Articles Tagged With: stroke
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Clinical and Perfusion Mismatch Criteria Both Are Reliable in Identifying Patients Who Will Benefit from Endovascular Therapy
Since 2015, when multiple clinical trials were published showing the efficacy of endovascular thrombectomy (EVT) for large vessel occlusion within six hours of stroke onset, additional criteria have been developed to identify those patients who will benefit from EVT beyond six hours. The AURORA investigators collected patient data from six large clinical trials and performed a meta-analysis to determine if a clinical mismatch or an imaging mismatch protocol was better at predicting good outcomes in patients treated between six hours and 24 hours after the onset of clinical stroke symptoms.
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Basilar Artery Occlusion: Endovascular Thrombectomy and Medical Therapy Have Similar Outcomes
Basilar artery occlusion is a rare form of ischemic stroke and accounts for about 10% of large vessel occlusions reported in the literature. These investigators conducted a randomized trial, enrolling patients from 2011 through 2019, even though multiple studies published in 2015 demonstrated benefit of endovascular therapy in anterior circulation large vessel occlusions. Efficacy and safety were compared with medical therapy in patients who underwent endovascular therapy within six hours after the estimated time of onset of symptoms.
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Telestroke Consultation Increases Rate of Thrombolysis and Reduces Mortality
Real-time video conferencing between the patient, a remotely located stroke specialist, and the bedside healthcare provider in a hospital emergency department is referred to as “telestroke.” However, there are little data comparing its benefit with in-person evaluation and treatment for hospitals that do not have in-hospital stroke specialists 24 hours per day, seven days per week.
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Intensive Lowering of Blood Pressure Does Not Affect the Progression of Small Vessel Disease
Small vessel disease of the brain accounts for 20% to 25% of all ischemic strokes and is a common cause of vascular cognitive impairments. The major risk factor for small vessel disease is hypertension. Targeting a systolic blood pressure of 120 mmHg to 125 mmHg has been recommended, but this has not been confirmed as effective in preventing stroke or long-term cognitive impairment in these patients.
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Pregnancy-Associated Stroke Is Increasing in Frequency
Stroke during pregnancy or the puerperium is a rare event but accounts for a considerable part of maternal morbidity and mortality. The incidence has been increasing in all countries, particularly in wealthy industrialized countries, where pregnancy is being delayed considerably and other cardiovascular risk factors have taken on greater importance.
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Vitamin and Mineral Supplements for Cardiovascular Disease
A meta-analysis of systematic reviews and randomized, controlled trials to analyze the role of commonly used dietary supplements for prevention and treatment of cardiovascular disease suggests no significant effect on cardiovascular outcomes or all-cause mortality, although some B vitamins appear to reduce stroke incidence, and B3 appears to increase all-cause mortality.
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The Difficulty of Showing Benefit of Cerebral Protection Devices During TAVR
In this trial of cerebral protection in transcatheter aortic valve replacement, the TriGUARD device was safe vs. historical controls, but failed to meet its primary efficacy endpoint. -
Anticoagulation Plus Antiplatelet Therapy in Chronic Atherosclerosis
An analysis of the COMPASS trial for the secondary endpoint of mortality showed the combination of low-dose rivaroxaban and aspirin significantly lowered the all-cause mortality rate vs. low-dose aspirin alone. -
Stroke and Risk of Suicide
Stroke should be considered a risk factor for suicide. Tactics to screen and treat depression and suicidal ideation should be an important component of long-term follow-up and care for stroke patients. -
Ischemic Stroke in Patients with COVID-19
Since the first cases of COVID-19 were reported in the United States, severe ischemic strokes also have been reported in some of these patients, some with large vessel occlusions and case reports of thrombectomy for treatment.