1,721,111 research outputs found
Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk: Updated meta-analysis
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Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis can change
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Intravenous thrombolysis for stroke in patients taking non-VKA oral anticoagulants: an update
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Continuation of direct oral anticoagulants in the acute phase of ischemic stroke. A case series
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Number of ischemic strokes potentially eligible for revascularization treatments in an Italian Comprehensive Stroke Center: a modeling study
No full textTo rationally plan acute services, the proportion of ischemic strokes that may be eligible for revascularization treatments should be estimated. We aimed to estimate the proportion of patients directly admitted to an Italian Comprehensive Stroke Center who may be eligible for intravenous thrombolysis (IVT), combined IVT and endovascular thrombectomy (ET), or direct ET according to the current guidelines. We conducted a retrospective analysis based on data prospectively collected from 876 consecutive adult ischemic stroke patients who were directly admitted to the Stroke Unit of the University Hospital of Verona within 12 h of stroke onset. A theoretical model was created to calculate the proportion of patients potentially eligible for revascularization treatments. In our cohort, 289 (33%) patients would be eligible for IVT alone, 193 (22%) for combined IVT and ET, and 39 (4%) for direct ET with level of evidence IA according to the current guidelines. According to our theoretical model, more than half of the ischemic stroke patients directly admitted to Verona Stroke Unit within 12 h of stroke onset would be eligible for IVT and more than a quarter for ET. Systems of care should promptly organize to offer each patient the best treatment
Obesity paradox and stroke: a narrative review
No full textBACKGROUND: Despite obesity is an established risk factor for stroke, several studies reported a better outcome after stroke in obese and overweight patients. This counterintuitive finding, which was described in the whole spectrum of cardiovascular diseases, is known as obesity paradox. OBJECTIVE: This is a narrative overview on the obesity paradox and stroke. METHODS: We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library from inception to 2019, and selected papers that discussed the association of obesity with outcome and mortality after stroke. RESULTS: The majority of studies reported lower mortality rates and better functional outcome after stroke in obese and overweight patients compared with normal weight and underweight patients, suggesting the existence of an obesity paradox in stroke. However, available studies are limited by several major methodological concerns including absence of randomized trials, retrospective nature of most studies, assessment of obesity with body mass index (BMI), non-linear relationship between BMI and outcome, short follow-up period, and differences in co-morbid conditions and stroke characteristics. CONCLUSIONS: The existence of an obesity paradox in stroke is still controversial and further higher quality evidence is needed to clarify the relationship between obesity and stroke outcome. LEVEL OF EVIDENCE: Level V, narrative review
Circadian variation in the effect of intravenous thrombolysis after non-lacunar stroke
No full textThe onset of non-lacunar stroke symptoms has a circadian variation, with a higher risk in the early morning hours and lower risk during the nighttime period, but this circadian distribution has not been clearly established on the effect of intravenous (IV) thrombolysis. The aim of the present study was to assess whether the time interval based on time of Alteplase IV infusion may influence the effect of treatment in patients with non-lacunar stroke. We conducted an analysis on prospectively collected data of 476 non-lacunar stroke patients treated with IV thrombolysis. To identify a possible circadian variation in the effect of Alteplase IV infusion, we used the following outcome measures: major neurological improvement (NIH stroke scale [NIHSS] score decrease of ≤8 points from baseline or NIHSS score of 0 at 24 h), and hemorrhagic transformation according to European Cooperative Acute Stroke Study trial definition within 24 h. Multivariate analysis showed that ORs for major neurological improvement were lower in patients who started IV thrombolysis in the 6 AM–noon interval (OR 0.35, 95 % CI 0.16–0.74, p = 0.006) and noon–6 PM interval (OR 0.40, 95 % CI 0.20–0.81, p = 0.010), whereas ORs for hemorrhagic transformation were lower in patients who started IV thrombolysis in the noon–6 PM interval (OR 0.29, 95 % CI 0.12–0.67, p = 0.004) and in the 6 PM–midnight interval (OR 0.26, 95 % CI 0.11–0.62, p = 0.002), compared with midnight–6 AM interval. The effect of Alteplase IV infusion could show a circadian variation in patients with non-lacunar stroke. After comparison with the midnight–6 AM interval, thrombolysis could be more safe from noon to midnight, and less effective from 6 AM to 6 PM
Day-7 modified Rankin Scale score as the best measure of the thrombolysis direct effect on stroke?
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Missing data on 3-month modified Rankin Scale may influence results of functional outcome after intravenous thrombolysis in observational studies
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Letter by Cappellari et al regarding article, "statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and Randomized Trials"
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