Showing papers in "International Journal of Stroke in 2021"
TL;DR: The 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.
Abstract: 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 ...
437 citations
TL;DR: Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors, and the pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.
Abstract: BackgroundCoronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear.Ai...
333 citations
TL;DR: The CSPPC Stroke program has led to a significant improvement in stroke care, and this program needs to be further promoted nationwide.
Abstract: 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...
120 citations
Raul G Nogueira1, Mohamad Abdalkader2, Muhammed M. Qureshi2, Michael Frankel1 +269 more•Institutions (98)
TL;DR: In this paper, the authors measured the global impact of the COVID-19 pandemic on the volumes of the volumes for medical care in the United Kingdom and the United States.
Abstract: BackgroundThe COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.AimsWe sought to measure the global impact of the COVID-19 pandemic on the volumes for m...
109 citations
Rowan University1, Cooper University Hospital2, Bellvitge University Hospital3, University of Valladolid4, Spanish National Research Council5, Robert Wood Johnson University Hospital6, Rutgers University7, Autonomous University of Barcelona8, Emory University9, Grady Memorial Hospital10, University of Barcelona11, Alexandria University12, Carol Davila University of Medicine and Pharmacy13, Boston University14, University of Texas Health Science Center at Houston15, Ronald Reagan UCLA Medical Center16, University of Iowa Hospitals and Clinics17, University of Texas at Austin18
TL;DR: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke, and aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
Abstract: BackgroundSevere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.AimTo summarize the findings of a ...
108 citations
Hamilton Health Sciences1, McMaster University2, Heart and Stroke Foundation of Canada3, Ottawa Hospital4, University of Ottawa5, University Health Network6, Ottawa Hospital Research Institute7, HealthPartners8, Queen Elizabeth II Health Sciences Centre9, Dalhousie University10, University of Saskatchewan11, University of Alberta12, Université de Montréal13, Montreal Neurological Institute and Hospital14, University of British Columbia15, University of Calgary16
TL;DR: The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke.
Abstract: Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths f...
58 citations
University of Ibadan1, Monash University2, Universidade Federal do Rio Grande do Sul3, Cairo University4, World Health Organization5, University of Melbourne6, University College Hospital, Ibadan7, Menzies Research Institute8, National University of Ireland, Galway9, Masaryk University10, Lund University11, Auckland University of Technology12
TL;DR: The World Stroke Organization, World Health Organization and the Lancet Neurology Commission on Stroke as mentioned in this paper conducted a study on the impact of stroke services on reducing the global stroke burden.
Abstract: BackgroundImproving stroke services is critical for reducing the global stroke burden. The World Stroke Organization–World Health Organization–Lancet Neurology Commission on Stroke conducted a surv...
56 citations
TL;DR: Clinical outcome was better in patients with first-pass effect compared to non-first- pass effect patients, and a strategy combining thrombectomy and thrombo-aspiration was more effective than other strategies in achieving first-Pass effect.
Abstract: 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 ou...
50 citations
TL;DR: Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care, and combined high intensity groups for the primary outcome.
Abstract: BackgroundEffectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therap...
44 citations
TL;DR: In this paper, the authors assess the safety and efficacy of thrombectomy for stroke in acute basilar artery occlusion in the 6-24-hour time window.
Abstract: RationaleThere are no randomized trials examining the best treatment for acute basilar artery occlusion in the 6–24-hour time window.AimsTo assess the safety and efficacy of thrombectomy for stroke...
40 citations
TL;DR: There is evidence that the introduction of the Melbourne Mobile Stroke Unit is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
Abstract: Background The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. Aims To 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). Methods The 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. Results In 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. Conclusions There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
TL;DR: In this paper, randomized evidence for endovascular thrombectomy (EVT) safety and efficacy in patients with large core strokes is lacking. But, the efficacy and safety of EVT were evaluated in patients suffering from large core stroke.
Abstract: Rationale: Randomized evidence for endovascular thrombectomy(EVT) safety and efficacy in patients with large core strokes is lacking.Aims: To demonstrate EVT efficacy and safety in patients with la...
TL;DR: Net water uptake, a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days and may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU.
Abstract: BackgroundIschemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has rec...
TL;DR: A recent overview of apathy in stroke can be found in this article, where a network neuroscience approach is adopted to model apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behavior.
Abstract: Apathy is a reduction in goal-directed activity in the cognitive, behavioral, emotional, or social domains of a patient's life and occurs in one out of three patients after stroke. Despite this, apathy is clinically under-recognized and poorly understood. This overview provides a contemporary introduction to apathy in stroke for researchers and practitioners, covering topics including diagnosis, neurobiological mechanisms, associated consequences, and potential treatments for apathy. Apathy is often misdiagnosed as other post-stroke conditions such as depression. Accurate differential diagnosis of apathy, which manifests as reductions in initiative, and depression, which manifests as negative emotionality, is important as it informs prognosis. Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy. These may be resolved by adopting a network neuroscience approach, which models apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behavior. Importantly, networks can be affected by physiological changes related to stroke, including the acute infarct but also diaschisis and neurodegeneration. Aside from neurobiological changes, apathy is also associated with other negative outcome measures such as functional disability, cognitive impairment, and emotional distress, suggesting that apathy is indicative of a worse prognosis following stroke. Unfortunately, high-quality trials aimed at treating apathy are scarce. Antidepressants may have limited effects on apathy. Acetylcholine and dopamine pharmacotherapy, behavioral interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.
TL;DR: The proposed AF-ESUS score has high sensitivity and high negative predictive value to identify ESUS patients who have low probability of new incident AF and patients with a score of 1 or more may be better candidates for prolonged automated cardiac monitoring.
Abstract: 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 pat...
TL;DR: In this paper, treatment with intravenous alteplase prior to mechanical thrombectomy (MT) in acute ischemic stroke patients with large vessel occlusion is discussed.
Abstract: RationaleWhether treatment with intravenous alteplase prior to mechanical thrombectomy (MT) in acute ischemic stroke patients with large vessel occlusion is beneficial remains unclear.AimTo determi...
TL;DR: In this paper, direct mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT+MT) in acute ischemic stroke.
Abstract: BackgroundDirect mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT + MT) in acute ischemic stroke. Recent randomized controll...
TL;DR: Titan 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.
Abstract: 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 t...
TL;DR: There are currently no effective therapeutics available to cure or halt the progression of cerebral amyloid angiopathy, but emerging avenues for potential future interventions are discussed.
Abstract: Cerebral amyloid angiopathy is a common small vessel disease in the elderly involving vascular amyloid-β deposition. Cerebral amyloid angiopathy is one of the leading causes of intracerebral hemorrhage and a significant contributor to age-related cognitive decline. The awareness of a diagnosis of cerebral amyloid angiopathy is important in clinical practice as it impacts decisions to use lifelong anticoagulation or nonpharmacological alternatives to anticoagulation such as left atrial appendage closure in patients who have concurrent atrial fibrillation, another common condition in older adults. This review summarizes the latest literature regarding the management of patients with sporadic cerebral amyloid angiopathy, including diagnostic criteria, imaging biomarkers for cerebral amyloid angiopathy severity, and management strategies to decrease intracerebral hemorrhage risk. In a minority of patients, the presence of cerebral amyloid angiopathy triggers an autoimmune inflammatory reaction, referred to as cerebral amyloid angiopathy-related inflammation, which is often responsive to immunosuppressive treatment in the acute phase. Diagnosis and management of cerebral amyloid angiopathy-related inflammation will be presented separately. While there are currently no effective therapeutics available to cure or halt the progression of cerebral amyloid angiopathy, we discuss emerging avenues for potential future interventions.
TL;DR: 40 years of critical imaging research on the ischaemic penumbra have allowed for considerable extension of the treatment time window and better patient selection for reperfusion therapy, and shown that “tissue is at least as important as time.”
Abstract: The discovery that brain tissue could potentially be salvaged from ischaemia due to stroke, has led to major advances in the development of therapies for ischemic stroke. In this review, we detail the advances in the understanding of this area termed the ischaemic penumbra, from its discovery to the evolution of imaging techniques, and finally some of the treatments developed. Evolving from animal studies from the 70s and 80s and translated to clinical practice, the field of ischemic reperfusion therapy has largely been guided by an array of imaging techniques developed to positively identify the ischemic penumbra, including positron emission tomography, computed tomography and magnetic resonance imaging. More recently, numerous penumbral identification imaging studies have allowed for a better understanding of the progression of the ischaemic core at the expense of the penumbra, and identification of patients than can benefit from reperfusion therapies in the acute phase. Importantly, 40 years of critical imaging research on the ischaemic penumbra have allowed for considerable extension of the treatment time window and better patient selection for reperfusion therapy. The translation of the penumbra concept into routine clinical practice has shown that "tissue is at least as important as time."
TL;DR: In this article, the burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality, and only one-month stroke case fatality is estimated.
Abstract: BackgroundThe burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortalityObjectiveTo estimate over one-month stroke case fatality in sub-Saharan AfricaM
TL;DR: COVID-19-related strokes were more severe in nature and resulted in higher mortality and morbidity and Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality.
Abstract: BackgroundCOVID-19-related strokes are increasingly being diagnosed across the world. Knowledge about the clinical profile, imaging findings, and outcomes is still evolving. Here we describe the ch...
TL;DR: It is demonstrated that ePWV is independently associated with the risk of stroke in middle-aged men.
Abstract: BackgroundIncreased aortic stiffness, assessed as carotid-femoral pulse wave velocity (cfPWV), contributes to cerebrovascular damage and is predictive of cerebrovascular events.Aims and methodsWe s...
TL;DR: Directly transferring patients to angiography and using multiphase computed tomographyAngiography to determine the eligibility for endovascular therapy is safe and may result in a significant reduction in treatment times.
Abstract: BackgroundBypassing the emergency department and the computed tomography suite by directly transporting to the neuroangiography suite for imaging assessment and treatment may shorten reperfusion ti...
TL;DR: Complications globally considered are not uncommon and may result in poor clinical outcome, so early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
Abstract: BackgroundThere are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes.AimsWe evaluated the cumulative incidence, the clinical r...
TL;DR: Discrepancies 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.
Abstract: BackgroundSome patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better.AimsWe explored factor...
TL;DR: The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth cause of disability as mentioned in this paper, and previous research suggests that the incidence of st...
Abstract: BackgroundThe burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of st...
University Hospital of North Norway1, Oslo University Hospital2, Hospital of Southern Norway3, University of Helsinki4, University of Copenhagen5, Tartu University Hospital6, Vilnius University7, University of Basel8, University Hospital of Basel9, University of Tromsø10, UCL Institute of Neurology11, University of Leicester12
TL;DR: In this paper, the authors showed that patients with wake-up ischemic stroke who have evidence of salvageable tissue on advanced imaging can benefit from intravenous thrombolysis.
Abstract: BackgroundPatients with wake-up ischemic stroke who have evidence of salvageable tissue on advanced imaging can benefit from intravenous thrombolysis. It is not known whether patients who do not fu...
TL;DR: In this article, the association of pro-inflammatory cytokines and post-stroke recurrence was found to be a new therapeutic target in coronary disease, but few data exist on the associations of key upstream cytokines.
Abstract: BackgroundInflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. ...
TL;DR: In this paper, the authors describe the expansion of the hematoma between the baseline computed tomography scan and a follow-up computed tomographic scan, which is the deadliest form of stroke.
Abstract: Introduction Intracerebral hemorrhage is the deadliest form of stroke. Hematoma expansion, growth of the hematoma between the baseline computed tomography scan and a follow-up computed tomography s...