung Li, Frederick C.P. Tsang, Pauline P.S. Woo, Eva L.H. Tsui, Philip Yu, Gilberto K. K. Leung
      First page: 69
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-11T02:12:42Z
      DOI: 10.1177/1747493019830585
  • Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in
           acute ischemic stroke
    • Authors: Elena Pizzo, Maureen Dumba, Kyriakos Lobotesis
      First page: 75
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-13T04:18:15Z
      DOI: 10.1177/1747493019830587
  • Incidence, clinical features and outcomes of atrial fibrillation and
           stroke in Qatar
    • Authors: Yahia Z Imam, Saadat Kamran, Naveed Akhtar, Dirk Deleu, Rajvir Singh, Rayaz A Malik, MS Abdelmoneim, Pablo Bermejo, Paula Bourke, Deborah Morgan, Mark Santos, Sujatha Joseph, Ashfaq Shuaib
      First page: 85
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-21T04:15:08Z
      DOI: 10.1177/1747493019830577
  • Location-specific differences in hematoma volume predict outcomes in
           patients with spontaneous intracerebral hemorrhage
    • Authors: Natasha Ironside, Ching-Jen Chen, Victoria Dreyer, Brandon Christophe, Thomas J Buell, Edward Sander Connolly
      First page: 90
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2019-02-12T04:10:29Z
      DOI: 10.1177/1747493019830589
  • TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion:
           Prioritize IV or endovascular treatment—A randomized trial
    • Authors: Anne Behrndtz, Søren P Johnsen, Jan B Valentin, Martin F Gude, Rolf A Blauenfeldt, Grethe Andersen, Charles BLM Majoie, Marc Fisher, Claus Z Simonsen
      First page: 103
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleFor patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy.AimFor patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome.Sample sizeWe aim to randomize 600 patients, 1:1.DesignA national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed.OutcomesThe primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients.DiscussionStudy results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.
      Citation: International Journal of Stroke
      PubDate: 2019-08-25T11:06:12Z
      DOI: 10.1177/1747493019869830
  • Secondary Prevention by Structured Semi-Interactive Stroke Prevention
           Package in India (SPRINT INDIA) study protocol
    • Authors: Mahesh Pundlik Kate, Deepti Arora, Shweta Jain Verma, PN Sylaja, Vishnu Renjith, Meenakshi Sharma, Jeyaraj Durai Pandian
      First page: 109
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleRecurrent stroke, cardiovascular morbidity, and mortality are important causes of poor outcome in patients with index stroke. Despite the availability of best medical management recurrent stroke occur in up to 15–20% of patients with stroke in India. Education for stroke prevention could be a strategy to prevent recurrent strokes.HypothesisWe hypothesize that a structured semi-interactive stroke prevention package can reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke at the end of one year.DesignSecondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA (SPRINT INDIA) is a multi-center stroke trial involving 25 centers under the Indian Stroke Clinical Trial Network. Patients with first ever sub-acute stroke within two days to three months of onset, age 18–85 years, mRS
      Citation: International Journal of Stroke
      PubDate: 2019-12-19T06:06:55Z
      DOI: 10.1177/1747493019895653
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Heriot-Watt University
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