Subjects -> MEDICAL SCIENCES (Total: 8677 journals)
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CARDIOVASCULAR DISEASES (338 journals)                  1 2 | Last

Showing 1 - 200 of 338 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 8)
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: 60)
American Journal of Cardiology     Hybrid Journal   (Followers: 68)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 18)
American Journal of Hypertension     Hybrid Journal   (Followers: 29)
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 Circulation     Open Access   (Followers: 2)
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: 6)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 4)
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)
Arrhythmia & Electrophysiology Review     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 33)
Artery Research     Hybrid Journal   (Followers: 5)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 4)
ASEAN Heart Journal     Open Access   (Followers: 3)
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: 9)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 18)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiac Failure Review     Open Access   (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: 11)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 9)
Cardiology in the Young     Hybrid Journal   (Followers: 35)
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: 11)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 9)
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: 2)
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: 16)
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: 104)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 270)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 19)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 12)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 17)
Circulation : Heart Failure     Hybrid Journal   (Followers: 28)
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: 10)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 5)
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: 3)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 5)
Current Cardiology Reports     Hybrid Journal   (Followers: 6)
Current Cardiology Reviews     Hybrid Journal   (Followers: 3)
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: 13)
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: 1)
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 Cardiology Review     Open Access   (Followers: 1)
European Heart Journal     Hybrid Journal   (Followers: 68)
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: 7)
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: 13)
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: 5)
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: 49)
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: 2)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 24)
Hypertension     Open Access   (Followers: 2)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 4)
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: 6)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 17)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 3)
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: 33)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Open Access  
JACC : Basic to Translational Science     Open Access   (Followers: 6)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 19)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 21)
JACC : Heart Failure     Full-text available via subscription   (Followers: 16)
JAMA Cardiology     Hybrid Journal   (Followers: 31)

        1 2 | Last

Similar Journals
Journal Cover
International Journal of Stroke
Journal Prestige (SJR): 1.966
Citation Impact (citeScore): 3
Number of Followers: 33  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1747-4930 - ISSN (Online) 1747-4949
Published by Sage Publications Homepage  [1090 journals]
  • Mood, cognition and fatigue, and advances in acute stroke care
    • Authors: Hugh S Markus
      Pages: 589 - 590
      Abstract: International Journal of Stroke, Volume 15, Issue 6, Page 589-590, August 2020.

      Citation: International Journal of Stroke
      PubDate: 2020-07-31T05:06:07Z
      DOI: 10.1177/1747493020941377
      Issue No: Vol. 15, No. 6 (2020)
  • Preceding infection and risk of stroke: An old concept revived by the
           COVID-19 pandemic
    • Authors: Kieron South, Laura McCulloch, Barry W McColl, Mitchell SV Elkind, Stuart M Allan, Craig J Smith
      Abstract: International Journal of Stroke, Ahead of Print.
      Anecdotal reports and clinical observations have recently emerged suggesting a relationship between COVID-19 disease and stroke, highlighting the possibility that infected individuals may be more susceptible to cerebrovascular events. In this review we draw on emerging studies of the current pandemic and data from earlier, viral epidemics, to describe possible mechanisms by which SARS-CoV-2 may influence the prevalence of stroke, with a focus on the thromboinflammatory pathways, which may be perturbed. Some of these potential mechanisms are not novel but are, in fact, long-standing hypotheses linking stroke with preceding infection that are yet to be confirmed. The current pandemic may present a renewed opportunity to better understand the relationship between infection and stroke and possible underlying mechanisms.
      Citation: International Journal of Stroke
      PubDate: 2020-07-24T11:22:22Z
      DOI: 10.1177/1747493020943815
  • Australian clinical consensus guideline for the subacute rehabilitation of
           childhood stroke
    • Authors: M Greenham, S Knight, J RoddaPhD, A Scheinberg, V Anderson, MC Fahey, MT Mackay
      Abstract: International Journal of Stroke, Ahead of Print.
      Childhood stroke results in long-term, multifaceted difficulties, affecting motor, cognitive, communication, and behavioral domains of function which impact on participation and quality of life. The Childhood Stroke Consensus Rehabilitation Guideline was developed to improve the care of children with stroke by providing health professionals with recommendations to assist in their rehabilitative treatment. Clinical questions were formulated to inform systematic database searches from 2001 to 2016, limited to English and pediatric studies. SIGN methodology and the National Health and Medical Research Council system were used to screen and classify the evidence. The Grade of Recommendation, Assessment, Development and Evaluation system was used to grade evidence as strong or weak. Where evidence was inadequate or absent, a modified Delphi consensus process was used to develop consensus-based recommendations. The guideline provides 56 recommendations (1 evidence-based recommendation and 55 consensus recommendations). These relate to the framework of rehabilitation service delivery as well as domain-specific rehabilitation treatment strategies for each domain of function. It is anticipated that this guideline will provide health professions with recommendations to improve the subacute care of children with stroke both in Australia and internationally.
      Citation: International Journal of Stroke
      PubDate: 2020-07-21T05:37:07Z
      DOI: 10.1177/1747493020941279
  • Closure of the patent foramen ovale in patients with embolic stroke of
           undetermined source: A clinical expert opinion and consensus statement for
           the Asian-Pacific region
    • Authors: Hans-Christoph Diener, Teiji Akagi, Kritvikrom Durongpisitkul, Viji Samuel Thomson, AT Prabhakar, Ross Sharpe, Bert Albers, Thorsten Lewalter, Koichi Oki, Vijay K Sharma
      Abstract: International Journal of Stroke, Ahead of Print.
      Recently published long-term data from randomized controlled trials have provided evidence for the prevention of recurrent embolic stroke of undetermined source by percutaneous closure of the patent foramen ovale. However, most data were obtained from Caucasian populations and evidence on patent foramen ovale closure in Asian-Pacific patients is limited. The relative paucity in clinical data from this population, as well as the fact that Asian-Pacific patients may have higher bleeding risks than Caucasians, complicates clinical decision-making. This document, resulting from a consensus meeting of Asian-Pacific clinical experts, states the consensus among these experts about how to treat Asian-Pacific patients who had an embolic stroke of undetermined source and have a patent foramen ovale, based on currently available evidence and expert opinions. In addition, uncertainties and the need for clinical data regarding patent foramen ovale closure for prevention of recurrent embolic stroke of undetermined source in general, and specifically for Asian-Pacific patients, are identified.
      Citation: International Journal of Stroke
      PubDate: 2020-07-17T10:18:50Z
      DOI: 10.1177/1747493020941658
  • Cilostazol versus aspirin in ischemic stroke with cerebral microbleeds
           versus prior intracerebral hemorrhage
    • Authors: Hong-Kyun Park, Ji Sung Lee, Bum Joon Kim, Jong-Ho Park, Yong-Jae Kim, Sungwook Yu, Yang-Ha Hwang, Joung-Ho Rha, Sung Hyuk Heo, Seong Hwan Ahn, Woo-Keun Seo, Jong-Moo Park, Ju-Hun Lee, Jee-Hyun Kwon, Sung-Il Sohn, Jin-Man Jung, Sun U Kwon, Keun-Sik Hong
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIn PreventIon of CArdiovascular Events in Ischaemic Stroke Patients with High Risk of Cerebral HaemOrrhage (PICASSO), cilostazol versus aspirin was comparable for the end points of cerebral hemorrhage and major vascular events. However, underlying hemorrhage-prone lesions could modify the treatment effect.AimsWe explored whether the safety and efficacy of cilostazol versus aspirin would differ between hemorrhage-prone lesions (multiple cerebral microbleeds vs. prior intracerebral hemorrhage).MethodsIn this post hoc analysis of PICASSO, we divided patients into the cerebral microbleeds and prior intracerebral hemorrhage subgroups. The primary safety end point was the first occurrence of cerebral hemorrhage. The primary efficacy end point was the composite of stroke, myocardial infarction, or vascular death.ResultsOf 1512 patients, 903 (59.7%) had multiple cerebral microbleeds and 609 (40.3%) had prior intracerebral hemorrhage. The cerebral hemorrhage risk was lower with cilostazol versus aspirin (0.12%/year vs. 1.49%/year; hazard ratio, 0.08 [95% confidence interval 0.01–0.60]; p = 0.015) in the cerebral microbleeds subgroup, but was not different (1.26%/year vs. 0.79%/year; hazards ratio 1.60 [0.52–4.90]; p = 0.408) in the prior intracerebral hemorrhage subgroup. The interaction of treatment-by-subgroup was significant (pinteraction = 0.011). For the composite of major vascular events, there was a trend toward a lower risk with cilostazol versus aspirin (3.56%/year vs. 5.53%/year; hazards ratio 0.64 [0.41–1.01]; p = 0.056) in the cerebral microbleeds subgroup, but was comparable (5.21%/year vs. 5.05%/year; hazards ratio 1.03 [0.63–1.67]; p = 0.913) in the prior intracerebral hemorrhage subgroup without a significant treatment-by-subgroup interaction (pinteraction = 0.165).ConclusionsCilostazol versus aspirin might be a better option in ischemic stroke with multiple cerebral microbleeds, but confirmatory trials are needed.Clinical Trial RegistrationURL: NCT01013532.
      Citation: International Journal of Stroke
      PubDate: 2020-07-15T06:53:11Z
      DOI: 10.1177/1747493020941273
  • The impact of the COVID-19 pandemic on a stroke center in Latin America
    • Authors: Marcus Tulius Silva, Giseli Quintanilha, Louise Giesel, Ana Beatriz Soldati, Carolina Jabarra, Cristina Almeida, Ligia Rocha, Tayla Romão, Clarissa Sptiz, Cristiane Soares, Alex Sander Ribeiro, Moyses Damasceno, Abelardo Araujo, Marco Lima
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-07-14T09:41:37Z
      DOI: 10.1177/1747493020941637
  • Corrigendum
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-07-11T10:26:39Z
      DOI: 10.1177/1747493020942745
  • Poststroke shoulder pain in subacute patients and its correlation with
           upper limb recovery after robotic or conventional treatment: A secondary
           analysis of a multicenter randomized controlled trial
    • Authors: I Aprile, M Germanotta, A Cruciani, C Pecchioli, S Loreti, D Papadopoulou, A Montesano, S Galeri, M Diverio, C Falsini, G Speranza, E Langone, MC Carrozza, F Cecchi
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsPoststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation.MethodsThis is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2).ResultsA moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life.Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function.ConclusionsPoststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention.
      Citation: International Journal of Stroke
      PubDate: 2020-07-09T06:44:43Z
      DOI: 10.1177/1747493020937192
  • Atrial fibrillation trial to evaluate real-world procedures for their
           utility in helping to lower stroke events: A randomized clinical trial
    • Authors: Wen-Yi Huang, Meng Lee, Sheng-Feng Sung, Sung-Chun Tang, Kuo-Hsuan Chang, Yung-Sung Huang, Jiann-Der Lee, Tsong-Hai Lee, Jiann-Shing Jeng, Chang-Min Chung, Yi-Ling Wu, Tsung-Ta Hsieh, Bruce Ovbiagele
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundEnhancing detection of unrecognized atrial fibrillation among acute ischemic stroke patients is crucial for secondary stroke prevention.AimTo evaluate whether the detection rate of new atrial fibrillation in acute ischemic stroke patients without known atrial fibrillation could be improved by doing serial 12-lead electrocardiograms once daily for five days, compared with conventional 24-h Holter monitoring (24-h Holter).MethodsWe conducted a randomized clinical trial to compare the detection rates of paroxysmal atrial fibrillation between serial electrocardiograms versus 24-h Holter from October 2015 to October 2018 at six hospitals. Eligible participants were acute ischemic stroke patients with aged ≥65 years, with neither atrial fibrillation history nor any presence of atrial fibrillation on baseline electrocardiogram at admission. The primary outcome was newly detected electrocardiogram in the serial electrocardiograms and 24-h Holter group.ResultsAmong 826 patients, baseline characteristics were similar between both groups. In the intention-to-treat analysis, there was no statistical difference between serial electrocardiograms versus 24-Holter to detect atrial fibrillation (8.4% vs. 6.9%; adjusted odds ratio 1.17, 95% confidence interval 0.69–2.01). Stepwise multivariate logistic regression revealed age ≥80 years and history of heart failure were associated with detection of paroxysmal atrial fibrillation whereas patients with lacunar infarction had lower odds for detection of paroxysmal atrial fibrillation.ConclusionsSerial electrocardiograms had comparable detection rate of paroxysmal atrial fibrillation compared with 24-h Holter and might be a viable alternative to 24-h Holter as a first-line approach to survey for potential paroxysmal atrial fibrillation among elderly patients with acute ischemic stroke.Clinical Trial Registration: URL Identifiers: NCT02578979
      Citation: International Journal of Stroke
      PubDate: 2020-07-09T06:44:43Z
      DOI: 10.1177/1747493020938297
  • Worse prognosis in women, compared with men, after thrombolysis: An
           individual patient data pooling study of Asian acute stroke registries
    • Authors: Xia Wang, Cheryl Carcel, Ruigang Wang, Jingwei Li, Hee-Joon Bae, Yilong Wang, Anxin Wang, Yongjun Wang, Kazunori Toyoda, Yi Sui, Tsong-Hai Lee, Jose C Navarro, Mu-Chien Sun, Craig S Anderson, Vijay Sharma, Else C Sandset, Mark Woodward
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purposeTo examine sex differences in disease profiles and short-term outcomes after acute ischemic stroke treated with recombinant tissue plasminogen activator.MethodsEight national and regional stroke registries contributed individual participant data from mainland China, Japan, Philippines, Singapore, South Korea and Taiwan in 2005–2018. The primary outcome was ordinal-modified Rankin scale at 90 days. Key safety outcome was symptomatic intracerebral hemorrhage (sICH).ResultsOf 4453 patients included in the analyses, 1692 (36.3%) were women who were older, more likely to have a more severe neurological deficit, history of hypertension and atrial fibrillation, and a cardioembolic stroke compared to men. Women were more likely than men to have unfavorable shift of modified Rankin scale (fully adjusted odds ratio) (women vs. men) 1.14, 95% confidence interval 1.02–1.28). There was no significant sex difference for death 1.05 (0.84–1.31) or sICH (1.17, 0.89–1.54). Women were more likely to have unfavorable functional outcome with increasing age (P = 0.022 for interaction). In the age groups 70–80 and ≥80 years, women had a worse functional outcome compared to men (1.22, 1.02–1.47 and 1.43, and 1.06–1.92, respectively).ConclusionIn this pooled data from Asian acute stroke registries, women had poorer prognosis than men after receiving recombinant tissue plasminogen activator for acute ischemic stroke, which worsened with age. Women older than 70 appear to have a worse outcome than men which could be explained by greater stroke severity, more AF, and cardioembolic stroke.
      Citation: International Journal of Stroke
      PubDate: 2020-07-08T10:55:07Z
      DOI: 10.1177/1747493020938307
  • Tenecteplase versus alteplase after acute ischemic stroke at high age
    • Authors: Bente Thommessen, Halvor Næss, Nicola Logallo, Christopher E Kvistad, Ulrike Waje-Andreassen, Hege Ihle-Hansen, Håkon Ihle-Hansen, Lars Thomassen, Ole Morten Rønning
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundStroke prevalence is increasing with age. Alteplase is the only agent approved for thrombolytic treatment for patients with ischemic stroke, including patients ≥80 years. In the present study, the aim was to compare efficacy and safety of tenecteplase and alteplase in patients ≥80 years.MethodsData from the Norwegian Tenecteplase Stroke Trial, a randomized controlled trial comparing alteplase and tenecteplase, were assessed.ResultsOf the 273 patients ≥80 years included, mean age was 85.5 years.In the intention-to-treat analyses, 43.1% receiving tenecteplase and 39.9% receiving alteplase reached excellent functional outcome (modified Rankin Scale score 0–1) after 3 months (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.70–1.85, p=0.59). No significant differences among patients in the two treatment groups regarding frequency of symptomatic intracranial hemorrhage during the first 48 h were identified (11 (8.5%) in the tenecteplase group, 10 (7.0%) in the alteplase group, OR 1.23, 95% CI 0.50–3.00, p 0.65). Death within 3 months occurred in 18 patients (14.3%) in the tenecteplase group and in 21 (15.3%) in the alteplase group (p 0.84). After excluding stroke mimics, the proportion of patients with excellent functional outcome was 44.1% in the tenecteplase group and 34.4% in the alteplase group (OR 1.50 CI 0.90–2.52, p 0.12).ConclusionNo differences in the efficacy and safety of tenecteplase versus alteplase in patients ≥80 years were identified.Trial (NCT01949948)
      Citation: International Journal of Stroke
      PubDate: 2020-07-07T04:56:32Z
      DOI: 10.1177/1747493020938306
  • In Memoriam: John W Norris (1933–2020)
    • Authors: Vladimir Hachinski, Natan M Bornstein, Hugh S Markus
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-29T02:07:29Z
      DOI: 10.1177/1747493020925315
  • Coronavirus disease 2019 and stroke in Iran: a case series and effects on
           stroke admissions
    • Authors: M Mehrpour, A Shuaib, M Farahani, HR Hatamabadi, Z Fatehi, M Ghaffari, NB Moghadam, SH Aghamiri, B Mansouri, F Assarzadegan, BS Lima, O Hesami
      Abstract: International Journal of Stroke, Ahead of Print.
      ObjectiveThe coronavirus disease 2019 pandemic has affected healthcare systems around the globe and massively impacted patients with various non-infectious, life-threatening conditions. Stroke is a major neurological disease contributing to death and disability worldwide, and is still an ongoing issue during the pandemic. Here we investigate the impact of the coronavirus disease 2019 outbreak on stroke manifestations, treatment courses, the outcome of stroke patients, and the hospitalization rate in a referral center for stroke management in Tehran, Iran.MethodsWe extracted data regarding 31 stroke patients (10 patients with laboratory-confirmed coronavirus disease 2019) and compared the demographic and pathological characteristics of the patients with or without coronavirus disease 2019 infection. The association of demographic/pathological characteristics of stroke patients during the coronavirus disease 2019 pandemic and a corresponding period during the previous year (49 patients) and an earlier period during the same year as the pandemic (50 patients) was also evaluated.ResultsThe absolute number of admissions decreased about 40% during the coronavirus disease 2019 pandemic. Except for the stroke severity (P = 0.002), there were no significant changes in the demographic and pathological characteristics of the stroke patients during the three studied periods. A significantly higher mean of age (75.60 ± 9.54 versus 60.86 ± 18.45; P = 0.007), a significant difference in the type of stroke (P = 0.046), and significantly higher stroke severity (P = 0.024) were observed in stroke patients with coronavirus disease 2019 compared with those of stroke patients without coronavirus disease 2019. Treatment approaches, duration of hospitalization, and mortality rates did not differ significantly.ConclusionsThis report shows that the pandemic caused the number of acute stroke admissions to plummet compared to other periods. Although the pandemic did not affect the treatment plans and care of the patients, stroke cases with coronavirus disease 2019 had higher age, more large vessel ischemic stroke, and more severe stroke. Further studies are urgently needed to realize the probable interaction of the coronavirus disease 2019 pandemic and the neurologic disease.
      Citation: International Journal of Stroke
      PubDate: 2020-06-26T02:23:14Z
      DOI: 10.1177/1747493020937397
  • Cerebral ischemic and hemorrhagic complications of coronavirus disease
    • Authors: Ahmad Sweid, Batoul Hammoud, Kimon Bekelis, Symeon Missios, Stavropoula I Tjoumakaris, Michael R Gooch, Nabeel A Herial, Hekmat Zarzour, Victor Romo, Maureen DePrince, Robert H Rosenwasser, Pascal Jabbour
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe coronavirus disease 2019 is associated with neurological manifestations including stroke.ObjectivesWe present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.MethodsA retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.ResultsThe total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3–6) at discharge, and the total mortality incidence was eight (36.4%).ConclusionsDespite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.
      Citation: International Journal of Stroke
      PubDate: 2020-06-26T02:22:14Z
      DOI: 10.1177/1747493020937189
  • Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital
           mortality in North-West Spain
    • Authors: Herbert Tejada Meza, Álvaro Lambea Gil, Agustín Sancho Saldaña, Maite Martínez-Zabaleta, Patricia de la Riva Juez, Elena López-Cancio Martínez, María Castañón Apilánez, María Herrera Isasi, Juan Marta Enguita, Mercedes de Lera Alfonso, Juan F Arenillas, Jon Segurola Olaizola, Juan José Timiraos Fernández, Joaquín Sánchez, Mar Castellanos-Rodrigo, Alexia Roel, Ignacio Casado Menéndez, Mar Freijo, Alain Luna Rodriguez, Enrique Palacio Portilla, Yésica Jiménez López, Emilio Rodríguez Castro, Susana Arias Rivas, Javier Tejada García, Iria Beltrán Rodríguez, Francisco Julián-Villaverde, Maria Pilar Moreno García, José María Trejo-Gabriel-Galán, Ana Echavarría Iñiguez, Carlos Tejero Juste, Cristina Pérez Lázaro, Javier Marta Moreno, on behalf of the NORDICTUS Investigators
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purposeSpain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain.MethodsSpanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality.ResultsIn the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p
      Citation: International Journal of Stroke
      PubDate: 2020-06-26T02:21:35Z
      DOI: 10.1177/1747493020938301
  • Qureshi AI, Abd-Allah F, Alsenani F, et al. Management of acute ischemic
           stroke in patients with COVID-19 infection: Report of an international
           panel. Int J Stroke. Epub ahead of print 03 May 2020. DOI:
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-22T04:58:27Z
      DOI: 10.1177/1747493020935396
  • A score to predict one-year risk of recurrence after acute ischemic stroke
    • Authors: Davide Strambo, Alexandros Zachariadis, Dimitris Lambrou, Ghil Schwarz, Gaia Sirimarco, Karolinaa Aarnio, Jukka Putaala, George Ntaios, Kostantinos Vemmos, Patrik Michel
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAn acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke.MethodsAn integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens (n = 2495), Milan (n = 1279), and Helsinki (n = 714) by means of calibration and discrimination.ResultsIn the derivation cohort, the recurrence rate was 7% (n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9–4.1) in 932 (29%) patients with a score 0–1, 7.2% (6.1–8.3) in 2038 (63%) with a score 2–4, and 19.2% (14.6–23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively.ConclusionWe developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors.
      Citation: International Journal of Stroke
      PubDate: 2020-06-17T01:00:15Z
      DOI: 10.1177/1747493020932787
  • Economic evaluation of the Melbourne Mobile Stroke Unit
    • Authors: Joosup Kim, Damien Easton, Henry Zhao, Skye Coote, Garveeta Sookram, Karen Smith, Michael Stephenson, Stephen Bernard, Mark W Parsons, Bernard Yan, Patricia M Desmond, Peter J Mitchell, Bruce CV Campbell, Geoffrey A Donnan, Stephen M Davis, Dominique A Cadilhac
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy.AimsTo estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care).MethodsThe costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses.ResultsIn 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care.ConclusionsThere is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
      Citation: International Journal of Stroke
      PubDate: 2020-06-14T11:21:49Z
      DOI: 10.1177/1747493020929944
  • Prevalence of stroke in Argentina: A door-to-door population-based study
    • Authors: SF Ameriso, MM Gomez-Schneider, MA Hawkes, VA Pujol-Lereis, DE Dossi, MJ Alet, F Rodriguez-Lucci, GP Povedano, CD Gonzalez, MO Melcon
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundStroke burden is highest and is still rising in low- and middle-income countries. Epidemiologic stroke data are lacking in many of these countries. Stroke prevalence in Argentina has been unexplored for almost three decades.AimThis population-based study aims to determine prevalence of stroke in a representative sample of the Argentinean population.MethodsWe performed a door-to-door survey of randomly selected households in a city of 18,650 inhabitants. A structured questionnaire screening for potential stroke cases was used. All subjects screened positive were then evaluated by stroke neurologists for final adjudication. Data about stroke subtypes, neurological status, vascular risk factors, medications, and diagnostic tests were also collected.ResultsAmong 2156 surveys, 294 were screened positive for a possible stroke. After neurological evaluation, there were 41 confirmed cases. The adjusted stroke prevalence was 1,974/100,000 inhabitants older than 40 years, and it was higher in men than in women (26.3‰ vs 13.2‰, p
      Citation: International Journal of Stroke
      PubDate: 2020-06-14T11:21:48Z
      DOI: 10.1177/1747493020932769
  • Controlling Hypertension After Severe Cerebrovascular Event (CHASE): A
           randomized, multicenter, controlled study
    • Authors: Fang Yuan, Fang Yang, Jingjing Zhao, Feng Fu, Yi Liu, Changhu Xue, Kangjun Wang, Xiangjun Yuan, Dingan Li, Qiuwu Liu, Wei Zhang, Yi Jia, Jianbo He, Jun Zhou, Xiaocheng Wang, Hua Lv, Kang Huo, Zhuanhui Li, Bei Zhang, Chengkai Wang, Li Li, Hongzeng Li, Wen Jiang
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe optimal blood pressure lowering target in the acute phase of severe stroke is uncertain. Our aim was to compare the efficacy and safety of individualized blood pressure lowering with standard blood pressure lowering in severe stroke.MethodsFive-hundred consecutive patients with acute severe stroke and elevated BP were recruited from 26 Chinese hospitals. Eligible patients were randomized into an individualized blood pressure lowering group (with 10–15% reduction in systolic blood pressure from admission level or standard blood pressure lowering group (with a target SBP of
      Citation: International Journal of Stroke
      PubDate: 2020-06-11T02:09:51Z
      DOI: 10.1177/1747493020932784
  • Effect of emergent carotid stenting during endovascular therapy for acute
           anterior circulation stroke patients with tandem occlusion: A multicenter,
           randomized, clinical trial (TITAN) protocol
    • Authors: François Zhu, Gabriela Hossu, Marc Soudant, Sébastien Richard, Hamza Achit, Mélanie Beguinet, Vincent Costalat, Caroline Arquizan, Arturo Consoli, Bertrand Lapergue, Aymeric Rouchaud, Francisco Macian-Montoro, Alessandra Biondi, Thierry Moulin, Gaultier Marnat, Igor Sibon, Christophe Paya, Stéphane Vannier, Christophe Cognard, Alain Viguier, Mikael Mazighi, Michael Obadia, Wagih B Hassen, Guillaume Turc, Frédéric Clarençon, Yves Samson, Benjamin Dumas-Duport, Cécile Preterre, Charlotte Barbier, Marion Boulanger, Kevin Janot, Mariam Annan, Nicolas Bricout, Hilde Henon, Sébastien Soize, Solène Moulin, Marc-Antoine Labeyrie, Peggy Reiner, Raoul Pop, Valérie Wolff, Julien Ognard, Serge Timsit, Anthony Reyre, Charline Perot, Chrysanthi Papagiannaki, Aude Triquenot-Bagan, Serge Bracard, René Anxionnat, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, Emmanuelle Schmitt, Sophie Planel, Francis Guillemin, Benjamin Gory
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and hypothesisThere is no consensus on the optimal endovascular management of the extracranial internal carotid artery steno-occlusive lesion in patients with acute ischemic stroke due to tandem occlusion. We hypothesized that intracranial mechanical thrombectomy plus emergent internal carotid artery stenting (and at least one antiplatelet therapy) is superior to intracranial mechanical thrombectomy alone in patients with acute tandem occlusion.Study designTITAN is an investigator-initiated, multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. Eligibility requires a diagnosis of acute ischemic stroke, pre-stroke modified Rankin Scale (mRS)≤2 (no upper age limit), National Institutes of Health Stroke Scale (NIHSS)≥6, Alberta Stroke Program Early Computed Tomography Score (ASPECTS)≥6, and tandem occlusion on the initial catheter angiogram. Tandem occlusion is defined as large vessel occlusion (intracranial internal carotid artery , M1 and/or M2 segment) and extracranial severe internal carotid artery stenosis ≥90% (NASCET) or complete occlusion. Patients are randomized in two balanced parallel groups (1:1) to receive either intracranial mechanical thrombectomy plus internal carotid artery stenting (and at least one antiplatelet therapy) or intracranial mechanical thrombectomy alone within 8 h of stroke onset. Up to 432 patients are randomized after tandem occlusion confirmation on angiogram.Study outcomesThe primary outcome measure is complete reperfusion rate at the end of endovascular procedure, assessed as a modified Thrombolysis in Cerebral Infarction (mTICI) 3, and ≥4 point decrease in NIHSS at 24 h. Secondary outcomes include infarct growth, recurrent clinical ischemic event in the ipsilateral carotid territory, type and dose of antiplatelet therapy used, mRS at 90 (±15) days and 12 (±1) months. Safety outcomes are procedural complications, stent patency, intracerebral hemorrhage, and death. Economics analysis includes health-related quality of life, and costs utility comparison, especially with the need or not of endarterectomy.DiscussionTITAN is the first randomized trial directly comparing two types of treatment in patients with acute ischemic stroke due to anterior circulation tandem occlusion, and especially assessing the safety and efficacy of emergent internal carotid artery stenting associated with at least one antiplatelet therapy in the acute phase of stroke reperfusion.Trial NCT03978988
      Citation: International Journal of Stroke
      PubDate: 2020-06-09T12:43:11Z
      DOI: 10.1177/1747493020929948
  • Discrepancy between post-treatment infarct volume and 90-day outcome in
           the ESCAPE randomized controlled trial
    • Authors: Aravind Ganesh, Bijoy K Menon, Zarina A Assis, Andrew M Demchuk, Fahad S Al-Ajlan, Mohammed A Al-Mekhlafi, Jeremy L Rempel, Ashfaq Shuaib, Blaise W Baxter, Thomas Devlin, John Thornton, David Williams, Alexandre Y Poppe, Daniel Roy, Timo Krings, Leanne K Casaubon, Nima Kashani, Michael D Hill, Mayank Goyal
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundSome patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better.AimsWe explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome.MethodsWe identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24–48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24–48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between “discrepant cases” – those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV – and “non-discrepant cases”. Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome.ResultsAmong 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement (p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age (p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS (p = 0.007) and post-stroke complications (p = 0.026). Absence of vascular risk-factors (p = 0.004), CT-based lentiform nucleus sparing (p = 0.002), lower 24-hour NIHSS (p = 0.001), and absence of complications (p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results.ConclusionsDiscrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care.Clinical trial registration
      Citation: International Journal of Stroke
      PubDate: 2020-06-09T12:43:10Z
      DOI: 10.1177/1747493020929943
  • Carotid artery webs in embolic stroke of undetermined source with large
           intracranial vessel occlusion
    • Authors: Marc-Antoine Labeyrie, Fabiola Serrano, Vittorio Civelli, Clément Jourdaine, Peggy Reiner, Jean-Pierre Saint-Maurice, Hugues Chabriat, Emmanuel Houdart
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundWhether carotid artery web can be considered as a potential source of arterial thromboembolism in ischemic stroke remains uncertain.AimsIn a large sample of individuals with large intracranial artery occlusion, we compared the prevalence of carotid artery webs between patients with and without embolic stroke of undetermined source.MethodsIn a single-center study of consecutive patients with anterior circulation ischemic stroke referred for mechanical thrombectomy, the presence of carotid artery web was systematically assessed by two independent readers. Thereafter, its prevalence was compared between patients with and without embolic stroke of undetermined source.ResultsAmong 466 patients of whom 12% were considered to have had an embolic stroke of undetermined source, ipsilateral carotid artery web was detected in 1.9% (confidence interval 95% = 0.7–3.1). Ipsilateral carotid artery web was more frequent in embolic stroke of undetermined source than in the rest of the sample (10.7% (confidence interval 95% = 2.7–18.7] vs. 0.7% (0–1.5), P 
      Citation: International Journal of Stroke
      PubDate: 2020-06-09T12:43:10Z
      DOI: 10.1177/1747493020929945
  • WITHDRAWAL – Administrative Duplicate Publication: Bilateral versus
           ipsilesional corticosubcortical activity patterns in stroke show
           hemispheric dependence
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-09T01:19:32Z
      DOI: 10.1177/1747493020931746
  • CORRIGENDUM to “Viral and parasitic pathogen burden and the association
           with stroke in a population-based cohort”
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-04T05:04:59Z
      DOI: 10.1177/1747493020932824
  • DEVT: A randomized, controlled, multicenter trial of direct endovascular
           treatment versus standard bridging therapy for acute stroke patients with
           large vessel occlusion in the anterior circulation – Protocol
    • Authors: Zhongming Qiu, Hansheng Liu, Fengli Li, Weidong Luo, Deping Wu, Zhonghua Shi, Wenhua Liu, Wenguo Huang, Xinmin Fu, Tao Qiu, Li Wang, Shiquan Yang, Shuai Zhang, Yan Wang, Yongjie Bai, Xuan Liu, Huagang Li, Yong Liu, Wei Li, Yue Wan, Zhibing Ai, Xiaoxi Yao, Jun Luo, Jie Pu, Zhiming Zhou, Shouchun Wang, Changming Wen, Wentong Ling, Shudong Liu, Weimin Yang, Guoyong Zeng, Youlin Wu, Fuqiang Guo, Shengli Chen, Junjie Huang, Zhen Wang, Miao Peng, Min Zhang, Peiyang Zhou, Luming Chen, Shuai Liu, Chengsong Yue, Jun Yang, Zili Gong, Jie Shuai, Hongfei Sang, Raul G Nogueira, Wenjie Zi, Qingwu Yang
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundEight randomized controlled trials have consistently shown that endovascular treatment plus best medical treatment improves outcome after acute anterior proximal intracranial large vessel occlusion strokes. Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation, large vessel occlusion is of any additional benefits remains unclear.ObjectiveThis study compares the safety and efficacy of direct endovascular treatment versus intravenous recombinant tissue-type plasminogen activator bridging with endovascular treatment (bridging therapy) in acute stroke patients with intracranial internal carotid artery or middle cerebral artery-M1 occlusion within 4.5 h of symptom onset.Methods and designThe DEVT study is a randomized, controlled, multicenter trial with blinded outcome assessment. This trial uses a five-look group-sequential non-inferiority design. Up to 194 patients in each interim analysis will be consecutively randomized to direct endovascular treatment or bridging therapy group in 1:1 ratio over three years from about 30 hospitals in China.OutcomesThe primary end-point is the proportion of independent neurological function defined as modified Rankin scale score of 0 to 2 at 90 days. The primary safety measure is symptomatic intracerebral hemorrhage at 48 h and mortality at 90 days.Trial registry numberChiCTR-IOR-17013568 (
      Citation: International Journal of Stroke
      PubDate: 2020-05-23T08:09:36Z
      DOI: 10.1177/1747493020925349
  • Identification of patients with embolic stroke of undetermined source and
           low risk of new incident atrial fibrillation: The AF-ESUS score
    • Authors: George Ntaios, Kalliopi Perlepe, Dimitris Lambrou, Gaia Sirimarco, Davide Strambo, Ashraf Eskandari, Efstathia Karagkiozi, Anastasia Vemmou, Eleni Korompoki, Efstathios Manios, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsOnly a minority of patients with Embolic Stroke of Undetermined Source (ESUS) receive prolonged cardiac monitoring despite current recommendations. The identification of ESUS patients who have low probability of new diagnosis of atrial fibrillation (AF) could potentially support a strategy of more individualized allocation of available resources and hence, increase their diagnostic yield. We aimed to develop a tool that can identify ESUS patients who have low probability of new incident AF.MethodsWe performed multivariate stepwise regression in a pooled dataset of consecutive ESUS patients from three prospective stroke registries to identify predictors of new incident AF. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integer-based point scoring system.ResultsAmong 839 patients (43.1% women, median age 67.0 years) followed-up for a median of 24.3 months (2999 patient-years), 125 (14.9%) had new incident AF. The proposed score assigns 3 points for age ≥ 60 years; 2 points for hypertension; −1 point for left ventricular hypertrophy reported at echocardiography; 2 points for left atrial diameter>40 mm; −3 points for left ventricular ejection fraction  0 (relative risk: 13.7, 95%CI: 5.9--31.5). The area under the curve of the score was 84.8% (95%CI: 79.9--86.9%). The sensitivity and negative predictive value of a score of ≤0 for new incident AF during follow-up were 94.9% (95%CI: 89.3--98.1%) and 98.0% (95%CI: 95.8--99.3%), respectively.ConclusionsThe proposed AF-ESUS score has high sensitivity and high negative predictive value to identify ESUS patients who have low probability of new incident AF. Patients with a score of 1 or more may be better candidates for prolonged automated cardiac monitoring.Clinical trial registrationURL: Unique identifier: NCT02766205.
      Citation: International Journal of Stroke
      PubDate: 2020-05-19T08:49:49Z
      DOI: 10.1177/1747493020925281
  • Identifying the predictors of first-pass effect and its influence on
           clinical outcome in the setting of endovascular thrombectomy for acute
           ischemic stroke: Results from a multicentric prospective registry
    • Authors: Federico Di Maria, Maéva Kyheng, Arturo Consoli, Jean-Philippe Desilles, Benjamin Gory, Sébastien Richard, Georges Rodesch, Julien Labreuche, Jean-Baptiste Girot, Cyril Dargazanli, Gaultier Marnat, Bertrand Lapergue, Romain Bourcier
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe first-pass effect, defined as a complete or near-complete recanalization after one pass (first-pass effect) of a mechanical thrombectomy device, has been related to better clinical outcome than good recanalization after more than one pass in acute ischemic stroke. We searched for predictors of first-pass effect by analyzing the results within a large prospective multicentric registry.MethodsWe included patients treated by mechanical thrombectomy for isolated anterior intracranial occlusions. A multi-variate logistic regression analysis was carried out to search for predictors of first-pass effect. We also analyzed the percentage of patients with 90-day modified Rankin Scale score 0 to 2, excellent outcome (90-day modified Rankin Scale 0 to 1), 24-h NIHSS change, and 90-day all-cause mortality.ResultsAmong the 1832 patients included, clinical outcome at 90 days was significantly better in first-pass effect patients (50.6% vs. 38.9% in patients without first-pass effect), with a center-adjusted OR associated with first-pass effect of 1.74 (95%CI, 1.24 to 1.77). Older age, a lower systolic blood pressure, an MCA-M1 occlusion, higher DWI-ASPECTS at admission, mechanical thrombectomy under local anesthesia, and combined first-line device strategy were independent predictors of first-pass effect.ConclusionsIn this study, a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-pass effect. In addition, we confirm that clinical outcome was better in patients with first-pass effect compared to non-first-pass effect patients.
      Citation: International Journal of Stroke
      PubDate: 2020-05-08T03:16:00Z
      DOI: 10.1177/1747493020923051
  • Safety and outcomes of mechanical thrombectomy for acute stroke related to
           infective endocarditis: A case–control study
    • Authors: Gaultier Marnat, Igor Sibon, Benjamin Gory, Sébastien Richard, Stéphane Olindo, Arturo Consoli, Romain Bourcier, Maeva Kyheng, Julien Labreuche, Cyril Darganzali, Adrien ter Schiporst, Florent Gariel, Raphaël Blanc, Bertrand Lapergue
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purposeSuccessful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes.MethodsThis was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality.ResultsBetween June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case–control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group.ConclusionsMechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.
      Citation: International Journal of Stroke
      PubDate: 2020-05-08T03:15:58Z
      DOI: 10.1177/1747493020925360
  • Corrigendum
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-04-29T09:43:02Z
      DOI: 10.1177/1747493020922800
  • Pre-existing Comorbidity Burden and Patient Perceived Stroke Impact
    • Authors: Katherine Sewell, Tamara Tse, Elizabeth Harris, Thomas Matyas, Leonid Churilov, Henry Ma, Stephen M Davis, Geoffrey A Donnan, Leeanne M Carey
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundPre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual.AimOur aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex.MethodsThe sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery.ResultsSignificant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: −11.26, −2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: −5.62, −1.54; p = .001) and 1.76-points decrease (95%CI: −2.80, −0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: −11.05, −1.89; p = .006) and 1.26-points decrease (95%CI: −2.11, −0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months.ConclusionComorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.
      Citation: International Journal of Stroke
      PubDate: 2020-04-24T03:09:03Z
      DOI: 10.1177/1747493020920838
  • Mechanisms of action of acute and subacute sphenopalatine ganglion
           stimulation for ischemic stroke
    • Authors: Mersedeh Bahr Hosseini, Jeffrey L Saver
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundSphenopalatine ganglion stimulation (SPG-Stim) for ischemic stroke, starting 8–24 h after onset and continuing through five days in a pooled analysis of two recent, randomized, sham-controlled trials, improved outcome of acute ischemic stroke patients with confirmed cortical involvement. As a neuromodulatory therapy, SPG-Stim differs substantially from existing pharmacologic (lytic and antiplatelets) and device (endovascular thrombectomy) acute ischemic stroke treatments.AimFocused review of SPG anatomy, physiology, and neurovascular and neurobiologic mechanisms of action mediating benefit of SPG-Stim in acute ischemic stroke.Summary of reviewLocated posterior to the maxillary sinus, the SPG is the main source of parasympathetic innervation to the anterior circulation. Preclinical and human studies delineate four distinct mechanisms of action by which the SPG-Stim may confer benefit in acute ischemic stroke: (1) collateral vasodilation and enhanced cerebral blood flow, mediated by release of neurotransmitters with vasodilatory effects, nitric oxide, and acetylcholine, (2) stimulation frequency- and intensity-dependent stabilization of the blood–brain barrier, reducing edema (3) direct acute neuroprotection from activation of the central cholinergic system with resulting anti-inflammatory, anti-apoptotic, and anti-excitatory effects; and (4) neuroplasticity enhancement from enhanced central cholinergic and adrenergic neuromodulation of cortical networks and nitrous oxide release stimulating neurogenesis.ConclusionThe benefit of SPG-Stim in acute ischemic stroke is likely conferred not only by potent collateral augmentation, but also blood–barrier stabilization, direct neuroprotection, and neuroplasticity enhancement. Further studies clarifying the relative contribution of these mechanisms and the stimulation protocols that maximize each may help optimize SPG-Stim as a therapy for acute ischemic stroke.
      Citation: International Journal of Stroke
      PubDate: 2020-04-24T03:09:02Z
      DOI: 10.1177/1747493020920739
  • Corrigendum
    • Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-04-22T10:17:52Z
      DOI: 10.1177/1747493020922513
  • Taking Charge after Stroke: A randomized controlled trial of a
           person-centered, self-directed rehabilitation intervention
    • Authors: Vivian Fu, Mark Weatherall, Kathryn McPherson, William Taylor, Anna McRae, Tom Thomson, John Gommans, Geoff Green, Matire Harwood, Annemarei Ranta, Carl Hanger, Judith Riley, Harry McNaughton
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purpose“Take Charge” is a novel, community-based self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. In a previous randomized controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders. We tested the same intervention in three doses (zero, one, or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We aimed to confirm whether the Take Charge intervention improved quality of life at 12 months after stroke in a different population and whether two sessions were more effective than one.MethodsWe randomized 400 people within 16 weeks of acute stroke who had been discharged to institution-free community living at seven centers in New Zealand to a single Take Charge session (TC1, n = 132), two Take Charge sessions six weeks apart (TC2, n = 138), or a control intervention (n = 130). Take Charge is a “talking therapy” that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the Physical Component Summary score of the Short Form 36 at 12 months following stroke comparing any Take Charge intervention to control.ResultsOf the 400 people randomized (mean age 72.2 years, 58.5% male), 10 died and two withdrew from the study. The remaining 388 (97%) people were followed up at 12 months after stroke. Twelve months following stroke, participants in either of the TC groups (i.e. TC1 + TC2) scored 2.9 (95% confidence intervals (CI) 0.95 to 4.9, p = 0.004) points higher (better) than control on the Short Form 36 Physical Component Summary. This difference remained significant when adjusted for pre-specified baseline variables. There was a dose effect with Short Form 36 Physical Component Summary scores increasing by 1.9 points (95% CI 0.8 to 3.1, p 
      Citation: International Journal of Stroke
      PubDate: 2020-04-15T02:38:03Z
      DOI: 10.1177/1747493020915144
  • Haptoglobin is associated with increased early perihematoma edema
           progression in spontaneous intracranial hemorrhage
    • Authors: Michael R Halstead, W Andrew Mould, Kevin N Sheth, Jonathan Rosand, Richard Thompson, Andrew Levy, Daniel F Hanley, Joshua N Goldstein, Paul Nyquist
      Abstract: International Journal of Stroke, Ahead of Print.
      IntroductionPerihematomal edema in intracranial hemorrhage is influenced by free hemoglobin clearance and inflammation. Serum Haptoglobin (Hp) binds free hemoglobin, affecting heme clearance and free radical production. Of the three Hp phenotypes, Hp 1-1 has the greatest effect on free hemoglobin clearance.AimTo determine if individuals with Hp 1-1 phenotype have different rates of early perihematomal edema formation as compared to those with Hp 2-1 and Hp 2-2.MethodsWe determined Hp phenotype, intracranial hemorrhage volume, and rate of early change in perihematomal volume in participants from three prospectively collected intracranial hemorrhage cohorts. The association of Hp phenotypes 1-1, 2-1, 2-2, with early change in perihematomal volume, while controlling for key clinical characteristics was analyzed using a multivariate model.FindingsOne-hundred and sixty-six participants were included: 73 (44%) female, 41 ( 25%) African Americans, 34 (20%) diabetics, 133 (80%) with hypertension, and 75 (45%) active smokers. There were 15 subjects with Hp phenotype 1-1, 86 with 2-1, and 65 with 2-2. In fully adjusted analysis, Hp 1-1 had a significantly increased estimated mean rate of early change in perihematomal volume at 1.15 (95% confidence interval 0.58–1.71) as compared to all other Hp 2-1 or Hp 2-2 containing phenotypes (0.30, 95% confidence interval 0.06–0.54; 0.29 95% CI 0.02–0.56). Neither mortality nor discharge mRS differed between Hp phenotypes.ConclusionHaptoglobin phenotype is associated with early change in perihematomal volume. Hp 1-1 phenotype had significantly increased mean rate of early change in perihematomal volume within the first 96 h, suggesting that haptoglobin phenotype may be a key player in understanding the multiphasic progression of perihematomal volume in spontaneous intracerebral hemorrhage. A larger prospective observational study is warranted.
      Citation: International Journal of Stroke
      PubDate: 2020-04-08T01:26:24Z
      DOI: 10.1177/1747493020912602
  • Incidence and risk factors for stroke following percutaneous coronary
    • Authors: Luke P Dawson, Justin A Cole, Terase F Lancefield, Andrew E Ajani, Nick Andrianopoulos, Amanda G Thrift, David J Clark, Angela L Brennan, Melanie Freeman, Jessica O'Brien, Martin Sebastian, William Chan, James A Shaw, Diem Dinh, Christopher M Reid, Stephen J Duffy
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundStroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population.AimsThis study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls.MethodsData were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005–2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997–1999) and predefined variables assessed for association with inpatient or outpatient stroke.ResultsInpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p 
      Citation: International Journal of Stroke
      PubDate: 2020-04-04T04:22:47Z
      DOI: 10.1177/1747493020912607
  • CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3
    • Authors: May Kim-Tenser, Michael Mlynash, Maarten G Lansberg, Matthew Tenser, Sebina Bulic, Bharathi Jagadeesan, Soren Christensen, Alexis Simpkins, Gregory W Albers, Michael P Marks
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe role of Alberta Stroke Program Early CT Score (ASPECTS) for thrombectomy patient selection and prognostication in late time windows is unknown.AimsWe compared baseline ASPECTS and core infarction determined by CT perfusion (CTP) as predictors of clinical outcome in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE) 3 trial.MethodsWe included all DEFUSE 3 patients with baseline non-contrast CT and CTP imaging. ASPECTS and core infarction were determined by the DEFUSE 3 core laboratory. Primary outcome was functional independence (modified Rankin Scale (mRS) ≤2). Secondary outcomes included ordinal mRS shift at 90 days and final core infarction volume.ResultsOf the 142 patients, 85 patients (60%) had ASPECTS 8–10 and 57 (40%) had ASPECTS 5–7. Thirty-one patients (36%) with ASPECTS 8–10 and 11 patients (19%) with ASPECTS 5–7 were functionally independent at 90 days (p = 0.03). In the primary and secondary logistic regression analysis, there was no difference in ordinal mRS shift (p = 0.98) or functional independence (mRS ≤ 2; p = 0.36) at 90 days between ASPECTS 8–10 and ASPECTS 5–7 patients. Similarly, primary and secondary logistic regression analyses found no difference in ordinal mRS shift (p = 1.0) or functional independence (mRS ≤ 2; p = 0.87) at 90 days between patients with baseline small core ( 
      Citation: International Journal of Stroke
      PubDate: 2020-04-01T02:00:51Z
      DOI: 10.1177/1747493020915141
  • Structural integrity of white matter tracts as a predictor of acute
           ischemic stroke outcome
    • Authors: Deepthi Rajashekar, Pauline Mouchès, Jens Fiehler, Bijoy K Menon, Mayank Goyal, Andrew M Demchuk, Michael D Hill, Sean P Dukelow, Nils D Forkert
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and purposeClinical assessment scores in acute ischemic stroke are only moderately correlated with lesion volume since lesion location is an important confounding factor. Many studies have investigated gray matter indicators of stroke severity, but the understanding of white matter tract involvement is limited in the early phase after stroke. This study aimed to measure and model the involvement of white matter tracts with respect to 24-h post-stroke National Institutes of Health Stroke Scale (NIHSS).Material and methodsA total of 96 patients (50 females, mean age 66.4 ± 14.0 years, median NIHSS 5, interquartile range: 2–9.5) with follow-up fluid-attenuated inversion recovery magnetic resonance imaging data sets acquired one to seven days after acute ischemic stroke onset due to proximal anterior circulation occlusion were included. Lesions were semi-automatically segmented and non-linearly registered to a common reference atlas. The lesion overlap and tract integrity were determined for each white matter tract in the AALCAT atlas and used to model NIHSS outcomes using a supervised linear-kernel support vector regression method, which was evaluated using leave-one-patient-out cross validation.ResultsThe support vector regression model using the tract integrity and tract lesion overlap measurements predicted the 24-h NIHSS score with a high correlation value of r = 0.7. Using the tract overlap and tract integrity feature improved the modeling accuracy of NIHSS significantly by 6% (p 
      Citation: International Journal of Stroke
      PubDate: 2020-04-01T02:00:50Z
      DOI: 10.1177/1747493020915251
  • Stroke prevention and control system in China: CSPPC-Stroke Program
    • Authors: Bao-Hua Chao, Feng Yan, Yang Hua, Jian-Min Liu, Ge Yang, Xun-Ming Ji, Bin Peng, Guo-Guang Zhao, Yong-Jun Wang, De-Zhi Kang, Yi-Long Wang, Jin-Sheng Zeng, Lan Chu, Tian-Xiao Li, Yu-Ming Xu, Ming Liu, Li He, Yun Xu, Jiang Wu, Min Lou, Wei Yue, Lei Cao, Wen-Jun Tu, Long-De Wang
      Abstract: International Journal of Stroke, Ahead of Print.
      In China, stroke is a major cause of mortality, and long-term physical and cognitive impairment. To meet this challenge, the Ministry of Health China Stroke Prevention Project Committee (CSPPC) was established in April 2011. This committee actively promotes stroke prevention and control in China. With government financial support of 838.4 million CNY, 8.352 million people from 536 screening points in 31 provinces have received stroke screening and follow-up over the last seven years (2012–2018). In 2016, the CSPPC issued a plan to establish stroke centers. To shorten the pre-hospital period, the CSPPC established a stroke center network, stroke map, and stroke “Green Channel” to create three 1-h gold rescue circles, abbreviated as “1-1-1” (onset to call time
      Citation: International Journal of Stroke
      PubDate: 2020-03-30T05:36:24Z
      DOI: 10.1177/1747493020913557
  • Global Stroke Statistics 2019
    • Authors: Joosup Kim, Tharshanah Thayabaranathan, Geoffrey A Donnan, George Howard, Virginia J Howard, Peter M Rothwell, Valery Feigin, Bo Norrving, Mayowa Owolabi, Jeyaraj Pandian, Liping Liu, Dominique A Cadilhac, Amanda G Thrift
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundData on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning.AimsTo provide the most current incidence, mortality and case–fatality data on stroke and describe current availability of stroke units around the world by country.MethodsWe searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case–fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population.ResultsSince our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case–fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries.ConclusionUp-to-date data on stroke incidence, case–fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low–middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
      Citation: International Journal of Stroke
      PubDate: 2020-03-09T08:15:11Z
      DOI: 10.1177/1747493020909545
  • Characteristics and outcomes of Embolic Stroke of Undetermined Source
           according to stroke severity
    • Authors: Ioannis Leventis, Kalliopi Perlepe, Dimitrios Sagris, Gaia Sirimarco, Davide Strambo, Georgios Georgiopoulos, Ashraf Eskandari, Efstathia Karagkiozi, Anastasia Vemmou, Eleni Koroboki, Efstathios Manios, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel, George Ntaios
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsPatients with embolic strokes of undetermined source (ESUS) usually present with mild symptoms. We aimed to compare the baseline characteristics between mild and severe ESUS, identify predictors for severe ESUS, and assess outcomes of patients with severe ESUS.MethodsIn the AF-ESUS (AF-ESUS) dataset, we stratified ESUS severity using the median National Institutes of Health Stroke Scale (NIHSS) score on admission as cut-off. We performed multivariable stepwise regression analyses to identify independent predictors of severe ESUS and to assess the association between ESUS severity and stroke recurrence, death, and new incident atrial fibrillation (AF) on follow-up. The 10-year cumulative probabilities of outcome incidence were estimated by the Kaplan–Meier product limit method.ResultsIn 772 patients (median NIHSS: 6 (interquartile range: 3–12)), 414 (53.6%) patients had severe ESUS (i.e. NIHSS ≥6). Female sex was the only independent predictor for severe ESUS (odds ratio: 1.72 (1.27–2.33)). The rates of recurrence (3.3%/year vs. 3.4%/year, adjusted-hazard ratio: 1.09 (0.73–1.62)) and new incident AF (13.5% vs. 17.0%, adjusted odds ratio: 0.67 (0.44–1.03)) were similar between severe and mild ESUS, but mortality was higher (5.4%/year vs. 3.7%/year, adjusted-hazard ratio: 1.51 (1.05–2.16)) in severe ESUS. The 10-year cumulative probability for stroke recurrence was similar between severe and mild ESUS (38.1% (29.2–48.6) vs. 36.6% (27.8–47.0), log-rank test: 0.01, p = 0.920). The 10-year cumulative probability of death was higher in patients with severe ESUS compared with mild ESUS (40.5% (32.5–50.0) vs. 34.0% (26.0–43.6) respectively; log-rank test: 4.54, p = 0.033).ConclusionsWomen have more severe ESUS compared with men. Patients with severe ESUS have similar rates of stroke recurrence and new incident AF, but higher mortality compared with mild ESUS.
      Citation: International Journal of Stroke
      PubDate: 2020-03-03T07:30:58Z
      DOI: 10.1177/1747493020909546
  • Do thrombolysis outcomes differ between anterior circulation stroke and
           posterior circulation stroke' A systematic review and meta-analysis
    • Authors: Sang-Hun Lee, Jung Hoon Han, Ileok Jung, Jin-Man Jung
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIt remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials.AimsUsing multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group.Summary of reviewTwenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome.ConclusionsSafety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients’ profiles associated with benefit of treatment.
      Citation: International Journal of Stroke
      PubDate: 2020-03-03T07:30:58Z
      DOI: 10.1177/1747493020909634
  • qTICI: Quantitative assessment of brain tissue reperfusion on digital
           subtraction angiograms of acute ischemic stroke patients
    • Authors: Haryadi Prasetya, Lucas A Ramos, Thabiso Epema, Kilian M Treurniet, Bart J Emmer, Ido R van den Wijngaard, Guang Zhang, Manon Kappelhof, Olvert A Berkhemer, Albert J Yoo, Yvo BEWM Roos, Robert J van Oostenbrugge, Diederik WJ Dippel, Wim H van Zwam, Aad van der Lugt, Bas AJM de Mol, Charles BLM Majoie, Ed van Bavel, Henk A Marquering
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundThe Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading.AimsWe present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology.MethodsWe included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0–2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors.ResultsIn total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58–88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome.ConclusionqTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.
      Citation: International Journal of Stroke
      PubDate: 2020-02-26T06:09:42Z
      DOI: 10.1177/1747493020909632
  • INFOMATAS multi-center systematic review and meta-analysis individual
           patient data of dynamic cerebral autoregulation in ischemic stroke
    • Authors: L Beishon, JS Minhas, R Nogueira, P Castro, C Budgeon, M Aries, S Payne, TG Robinson, RB Panerai
      Abstract: International Journal of Stroke, Ahead of Print.
      RationaleDisturbances in dynamic cerebral autoregulation after ischemic stroke may have important implications for prognosis. Recent meta-analyses have been hampered by heterogeneity and small samples.Aim and/or hypothesisThe aim of study is to undertake an individual patient data meta-analysis (IPD-MA) of dynamic cerebral autoregulation changes post-ischemic stroke and to determine a predictive model for outcome in ischemic stroke using information combined from dynamic cerebral autoregulation, clinical history, and neuroimaging.Sample size estimatesTo detect a change of 2% between categories in modified Rankin scale requires a sample size of ∼1500 patients with moderate to severe stroke, and a change of 1 in autoregulation index requires a sample size of 45 healthy individuals (powered at 80%, α = 0.05). Pooled estimates of mean and standard deviation derived from this study will be used to inform sample size calculations for adequately powered future dynamic cerebral autoregulation studies in ischemic stroke.Methods and designThis is an IPD-MA as part of an international, multi-center collaboration (INFOMATAS) with three phases. Firstly, univariate analyses will be constructed for primary (modified Rankin scale) and secondary outcomes, with key co-variates and dynamic cerebral autoregulation parameters. Participants clustering from within studies will be accounted for with random effects. Secondly, dynamic cerebral autoregulation variables will be validated for diagnostic and prognostic accuracy in ischemic stroke using summary receiver operating characteristic curve analysis. Finally, the prognostic accuracy will be determined for four different models combining clinical history, neuroimaging, and dynamic cerebral autoregulation parameters.Study outcome(s)The outcomes for this study are to determine the relationship between clinical outcome, dynamic cerebral autoregulation changes, and baseline patient demographics, to determine the diagnostic and prognostic accuracy of dynamic cerebral autoregulation parameters, and to develop a prognostic model using dynamic cerebral autoregulation in ischemic stroke.DiscussionThis is the first international collaboration to use IPD-MA to determine prognostic models of dynamic cerebral autoregulation for patients with ischemic stroke.
      Citation: International Journal of Stroke
      PubDate: 2020-02-24T12:26:01Z
      DOI: 10.1177/1747493020907003
  • Cost of hospitalization for stroke in a low–middle-income country:
           Findings from a public tertiary hospital in the Philippines
    • Authors: Jose Danilo Bengzon Diestro, Abdelsimar Tan Omar, Robert Joseph Cruz Sarmiento, Clare Angeli Guinto Enriquez, Lennie Lynn Chua-De Castillo, Beverly Lorraine Ho, Kathleen Joy Ong Lopez Khu, Jose Leonard Rivera Pascual V
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundDetermining the cost of hospitalization for acute stroke is important in the appropriate allocation of resources for public health facilities and in the cost effectiveness analysis of interventions. Despite being the second leading cause of mortality in the Philippines, there are no published data on the cost of stroke in the country.AimThe study aims to determine the in-hospitalization cost for stroke (IHCS) in a tertiary public hospital in the Philippines and identify the factors influencing IHCS.MethodsThe study was a retrospective review of the medical and billing records of the hospital. Adult patients admitted for acute stroke between 1 June 2017 and 31 May 2018 were included in the analysis. After the mean cost of stroke was determined, multivariate logistic regression analysis was done to determine demographic and clinical characteristics that were predictive of stroke cost.ResultsA total of 863 patient records were analyzed. The median in-hospitalization cost for stroke was PHP 17,141.50 or US$329.52. Independent determinants of higher cost include male sex (p = 0.021), stroke type (hemorrhagic stroke, p = 0.001; subarachnoid hemorrhage, p 
      Citation: International Journal of Stroke
      PubDate: 2020-02-20T05:35:24Z
      DOI: 10.1177/1747493020906872
  • Total small vessel disease score and cerebro-cardiovascular events in
           healthy adults: The Kashima scan study
    • Authors: Kohei Suzuyama, Yusuke Yakushiji, Atsushi Ogata, Masashi Nishihara, Makoto Eriguchi, Atsushi Kawaguchi, Tomoyuki Noguchi, Junko Nakajima, Hideo Hara
      Abstract: International Journal of Stroke, Ahead of Print.
      Background and aimsWe explored the association between the total small vessel disease score obtained from baseline magnetic resonance imaging and subsequent cerebro-cardiovascular events in neurologically healthy Japanese adults.MethodsThe presence of small vessel disease features, including lacunae, cerebral microbleeds, white matter changes, and basal ganglia perivascular spaces on magnetic resonance imaging, was summed to obtain a “total small vessel disease score” (range, 0–4). After excluding participants with previous stroke or ischemic heart disease, intracranial artery stenosis (≥50%), or cerebral aneurysm (≥4 mm), a total of 1349 participants (mean age, 57.7 years; range, 22.8–85.0 years; 46.9% male) were classified into three groups by total small vessel disease score: 0 (n = 984), 1 (n = 269), and ≥2 (n = 96). Cerebro-cardiovascular events (i.e., any stroke, transient ischemic attack, ischemic heart disease, acute heart failure, and aortic dissection) were defined as the primary end point. The hazard ratio (HR) of events during follow-up was calculated using Cox proportional hazards modeling with adjustments for age, sex, hypertension, diabetes mellitus, and smoking. Cumulative event-free rates were estimated using the Kaplan–Meier method.ResultsDuring follow-up (mean, 6.7 years), 35 cerebro-cardiovascular (16 cerebrovascular) events were identified. Higher small vessel disease score was associated with increased risk of cerebro-cardiovascular events (HR per unit increase, 2.17; 95% confidence interval, 1.36–3.46; P = 0.001). Events were more frequent among participants with higher score (P 
      Citation: International Journal of Stroke
      PubDate: 2020-02-20T05:35:24Z
      DOI: 10.1177/1747493020908144
  • Primary intraventricular hemorrhage outcomes in the CLEAR III trial
    • Authors: Sarah E Nelson, W Andrew Mould, Dheeraj Gandhi, Richard E Thompson, Sarah Salter, Rachel Dlugash, Issam A Awad, Daniel F Hanley, Wendy Ziai
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundIntraventricular hemorrhage occurs due to intracerebral hemorrhage with intraventricular extension or without apparent parenchymal involvement, known as primary intraventricular hemorrhage.AimsWe evaluated the prognosis of primary intraventricular hemorrhage patients in the CLEAR III trial (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage).MethodsIn patients with primary intraventricular hemorrhage versus those with secondary intraventricular hemorrhage, we compared intraventricular alteplase response and outcomes including modified Rankin Scale, Barthel Index, National Institutes of Health Stroke Scale (NIHSS), and extended Glasgow Outcome Scale (eGOS) at 30, 180, and 365 days. Outcomes were also compared in primary intraventricular hemorrhage patients who received intraventricular alteplase versus placebo (normal saline) and in matched primary and secondary intraventricular hemorrhage patients using inverse-probability-weighted regression adjustment.ResultsOf 500 patients enrolled in CLEAR III, 46 (9.2%) had primary intraventricular hemorrhage. Combining both treatment groups, primary intraventricular hemorrhage patients had larger intraventricular hemorrhage volumes (median: 34.2 mL vs. 20.8 mL, p 
      Citation: International Journal of Stroke
      PubDate: 2020-02-20T05:35:24Z
      DOI: 10.1177/1747493020908146
  • Prognostic significance of early urinary catheterization after acute
           stroke: Secondary analyses of the international HeadPoST trial
    • Authors: Menglu Ouyang, Laurent Billot, Lili Song, Xia Wang, Christine Roffe, Hisatomi Arima, Pablo M Lavados, Maree L Hackett, Verónica V Olavarría, Paula Muñoz-Venturelli, Sandy Middleton, Octavio M Pontes-Neto, Tsong-Hai Lee, Caroline L Watkins, Thompson G Robinson, Craig S Anderson
      Abstract: International Journal of Stroke, Ahead of Print.
      BackgroundAn indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST).MethodsData were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates.ResultsOverall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13.ConclusionsIUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
      Citation: International Journal of Stroke
      PubDate: 2020-02-20T05:35:23Z
      DOI: 10.1177/1747493020908140
  • 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
  • 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
  • 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
  • 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
  • International translation of Fever, Sugar, Swallow Protocols: The Quality
           in Acute Stroke Care Europe Project
    • Authors: S Middleton, W Pfeilschifter
      First page: 591
      Abstract: International Journal of Stroke, Ahead of Print.
      The Quality in Acute Stroke (QASC) trial demonstrated a significant reduction in death and disability when clinicians were assisted to introduce protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS) following stroke. We describe a unique international collaboration between the Nursing Research Institute at Australian Catholic University; the European Stroke Organisation; and the Angels Initiative, working collaboratively to support implementation of the nurse-led FeSS Protocols in 20 European countries. We currently have 71 hospitals from 16 countries participating (hospitals from four countries are in the preparation phase) with 49 hospitals currently entering data (n=2819 patients to-date). Baseline data have been received from 39 hospitals, with FeSS Protocol implementation commenced at 16 hospitals. Five hospitals have completed the Project. 'Upscale and spread' of these evidence-based, nursing protocols into countries with vastly different healthcare systems, many of whom also have no access to the latest stroke therapies, is likely to make a significant impact in reducing death and disability after stroke.
      Citation: International Journal of Stroke
      PubDate: 2020-04-17T02:57:41Z
      DOI: 10.1177/1747493020915130
  • Mobile stroke unit versus standard medical care in the management of
           patients with acute stroke: A systematic review and meta-analysis
    • Authors: Nida Fatima, Maher Saqqur, M Shazam Hussain, Ashfaq Shuaib
      First page: 595
      Abstract: International Journal of Stroke, Ahead of Print.
      IntroductionMobile stroke units have recently been introduced in the care of patients suspected of having an acute stroke, leading to shortening in the time to thrombolytics. We aimed to compare the clinical effectiveness in terms of functional outcome and survival among patients treated in mobile stroke unit and/or conventional care.MethodsA systematic search of electronic databases, comparing the clinical outcomes among patients with acute stroke in the same study was conducted from 1990 to 2019. Pooled and subgroup analysis were performed using the random- and fixed-effect model based upon the I2 heterogeneity.ResultsA total of 21,297 patients from 11 publications (seven randomized controlled trials and four non-randomized controlled trials including prospective cohort studies) were retrieved. This included 6065 (n = 28.4%) of the patients treated in the mobile stroke unit and 71.6% (n = 15,232) of the patients managed in the conventional care. The mean age at clinical presentation (70.1 ± 14.5 vs. 71.05 ± 15.8) and National Institute Health Stroke Scale (9.8 ± 1.7 vs. 8.4 ± 1.5) was comparable (p > 0.05) in patients treated with mobile stroke unit and conventional care, respectively. The mean time-to-treatment window was significantly shorter among the patients treated in mobile stroke unit compared to conventional care (62.0 min vs. 75.0 min; p = 0.03, respectively). The pooled analysis of clinical outcome at day 7 indicated that patients treated in mobile stroke unit had 1.46-folds higher likelihood of better clinical outcome (modified Rankin scale 0–2) than those in the hospital (odds ratio: 1.46, 95% confidence interval: 1.306–2.03, p = 0.02). However, there was no significant difference in terms of mortality (odds ratio: 0.98, 95% confidence interval: 0.81–1.18, p = 0.80), stroke-related neurological deficits (odds ratio: 1.37, 95% confidence interval: 0.81–2.32, p = 0.24), and other serious adverse events (odds ratio: 0.69, 95% confidence interval: 0.39–1.20, p = 0.19) among patients treated in mobile stroke unit versus conventional care.ConclusionOur results corroborate that patients treated in mobile stroke unit lead to short-term recovery following acute stroke without influencing the mortality rate. Further prospective studies are needed to validate our results.
      Citation: International Journal of Stroke
      PubDate: 2020-06-09T12:43:11Z
      DOI: 10.1177/1747493020929964
  • 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
      First page: 609
      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
  • COVID-19 and acute ischemic stroke – A case series from Dubai, UAE
    • Authors: Maria Khan, Rasha HM Ibrahim, Shaista A Siddiqi, Youssry Kerolos, Muhammad M Al-Kaylani, Suhail A AlRukn, Derk W Krieger
      First page: 699
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-26T02:16:41Z
      DOI: 10.1177/1747493020938285
  • Stroke in COVID-19 patients—A case series from Italy
    • Authors: Paolo Immovilli, Chiara Terracciano, Domenica Zaino, Elena Marchesi, Nicola Morelli, Emilio Terlizzi, Paola De Mitri, Stefano Vollaro, Fabiola Magnifico, Davide Colombi, Emanuele Michieletti, Donata Guidetti
      First page: 701
      Abstract: International Journal of Stroke, Ahead of Print.

      Citation: International Journal of Stroke
      PubDate: 2020-06-22T05:06:53Z
      DOI: 10.1177/1747493020938294
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