Mohamed Al-Khaled, MD,* Christine Matthis, MD, and J urgen Eggers, MD*
|
|
- Gervase Boone
- 6 years ago
- Views:
Transcription
1 Predictors of In-hospital Mortality and the Risk of Symptomatic Intracerebral Hemorrhage after Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Mohamed Al-Khaled, MD,* Christine Matthis, MD, and J urgen Eggers, MD* Recombinant tissue-plasminogen activator (rt-pa) therapy improves functional outcome in patients with acute ischemic stroke (AIS) but is associated with serious complications, including symptomatic intracerebral hemorrhage (sich). This study aimed to determine the independent predictors of in-hospital mortality (IHM) and the risk of sich after rt-pa therapy. A total of 1007 patients (mean age, years; 52% women; mean National Institutes of Health Stroke Scale [NIHSS] score, ) with AIS treated with rt-pawere enrolled in this study during a 42-month period beginning in November Univariate and multivariate regression analyses were performed to estimate the predictors of IHM. Eighty-three of the 1007 patients (8.2%) died during hospitalization (mean duration of hospitalization, days). Logistic regression estimated the following independent predictors for IHM: age $80 years (odds ratio [OR], 1.8; 95% confidence interval [CI], ; P 5.031), aphasia (OR, 2.0; 95% CI, ; P 5.017), altered consciousness (OR, 3.6; 95% CI, ; P,.001), hypertension (OR, 4; 95% CI, ; P ), sich (OR, 5.9; 95% CI, ; P, 0.001), and pneumonia during hospitalization (OR, 3.0; 95% CI, ; P,.001). After rt-pa therapy, 58 patients (5.8%) sustained sich, 16 (28%) of whom died. Increased age (P 5.008), higher NIHSS score (P 5.011), and atrial fibrillation (P 5.025) were correlated with sich. The findings from this study may help clinicians estimate the prognosis and risk of sich in patients with AIS treated with rt-pa. Key Words: Stroke treatment prognosis outcome complication epidemiology. Ó 2014 by National Stroke Association Thrombolysis with intravenous (IV) recombinant tissue-plasminogen activator (rt-pa) is the only medically approved treatment for patients with acute ischemic stroke (AIS) that improves functional outcome after stroke and prevents disability caused by stroke. 1,2 Based From the *Department of Neurology; and Institute of Social Medicine, University of L ubeck, L ubeck, Germany. Received January 22, 2012; revision received February 22, 2012; accepted April 8, Address correspondence to Mohamed Al-Khaled, MD, Department of Neurology, University of L ubeck, Campus L ubeck, Ratzeburger Allee 160, L ubeck, Germany. Mohamed.al-khaled@ neuro.uni-luebeck.de /$ - see front matter Ó 2014 by National Stroke Association doi: /j.jstrokecerebrovasdis on the findings of the European Cooperative Acute Stroke Study (ECASS) III, rt-pa therapy is effective when administered within hours after symptom onset. 3 Two previous studies (ECASS I and ECASS II) failed to demonstrate the efficacy of administering IV rt-pa up to 6 hours after symptom onset. 4,5 However, patients who were treated with IV rt-pa had an higher rate of symptomatic intracerebral hemorrhage (sich) and greater mortality compared with patients with AIS in general, possibly related to the selection of more severely affected patients for IV rt-pa therapy. 6,7 The aims of the present population-based study were to estimate the short-term risk and predictors of early in-hospital mortality (IHM) after IV rt-pa therapy, and to determine the risk of sich in patients treated with IV rt-pa. Journal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 1 (January), 2014: pp
2 8 Methods Study Design This study is a part of the benchmarking project Quality of Treatment of Stroke in Schleswig-Holstein (QugSS2), which has been described previously. 8 The German federal state of Schleswig-Holstein has 2.8 million inhabitants. Of the 15 participating sites, 2 were university departments of neurology, 8 were departments of neurology at nonuniversity hospitals, and 5 were departments of internal medicine at nonuniversity hospitals. Ten of the hospitals had a stroke unit certified by the German Stroke Society. All patients provided written informed consent for inclusion in this study. Inclusion criteria included treatment of AIS with IV rtpa for up to 4.5 hours after symptom onset and main residence in the state of Schleswig-Holstein. Patients who received local thrombolytic therapy with rtpa were excluded. The documentation and data collection procedures followed a uniform study manual, in accordance with recommendations of the German Stroke Register Study Group. Baseline characterizations at admission sex, age, National Institutes of Health Stroke Scale (NIHSS) score, neurologic deficits at admission, vascular risk factors, history of stroke, and complications during hospitalization were documented and analyzed. sich was defined as any bleeding that was not detected on a previous computed tomography (CT) scan and was associated with a worsening NIHSS score of at least 4 points. All patients underwent a head CT scan before and 24 hours after IV rt-pa treatment as part of the clinical routine of administering thrombolytic therapy. Approval for the study was obtained from the local Ethics Committee of the University of L ubeck. Statistics Data analysis was done using SPSS PASW Statistics 18 (IBM, Armonk, NY). Correlations between categorical variables were identified using the c 2 test, and correlations between continuous variables were determined using the Student t test. The Wilcoxon test was used to compare modified Rankin Scale (mrs) scores at admission and at discharge. Logistic regression was performed to estimate odds ratios (ORs) for predictors of mortality. Baseline characteristics found to be significantly associated with mortality on univariate analysis, sich and pneumonia, were evaluated by logistic regression. A P value of,.05 was considered statistically significant. Results M. AL-KHALED ET AL. Between November 2007 and March 2011, a total of 1007 patients (mean age, years; 52% women; mean NIHSS score, ) with AIS received treatment with IV rt-pa. Eighty-three patients (8.2%) died during hospitalization (mean duration of hospitalization, days). Table 1 presents the baseline characteristics Table 1. Baseline characteristics and risk factors Baseline characteristic/risk factor All (n ) IHM mortality (n 5 83) P value Age, years, mean (SD) 71.5 (12.2) 78.9 (8.4),.001 Age $80 years, n (%) 247 (25) 36 (44),.001 Female sex, n (%) 508 (51) 47 (57).22 NIHSS score, mean (SD); median (IQR) 11.6 (5.6); 11 (7-15) 16.4 (5.2); 17 (14-20),.001 mrs score, mean (SD); median (IQR) 4 (1.1); 4 (3-5) 4.5 (0.8); 5 (4-5).001 Paresis, n (%) 933 (94) 79 (98).15 Aphasia, n (%) 549 (56) 60 (74).001 Dysarthria, n (%) 672 (69) 61 (77).10 Dysphagia, n (%) 462 (49) 56 (71),.001 Altered unconsciousness, n (%) 136 (14) 29 (36),.001 Time to rt-pa, n (%),2 hours 367 (75) 24 (66) 2-3 hours 96 (20) 8 (22) hours 25 (5) 4 (11).19 Admission on weekday, n (%) 717 (72) 56 (69) Admission on weekend, n (%) 285 (28) 26 (32).49 Hypertension, n (%) 795 (81) 77 (95) Diabetes mellitus, n (%) 198 (20) 25 (31) 0.01 Hypercholesteremia, n (%) 477 (51) 30 (41) 0.06 Atrial fibrillation, n (%) 387 (40) 42 (54) 0.01 History of stroke, n (%) 197 (20) 15 (19) 0.79 Hospital stay, days, mean (SD) 10 (1.8) 3 (2.8),0.001 Abbreviations: IHM, in-hospital mortality; IQR, interquartile range; mrs, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; rt-pa, recombinant tissue-plasminogen activator; SD, standard deviation.
3 MORTALITY AND RISK OF SYMPTOMATIC ICH AFTER THROMBOLYTIC THERAPY 9 and risk factors found to correlate significantly with IHM on univariate analysis. The following independent predictors for IHM were estimated using logistic regression analysis: age $80 years (OR, 1.8; 95% CI, ; P 5.031), aphasia (OR, 2.0; 95% CI, ; P 5.017), altered consciousness (OR, 3.6; 95% CI, ; P,.001), hypertension (OR, 4; 95% CI, ; P 5.012), sich (OR, 5.9; 95% CI, ; P,.001), and pneumonia during hospitalization (OR, 3.0; 95% CI, ; P,.001) (Table 2). Neither the time between symptom onset and start of thrombolytic therapy variable nor the time of hospital admission variable (ie, weekend [28%] vs weekday [72%] admission) was correlated with IHM. After IV rt-pa treatment, 58 of the 1007 patients with AIS sustained sich (5.8%), 16 of whom died (27%). The patients with sich were significantly older than those without sich (78.8 years vs 70.9 years; P 5.008) and had a significantly higher mean NIHSS score at admission (13.5 vs 11.5; P 5.011). Atrial fibrillation was the sole baseline variable that was significantly more common in the patients with sich (55% vs 39%; P 5.025); no other baseline characteristics were associated with sich as a complication after IV rt-pa treatment. The data showed no significant increase in risk of sich in patients aged $80 years (Table 3). Complications after thrombolytic therapy with IV rt-pa and during hospitalization are summarized in Table 4. Patients who survived AIS had a significantly lower mean mrs score at discharge compared with that at admission (2.68 vs 3.98; P,.001). Discussion Data from Germany on the incidence of IHM and the risk of sich in population-based studies are sparse. We estimated the incidence of IHM and identified the independent predictors of early mortality in patients with AIS after thrombolytic therapy with IV rt-pa. The risk of IHM in our study cohort was 8.2%, lower than the previously reported 10%-11% risk of early mortality after rt-pa treatment. 1,9 Older age and greater severity of neurologic deficits at admission as measured by the NIHSS were significantly correlated with IHM. Logistic regression analysis revealed that patient age $80 years Table 2. Predictors of IHM in patients treated with IV rt-pa Predictor OR 95% CI P value Age $80 years Aphasia Altered consciousness ,.001 Hypertension sich ,.001 Pneumonia ,.001 Abbreviations: IHM, in-hospital mortality; IV, intravenous; OR, odds ratio; rt-pta, recombinant tissue-plasminogen activator; sich, symptomatic intracerebral hemhorrage. and the presence of neurologic deficits, such as aphasia and altered consciousness at admission, reflect the severity of stroke and are independent predictors of IHM. These findings are in agreement with those of a study by Heuschmann et al, 9 in which older age and altered consciousness were identified as independent predictors for hospital death in 1658 patients treated with rt-pa. The frequency of hypertension as a comorbid condition was 81% in our patient cohort overall, but 95% in the patients who died after receiving thrombolytic therapy with IV rt-pa. Our data also identify hypertension as an independent predictor of IHM, increasing the risk of death during hospitalization by approximately 4-fold. Hypertension generally promotes arteriosclerosis, possibly explaining the higher rate of IHM in patients with a known history of hypertension. The most feared complication after IV rt-pa therapy is sich, and after stroke is pneumonia suffered during hospitalization. The rate of sich in our study with 4.8% is lower than the rate (6%-7%) reported in previous studies. 9,10 On logistic regression analysis, the OR for death during hospitalization was approximately 6-fold higher in the patients with sich compared with those without sich. A previous study by Weimar et al 11 identified age and NIHSS score as independent predictors of outcome in ischemic stroke. In the present study, older age and higher NIHSS score were significantly correlated with sich. However, despite the significant correlation between older age and sich, no correlation was found between age $80 years and sich. Similarly, in a systematic review of 2244 patients, Engelter et al 12 found no difference in the likelihood of sich between patients aged.80 years and those aged,80 years. 12 In the present study, the patients with sich were significantly older than those without sich; however, when age was dichotomized (with patients divided into those aged $80 years and those aged,80 years), the risk of sich was not significantly greater in the older age group. Moreover, we found that the occurrence of sich was associated with the presence of atrial fibrillation and was significantly associated with higher IHM. These findings are in accordance with previous studies reporting poor outcomes in patients with stroke and atrial fibrillation. 13,14 Other comorbidities, including diabetes mellitus, hypercholesterinemia, hypertension, previous stroke, and neurologic deficits (eg, paresis, aphasia, dysarthria, dysphagia, altered consciousness) were not correlated with sich in the present study. In accordance with previous studies, 15,16 we found no association between the presence of diabetes mellitus alone or in combination with a previous stroke and the occurrence of sich after thrombolytic therapy with IV rt-pa. Pneumonia is the most common complication during hospitalization and carries the highest attributable risk of death in patients with stroke. 17 In our cohort, 35 of
4 10 M. AL-KHALED ET AL. Table 3. Baseline characteristics in patients with and without sich Baseline characteristic/risk factor All (n ) SICH (n 5 58) P value Age, years, mean (SD) 71.5 (12.2) 75.6 (9).008 Age $80 years, n (%) 247 (25) 18 (31).25 Female sex, n (%) 508 (51) 29 (50).88 NIHSS score, median (IQR) 11 (7-15) 17 (10-18).011 Paresis, n (%) 933 (94) 54 (95).78 Aphasia, n (%) 549 (56) 32 (55).93 Dysarthria, n (%) 672 (69) 42 (73).54 Dysphagia, n (%) 462 (49) 28 (52).63 Altered conscious, n (%) 136 (14) 8 (14).93 Time to rt-pa, n (%),2 hours 367 (75) 21 (75) 2-3 hours 96 (20) 6 (21) hours 25 (5) 1 (4).91 Hypertension, n (%) 795 (81) 48 (89).12 Diabetes mellitus, n (%) 198 (20) 14 (26).29 Hypercholesteremia, n (%) 477 (51) 20 (40).08 Atrial fibrillation, n (%) 387 (39) 29 (55).025 History of stroke, n (%) 197 (20) 8 (14).25 Abbreviations: IQR, interquartile range; NIHSS, National Institutes of Health Stroke Scale; rt-pa, recombinant tissue-plasminogen activator; SD, standard deviation; SICH, symptomatic intracerebral hemhorrage. the 83 patients who died had pneumonia (42%). Logistic regression analysis revealed that pneumonia was associated with a 3-fold increased risk for IHM. Other complications, including symptomatic edema and cardiovascular disease, were also associated with increased risk of death after IV rt-pa treatment. Despite the risk of sich after IV rt-pa treatment and pneumonia as a complication of hospitalization, we found that overall, our patients with AIS benefited from IV rt-pa treatment. As assessed in this observational study, the patients who survived AIS had a significantly lower mrs score at discharge compared with that at admission (mean score, 2.68 vs 3.98; P,.001). This finding requires further investigation in a randomized trial including patients not treated with IV rt-pa. The present study has several strengths, including its investigation of the interval between symptom onset and IV rt-pa administration, its population-based design, its large patient cohort, and data acquisition from 15 hospitals that follow a uniform protocol in the standardized treatment of stroke (based on recommendations of the German Society for Neurology). A limitation of this study is its failure to include long-term outcomes after hospital discharge. Further investigation is needed to determine whether long-term mortality differs from early IHM. In conclusion, we have identified the following independent predictors for IHM after thrombolytic therapy: age $80 years, aphasia, altered level of consciousness, hypertension as a vascular risk factor, sich, and pneumonia. These findings may provide prognostic information about patients receiving IV rt-pa and help clinicians focus attention on patients with these predictors. Acknowledgment: This article is dedicated in memory of a colleague, Dr Nahel Othman, who was killed for his Table 4. Complications during hospitalization after rt-pa treatment Complication All (n ) IHM (n 5 83) P value sich, n (%) 58 (5.8) 16 (19),.001 Pneumonia, n (%) 183 (18) 35 (42),.001 Stroke recurrence, n (%) 30 (3) 3 (4).70 Early seizure, n (%) 16 (2) 3 (4).10 Symptomatic edema, n (%) 40 (4) 21 (25),.001 Confusion, n (%) 34 (3) 1 (1).20 Fall during hospital stay, n (%) 16 (2) 0.20 Cardiovascular complications, n (%) 35 (4) 20 (24),.001 Other complications, n (%) 139 (14) 32 (39),.001 Abbreviations: IHM, in-hospital mortality; rt-pa, recombinant tissue-plasminogen activator; sich, symptomatic intracerebral hemhorrage.
5 MORTALITY AND RISK OF SYMPTOMATIC ICH AFTER THROMBOLYTIC THERAPY 11 involvement in administering medical treatment to injured peaceful protesters in Syria. References 1. National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006; 367: Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359: Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274: Hacke W, Kaste M, Fieschi C, et al. Second European- Australasian Acute Stroke Study Investigators. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998;352: Dubinsky R, Lai SM. Mortality of stroke patients treated with thrombolysis: Analysis of the Nationwide Inpatient Sample. Neurology 2006;66: Bateman BT, Schumacher HC, Boden-Albala B, et al. Factors associated with in-hospital mortality after administration of thrombolysis in acute ischemic stroke patients: An analysis of the Nationwide Inpatient Sample, 1999 to Stroke 2006;37: Matthis C, Raspe H. Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS). Z Evid Fortbild Qual Gesundhwes 2011;105: (in German). 9. Heuschmann PU, Kolominsky-Rabas PL, Roether J, et al. Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. JAMA 2004;292: Tanne D, Kasner SE, Demchuk AM, et al. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: The Multicenter rt-pa Stroke Survey. Circulation 2002; 105: Weimar C, K onig JR, Kraywinkel K, et al, German Stroke Study Collaboration. Age and National Institutes of Health Stroke Scale score within 6 hours after symptom onset are accurate predictors of outcome after cerebral ischemia: Development and external validation of prognostic models. Stroke 2004;35: Engelter ST, Bonati LH, Lyrer PH. Intravenous thrombolysis in stroke patients of $80 versus,80 years of age: A systematic review across cohort studies. Age Ageing 2006;35: Benjamin EJ, Wolf PA, D Agostino RB, et al. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation 1998;98: Tu HT, Campbell BC, Churilov L, et al. Frequent early cardiac complications contribute to worse stroke outcome in atrial fibrillation. Cerebrovasc Dis 2011; 32: Ahmed N, Davalos A, Eriksson N, et al. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: Results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Arch Neurol 2010; 67: Fuentes B, Martınez-Sanchez P, Alonso de Leci~nana M, et al. Diabetes and previous stroke: Hazards for intravenous thrombolysis? Eur J Neurol 2012;19: Heuschmann PU, Kolominsky-Rabas PL, Misselwitz B, et al, German Stroke Registers Study Group. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke. Arch Intern Med 2004; 164:
Early Hospitalization of Patients with TIA: A Prospective, Population-based Study
Early Hospitalization of Patients with TIA: A Prospective, Population-based Study Mohamed Al-Khaled, MD, and J urgen Eggers, MD Background: The German Stroke Society (GSS) recommends early hospitalization
More informationBlood Pressure Variability and Hemorrhagic Transformation after Intravenous Thrombolysis in Acute Ischemic Stroke
www.jneurology.com Neuromedicine www.jneurology.com Research Article Open Access Blood Pressure Variability and Hemorrhagic Transformation after Intravenous Thrombolysis in Acute Ischemic Stroke Hanna
More informationAcute ischemic stroke is a major cause of morbidity
Outcomes of Treatment with Recombinant Tissue Plasminogen Activator in Patients Age 80 Years and Older Presenting with Acute Ischemic Stroke Jennifer C. Drost, DO, MPH, and Susana M. Bowling, MD ABSTRACT
More informationRedgrave JN, Coutts SB, Schulz UG et al. Systematic review of associations between the presence of acute ischemic lesions on
6. Imaging in TIA 6.1 What type of brain imaging should be used in suspected TIA? 6.2 Which patients with suspected TIA should be referred for urgent brain imaging? Evidence Tables IMAG1: After TIA/minor
More informationPOTENTIAL RISK AND PROTECTIVE FACTORS
POTETIAL RISK AD PROTECTIVE FACTORS FOR I-HOSPITAL MORTALITY I HYPERACUTE ISCHEMIC STROKE PATIETS Chien-Hsun Li, 1 Gim-Thean Khor, 1 Chun-Hung Chen, 1 Poyin Huang, 1 and Ruey-Tay Lin 1,2 1 Department of
More informationNeurological Deterioration in Acute Ischemic Stroke
Neurological Deterioration in Acute Ischemic Stroke Potential Predictors and Associated Factors in the European Cooperative Acute Stroke Study (ECASS) I A. Dávalos, MD; D. Toni, MD; F. Iweins, MSc; E.
More informationENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning
More informationUse of cranial CT to identify a new infarct in patients with a transient ischemic attack
Use of cranial CT to identify a new infarct in patients with a transient ischemic attack Mohamed Al-Khaled 1, Christine Matthis 2, Thomas F. Münte 1 &Jürgen Eggers 1 1 Department of Neurology, University
More informationEFFECT OF OLDER AGE ON THE RISK OF HEMORRHAGIC COMPLICATIONS AFTER INTRAVENOUS AND/OR INTRA-ARTERIAL THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE
EFFECT OF OLDER AGE ON THE RISK OF HEMORRHAGIC COMPLICATIONS AFTER INTRAVENOUS AND/OR INTRA-ARTERIAL THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE By SVETLANA PUNDIK, M.D. Submitted in partial fulfillment of
More informationSetting The setting was secondary care. The economic analysis was conducted in Vancouver, Canada.
Cost-utility analysis of tissue plasminogen activator therapy for acute ischaemic stroke Sinclair S E, Frighetto, Loewen P S, Sunderji R, Teal P, Fagan S C, Marra C A Record Status This is a critical abstract
More informationClinical Study Experiences of Thrombolytic Therapy for Ischemic Stroke in Tuzla Canton, Bosnia and Herzegovina
ISRN Stroke, Article ID 313976, 4 pages http://dx.doi.org/10.1155/2014/313976 Clinical Study Experiences of Thrombolytic Therapy for Ischemic Stroke in Tuzla Canton, Bosnia and Herzegovina DDevdet SmajloviT,DenisaSalihoviT,
More informationJournal Club. 1. Develop a PICO (Population, Intervention, Comparison, Outcome) question for this study
Journal Club Articles for Discussion Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. N Engl J Med. 1995 Dec
More informationIschemic Stroke in Critically Ill Patients with Malignancy
Ischemic Stroke in Critically Ill Patients with Malignancy Jeong-Am Ryu 1, Oh Young Bang 2, Daesang Lee 1, Jinkyeong Park 1, Jeong Hoon Yang 1, Gee Young Suh 1, Joongbum Cho 1, Chi Ryang Chung 1, Chi-Min
More informationOne of the most important issues a clinician must consider
Defining Clinically Relevant Cerebral Hemorrhage After Thrombolytic Therapy for Stroke Analysis of the National Institute of Neurological Disorders and Stroke Tissue-Type Plasminogen Activator Trials Neal
More informationACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS. Justin Nolte, MD Assistant Profession Marshall University School of Medicine
ACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS Justin Nolte, MD Assistant Profession Marshall University School of Medicine History of Presenting Illness 64 yo wf with PMHx of COPD, HTN, HLP who was in
More informationRisk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator
Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue-Type Plasminogen Activator Bijoy K. Menon, MD; Jeffrey L. Saver, MD; Shyam Prabhakaran, MD,
More informationSubtherapeutic Warfarin Is Not Associated With Increased Hemorrhage Rates in Ischemic Strokes Treated With Tissue Plasminogen Activator
Subtherapeutic Warfarin Is Not Associated With Increased Hemorrhage Rates in Ischemic Strokes Treated With Tissue Plasminogen Activator Mervyn D.I. Vergouwen, MD, PhD; Leanne K. Casaubon, MD, MSc; Richard
More informationA trial fibrillation (AF) is a common arrhythmia that is
679 PAPER Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke K Kimura, K Minematsu, T Yamaguchi, for the Japan Multicenter Stroke
More informationThe Effect of Statin Therapy on Risk of Intracranial Hemorrhage
The Effect of Statin Therapy on Risk of Intracranial Hemorrhage JENNIFER HANIFY, PHARM.D. PGY2 CRITICAL CARE RESIDENT UF HEALTH JACKSONVILLE JANUARY 23 RD 2016 Objectives Review benefits of statin therapy
More informationUpdated tpa Guidelines: Expanding the opportunity for good outcomes. Benjamin Morrow, MSN RN UPMC Stroke Institute
Updated tpa Guidelines: Expanding the opportunity for good outcomes Benjamin Morrow, MSN RN UPMC Stroke Institute 1 Outline History Current State Review Exclusions: Minor stroke symptoms Severe strokes
More informationStroke thrombolysis in the Philippines
Neurology Asia 2018; 23(2) : 115 120 Stroke thrombolysis in the Philippines 1,7 Jose C Navarro MD MSc, 2,3 Maria Cristina San Jose MD, 2 Epifania Collantes MD, 3 Maria Cristina Macrohon-Valdez MD, 4 Artemio
More informationTranslent CT hyperattenuation after intraarterial thrombolysis in stroke. Contrast extravasation or hemorrhage
Translent CT hyperattenuation after intraarterial thrombolysis in stroke. Contrast extravasation or hemorrhage Poster No.: C-0053 Congress: ECR 2013 Type: Scientific Exhibit Authors: A. Losa Palacios,
More informationTissue Plasminogen Activator Overdose in Acute Ischemic Stroke Patients Linked to Poorer Functional Outcomes
Tissue Plasminogen Activator Overdose in Acute Ischemic Stroke Patients Linked to Poorer Functional Outcomes Demetrios J. Sahlas, MSc, MD,* Linda Gould, RPN, Richard H. Swartz, MD, PhD, Naufal Mohammed,
More informationThe Effect of Diagnostic Catheter Angiography on Outcomes of Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment
The Effect of Diagnostic Catheter Angiography on Outcomes of Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment Adnan I. Qureshi, MD 1, Muhammad A. Saleem, MD 1, Emrah Aytaç, MD
More informationAcute Stroke Care: the Nuts and Bolts of it. ECASS I and II ATLANTIS. Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center
Acute Stroke Care: the Nuts and Bolts of it Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center ECASS I and II tpa for patients presenting
More informationEarly neurological worsening in acute ischaemic stroke patients
Acta Neurol Scand 2016: 133: 25 29 DOI: 10.1111/ane.12418 2015 The Authors. Acta Neurologica Scandinavica Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA Early neurological in acute ischaemic
More informationThrombolysis in ischaemic stroke in rural North East Thailand by neurologist and non-neurologists
Neurology Asia 2016; 21(4) : 325 331 Thrombolysis in ischaemic stroke in rural North East Thailand by neurologist and non-neurologists 1,2 Kannikar Kongbunkiat MD, 1,2 Narongrit Kasemsap MD, 1,2 Somsak
More informationCerebrovascular Disease lll. Acute Ischemic Stroke. Use of Intravenous Alteplace in Acute Ischemic Stroke Louis R Caplan MD
Cerebrovascular Disease lll. Acute Ischemic Stroke Use of Intravenous Alteplace in Acute Ischemic Stroke Louis R Caplan MD Thrombolysis was abandoned as a stroke treatment in the 1960s due to an unacceptable
More informationGender Differences in the Functional Recovery after Acute Stroke
ORIGINAL ARTICLE J Clin Neurol 2010;6:183-188 Print ISSN 1738-6586 / On-line ISSN 2005-5013 10.3988/jcn.2010.6.4.183 Gender Differences in the Functional Recovery after Acute Stroke Ji-Sun Kim, MD; Kyung-Bok
More informationMechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationThe Impact of Smoking on Acute Ischemic Stroke
Smoking The Impact of Smoking on Acute Ischemic Stroke Wei-Chieh Weng, M.D. Department of Neurology, Chang-Gung Memorial Hospital, Kee-Lung, Taiwan Smoking related mortality Atherosclerotic vascular disease
More informationRisk Factors for Ischemic Stroke: Electrocardiographic Findings
Original Articles 232 Risk Factors for Ischemic Stroke: Electrocardiographic Findings Elley H.H. Chiu 1,2, Teng-Yeow Tan 1,3, Ku-Chou Chang 1,3, and Chia-Wei Liou 1,3 Abstract- Background: Standard 12-lead
More informationSafety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic stroke
Original Article Medical Journal of the Islamic Republic of Iran, Vol. 27, No. 3, Aug 2013, pp. 113-118 Safety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic
More informationAdvancing Stroke Systems of Care to Improve Outcomes Update on Target: Stroke Phase II
Advancing Stroke Systems of Care to Improve Outcomes Update on Target: Stroke Phase II Gregg C. Fonarow MD, Eric E. Smith MD, MPH, Jeffrey L. Saver MD, Lee H. Schwamm, MD UCLA Division of Cardiology; Department
More informationAntithrombotics: Percent of patients with an ischemic stroke or TIA prescribed antithrombotic therapy at discharge. Corresponding
Get With The Guidelines -Stroke is the American Heart Association s collaborative performance improvement program, demonstrated to improve adherence to evidence-based care of patients hospitalized with
More informationCanadian Best Practice Recommendations for Stroke Care. (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management
Canadian Best Practice Recommendations for Stroke Care (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management Reorganization of Recommendations 2008 2006 RECOMMENDATIONS: 2008 RECOMMENDATIONS:
More informationThe tpa Cage Match. Disclosures. Cage Match. Cage Match 1/27/2014. January 8, Advisory Boards
The tpa Cage Match January 8, 2014 Andy Jagoda, MD, FACEP Professor and Chair of Emergency Medicine Mount Sinai School of Medicine New York, New York Advisory Boards Disclosures Astra Zeneca, Pfizer, CSL
More informationRBWH ICU Journal Club February 2018 Adam Simpson
RBWH ICU Journal Club February 2018 Adam Simpson 3 THROMBOLYSIS Reperfusion therapy has become the mainstay of therapy for ischaemic stroke. Thrombolysis is now well accepted within 4.5 hours. - Improved
More informationThrombolytic Therapy in Clinical Practice The Norwegian Experience
Thrombolytic Therapy in Clinical Practice The Norwegian Experience Thomassen Lars Thomassen, Ulrike Waje-Andreassen, Halvor Næss ABSTRACT Background: Awaiting the European approval of thrombolysis, we
More information11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment
More informationPrediction of Hemorrhage in Acute Ischemic Stroke Using Permeability MR Imaging
AJNR Am J Neuroradiol 26:2213 2217, October 2005 Technical Note Prediction of Hemorrhage in Acute Ischemic Stroke Using Permeability MR Imaging Andrea Kassner, Timothy Roberts, Keri Taylor, Frank Silver,
More informationAn Updated Systematic Review of rt-pa in Acute Ischaemic Stroke
Wardlaw An Updated Systematic Review of rt-pa in Acute Ischaemic Stroke Joanna M Wardlaw COMPETING INTERESTS The author is on the Steering Committees of the Third International Stroke Trial (IST3) and
More informationOpen Access The Addition of MRI to CT Based Stroke and TIA Evaluation Does Not Impact One year Outcomes
Send Orders of Reprints at reprints@benthamscience.net The Open Neurology Journal, 2013, 7, 17-22 17 Open Access The Addition of MRI to CT Based Stroke and TIA Evaluation Does Not Impact One year Outcomes
More informationSupplementary Online Content
Supplementary Online Content Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical attention seeking after transient ischemic attack and minor stroke in relation to the UK Face, Arm, Speech, Time
More informationSupplementary Online Content
Supplementary Online Content Inohara T, Xian Y, Liang L, et al. Association of intracerebral hemorrhage among patients taking non vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital
More informationSafety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of Observational Studies
Review Received: September 29, 2015 Accepted: April 6, 2016 Published online: May 21, 2016 Safety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of
More informationA common clinical dilemma. Ischaemic stroke or TIA with atrial fibrillation MRI scan with blood-sensitive imaging shows cerebral microbleeds
Cerebral microbleeds and intracranial haemorrhage risk in patients with atrial fibrillation after acute ischaemic stroke or transient ischaemic attack: multicentre observational cohort study D. Wilson,
More informationOutcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tpa for Acute Ischemic Stroke
Original Research Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tpa for Acute Ischemic Stroke Bryan Darger, BA* Nicole Gonzales, MD Rosa C. Banuelos, PhD* Hui Peng, PhD
More informationDiagnostic and Therapeutic Consequences of Repeat Brain Imaging and Follow-up Vascular Imaging in Stroke Patients
AJNR Am J Neuroradiol 0:7, January 999 Diagnostic and Therapeutic Consequences of Repeat Brain Imaging and Follow-up Vascular Imaging in Stroke Patients Birgit Ertl-Wagner, Tobias Brandt, Christina Seifart,
More informationThrombolytic therapy for acute stroke in the United Kingdom: experience from the safe implementation of thrombolysis in stroke (SITS) register
Q J Med 2008; 1:863 869 doi:.93/qjmed/hcn2 Advance Access published on 11 August 2008 Thrombolytic therapy for acute stroke in the United Kingdom: experience from the safe implementation of thrombolysis
More informationPARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET
PARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET Hye Seon Jeong, *Jei Kim Department of Neurology and
More informationUpdated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข
Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข Emergency start at community level: Prehospital care Acute stroke
More informationDoor to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD. Virginia Mason Medical Center March 16, 2018
Door to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD Virginia Mason Medical Center March 16, 2018 2016 Virginia Mason Medical Center No disclosure 2016 Virginia Mason Medical Center
More informationPrognostic Value of the Hyperdense Middle Cerebral Artery Sign and Stroke Scale Score before Ultraearly Thrombolytic Therapy
Prognostic Value of the Hyperdense Middle Cerebral Artery Sign and Stroke Scale Score before Ultraearly Thrombolytic Therapy Thomas Tomsick, Thomas Brott, William Barsan, Joseph Broderick, E. Clarke Haley,
More informationThe determinant of poor prognostic factors in patients with primary intracerebral hemorrhage
ORIGINAL ARTICLE e-issn: 2349-0659 p-issn: 2350-0964 doi: 10.21276/apjhs.2017.4.4.37 The determinant of poor prognostic factors in patients with primary intracerebral hemorrhage Rizaldy Taslim Pinzon,
More informationSetting The setting was secondary care. The study was carried out in the UK, with emphasis on Scottish data.
Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan
More informationBACKGROUND AND SCIENTIFIC RATIONALE. Protocol Code: ISRCTN V 1.0 date 30 Jan 2012
BACKGROUND AND SCIENTIFIC RATIONALE Protocol Code: ISRCTN15088122 V 1.0 date 30 Jan 2012 Traumatic Brain Injury 10 million killed or hospitalised every year 90% in low and middle income countries Mostly
More informationAcute Stroke Treatment: Current Trends 2010
Acute Stroke Treatment: Current Trends 2010 Helmi L. Lutsep, MD Oregon Stroke Center Oregon Health & Science University Overview Ischemic Stroke Neuroprotectant trials to watch for IV tpa longer treatment
More informationCase Report Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis
Case Reports in Vascular Medicine Volume 2013, Article ID 371642, 4 pages http://dx.doi.org/10.1155/2013/371642 Case Report Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation
More informationRe-evaluation of the stroke prognostication using age and NIH Stroke Scale index (SPAN-100 index) in IVT patients the-span index
Möbius et al. BMC Neurology (2018) 18:129 https://doi.org/10.1186/s12883-018-1126-0 RESEARCH ARTICLE Re-evaluation of the stroke prognostication using age and NIH Stroke Scale index (SPAN-100 index) in
More informationIschemic stroke is one of the most common causes of death
Stroke Lesion Volumes and Outcome Are Not Different in Hemispheric Stroke Side Treated With Intravenous Thrombolysis Based on Magnetic Resonance Imaging Criteria Amir Golsari, MD; Bastian Cheng, MD; Jan
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationMedico-Legal Aspects of Using Tissue Plasminogen Activator in Acute Ischemic Stroke
Current Treatment Options in Cardiovascular Medicine (2011) 13:233 239 DOI 10.1007/s11936-011-0122-0 Cerebrovascular Disease and Stroke Medico-Legal Aspects of Using Tissue Plasminogen Activator in Acute
More informationSymptomatic Intracranial Hemorrhage After Stroke Thrombolysis Comparison of Prediction Scores
Symptomatic Intracranial Hemorrhage After Stroke Thrombolysis Comparison of Prediction Scores Daniel Strbian, MD, PhD, MSc (Stroke Med); Patrik Michel, MD; David J. Seiffge, MD; Jeffrey L. Saver, MD, FAHA;
More informationIodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis
Iodinated Contrast Media and Cerebral Hemorrhage After Intravenous Thrombolysis Niall J.J. MacDougall, MRCP; Ferghal McVerry, MRCP; Sally Baird; Tracey Baird, MRCP; Evelyn Teasdale, FRCR; Keith W. Muir,
More informationEarly mobilization after stroke What do we know (so far)?
NICIS Neurosciences in Critical Care International Symposium 19 th June, 2015 Early mobilization after stroke What do we know (so far)? Peter Langhorne, Professor of stroke care, Glasgow University Acknowledgements
More informationNoncontrast computed tomography (CT) reliably distinguishes
Extent of Early Ischemic Changes on Computed Tomography (CT) Before Thrombolysis Prognostic Value of the Alberta Stroke Program Early CT Score in ECASS II Imanuel Dzialowski, MD; Michael D. Hill, MD, MSc,
More informationList of Exhibits Adult Stroke
List of Exhibits Adult Stroke List of Exhibits Adult Stroke i. Ontario Stroke Audit Hospital and Patient Characteristics Exhibit i. Hospital characteristics from the Ontario Stroke Audit, 200/ Exhibit
More informationTENNESSEE STROKE REGISTRY QUARTERLY REPORT
TENNESSEE STROKE REGISTRY QUARTERLY REPORT Volume 1, Issue 2 July 2018 This report is published quarterly using data from the Tennessee Stroke Registry. Inside this report Data on diagnosis, gender distributions,
More informationACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke
ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center
More informationWAKE-UP has received funding from the European Union Seventh Framework Programme (FP7/ ) under grant agreement n
Intravenous Thrombombolysis in Stroke Patients with Unknown Time of Onset Results of the Multicentre, Randomized, Double-blind, Placebo- Controlled WAKE-UP Trial G. Thomalla, C.Z. Simonsen, F. Boutitie,
More informationComparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage
Journal of Stroke 2017;19(3):333-339 Original Article Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage Peter B. Sporns, a Michael
More informationGiuseppe Micieli Dipartimento di Neurologia d Urgenza IRCCS Fondazione Istituto Neurologico Nazionale C Mondino, Pavia
Giuseppe Micieli Dipartimento di Neurologia d Urgenza IRCCS Fondazione Istituto Neurologico Nazionale C Mondino, Pavia Charidimou et al, 2012 Pathogenesis of spontaneous and anticoagulationassociated
More informationOutcomes of intravenous thrombolysis in posterior versus anterior circulation stroke
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse CH-0 Zurich www.zora.uzh.ch Year: 0 Outcomes of intravenous thrombolysis in posterior versus anterior circulation stroke
More informationThe influence of early thrombolysis on C-reactive protein values and functional outcome after acute ischemic stroke.
Biomedical Research 2016; 27 (4): 1183-1187 ISSN 0970-938X www.biomedres.info The influence of early thrombolysis on C-reactive protein values and functional outcome after acute ischemic stroke. Ljubica
More informationDiabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke The China National Stroke Registry
Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke The China National Stroke Registry Qian Jia, MD*; Xingquan Zhao, MD*; Chunxue Wang, MD; Yilong Wang, MD; Yu Yan, MD, PhD; Hao Li,
More informationWhat can we learn from the AVERT trial (so far)?
South West Stroke Network Event, 29 th April, 2015 What can we learn from the AVERT trial (so far)? Peter Langhorne, Professor of stroke care, Glasgow University Disclosure PL was AVERT investigator and
More informationThe Outcome of Patients with Mild Stroke Improves after Treatment with Systemic Thrombolysis
The Outcome of Patients with Mild Stroke Improves after Treatment with Systemic Thrombolysis Xabier Urra 1,2, Helena Ariño 1, Laura Llull 1, Sergio Amaro 1,2,Víctor Obach 1,Álvaro Cervera 1,2, Ángel Chamorro
More informationTENNESSEE STROKE REGISTRY QUARTERLY REPORT
TENNESSEE STROKE REGISTRY QUARTERLY REPORT Volume 1, Issue 3 September 2018 This report is published quarterly using data from the Tennessee Stroke Registry. Inside this report Data on diagnosis, gender
More informationRole of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke
Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke Michal Karlinski, MD, PhD; Adam Kobayashi, MD, PhD; Anna Czlonkowska, MD, PhD; Robert Mikulik, MD, PhD;
More informationParameter Optimized Treatment for Acute Ischemic Stroke
Heart & Stroke Barnett Memorial Lectureship and Visiting Professorship Parameter Optimized Treatment for Acute Ischemic Stroke December 2, 2016, Thunder Bay, Ontario Adnan I. Qureshi MD Professor of Neurology,
More informationClinical specialist statement. Thank you for agreeing to give us a statement on your view of the technology and the way it should be used in the NHS.
Clinical specialist statement Thank you for agreeing to give us a statement on your view of the technology and the way it should be used in the NHS. Healthcare professionals can provide a unique perspective
More informationEarly neurological stability predicts adverse outcome after acute ischemic stroke
Research Early neurological stability predicts adverse outcome after acute ischemic stroke International Journal of Stroke 2016, Vol. 11(8) 882 889! 2016 World Stroke Organization Reprints and permissions:
More informationDetection of neurological symptoms of stroke on awakening
Treating Patients With Wake-Up Stroke The Experience of the AbESTT-II Trial Harold P. Adams, Jr, MD; Enrique C. Leira, MD; James C. Torner, PhD; Elliot Barnathan, MD; Lakshmi Padgett, PhD; Mark B. Effron,
More informationOutlook for intracerebral haemorrhage after a MISTIE spell
Outlook for intracerebral haemorrhage after a MISTIE spell David J Werring PhD FRCP Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital
More informationPatient characteristics. Intervention Comparison Length of followup. Outcome measures. Number of patients. Evidence level.
5.0 Rapid recognition of symptoms and diagnosis 5.1. Pre-hospital health professional checklists for the prompt recognition of symptoms of TIA and stroke Evidence Tables ASM1: What is the accuracy of a
More informationCarotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article
More informationIncidence and Impact of Antithrombotic-related Intracerebral Hemorrhage
Incidence and Impact of Antithrombotic-related Intracerebral Hemorrhage John J. Lewin III, PharmD, MBA, BCCCP, FASHP, FCCM, FNCS Division Director, Critical Care & Surgery Pharmacy Services, The Johns
More informationResearch Article Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke
Stroke Research and Treatment Volume 2016, Article ID 76161, 8 pages http://dx.doi.org/10.1155/2016/76161 Research Article Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome
More informationFrom interventional cardiology to cardio-neurology. A new subspeciality
From interventional cardiology to cardio-neurology. A new subspeciality in the future? Prof. Andrejs Erglis, MD, PhD Pauls Stradins Clinical University Hospital University of Latvia Riga, LATVIA Disclosure
More informationStroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University
More informationEndovascular Treatment for Acute Ischemic Stroke
ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1
More informationJournal of Stroke and Cerebrovascular Diseases, Vol. 23, No. 1 (January), 2014: pp e39-e45. e39
Internal Cerebral Vein Asymmetry on Follow-up Brain Computed Tomography after Intravenous Thrombolysis in Acute Anterior Circulation Ischemic Stroke Is Associated with Poor Outcome Vijay K. Sharma, MRCP,*
More informationAnalysis of DWI ASPECTS and Recanalization Outcomes of Patients with Acute-phase Cerebral Infarction
J Med Dent Sci 2012; 59: 57-63 Original Article Analysis of DWI ASPECTS and Recanalization Outcomes of Patients with Acute-phase Cerebral Infarction Keigo Shigeta 1,2), Kikuo Ohno 1), Yoshio Takasato 2),
More informationSupplementary webappendix
Supplementary webappendix This webappendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Hart RG, Diener H-C, Coutts SB, et al,
More informationBlood Pressure Reduction Among Acute Stroke Patients A Randomized Controlled Clinical Trial
Blood Pressure Reduction Among Acute Stroke Patients A Randomized Controlled Clinical Trial Jiang He, Yonghong Zhang, Tan Xu, Weijun Tong, Shaoyan Zhang, Chung-Shiuan Chen, Qi Zhao, Jing Chen for CATIS
More informationFrequency of Cardiac Risk Factors in. Ischemic
Frequency of Cardiac Risk Factors in Ischemic Stroke CORRESPONDING AUTHOR: MUSHTAQUE AHMED, MD EMAIL: BUGHIOAHMED@GMAIL.COM NEW YORK PRESBYTERIAN WEILL CORNELLL MEDICAL COLLEGE, NY ABSTRACT Stroke is the
More informationHow Low Should You Go? Management of Blood Pressure in Intracranial Hemorrhage
How Low Should You Go? Management of Blood Pressure in Intracranial Hemorrhage Rachael Scott, Pharm.D. PGY2 Critical Care Pharmacy Resident Pharmacy Grand Rounds August 21, 2018 2018 MFMER slide-1 Patient
More informationBY MARILYN M. RYMER, MD
Lytics, Devices, and Advanced Imaging The evolving art and science of acute stroke intervention. BY MARILYN M. RYMER, MD In 1996, when the US Food and Drug Administration (FDA) approved the use of intravenous
More information