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  • 1
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    Online Resource
    Early Apixaban Use Following Stroke in Patients With Atrial Fibrillation : Results of the AREST Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 4 ( 2021-04), p. 1164-1171
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 4 ( 2021-04), p. 1164-1171
    Abstract: It is unknown when to start anticoagulation after acute ischemic stroke (AIS) from atrial fibrillation (AF). Early anticoagulation may prevent recurrent infarctions but may provoke hemorrhagic transformation as AF strokes are typically larger and hemorrhagic transformation-prone. Later anticoagulation may prevent hemorrhagic transformation but increases risk of secondary stroke in this time frame. Our aim was to compare early anticoagulation with apixaban in AF patients with stroke or transient ischemic attack (TIA) versus warfarin administration at later intervals. Methods: AREST (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was an open-label, randomized controlled trial comparing the safety of early use of apixaban at day 0 to 3 for TIA, day 3 to 5 for small-sized AIS ( 〈 1.5 cm), and day 7 to 9 for medium-sized AIS (≥1.5 cm, excluding full cortical territory), to warfarin, in a 1:1 ratio at 1 week post-TIA, or 2 weeks post-AIS. Results: Although AREST ended prematurely after a national guideline focused update recommended direct oral anticoagulants over warfarin for AF, it revealed that apixaban had statistically similar yet generally numerically lower rates of recurrent strokes/TIA (14.6% versus 19.2%, P =0.78), death (4.9% versus 8.5%, P =0.68), fatal strokes (2.4% versus 8.5%, P =0.37), symptomatic hemorrhages (0% versus 2.1%), and the primary composite outcome of fatal stroke, recurrent ischemic stroke, or TIA (17.1% versus 25.5%, P =0.44). One symptomatic intracerebral hemorrhage occurred on warfarin, none on apixaban. Five asymptomatic hemorrhagic transformation occurred in each arm. Conclusions: Early initiation of anticoagulation after TIA, small-, or medium-sized AIS from AF does not appear to compromise patient safety. Potential efficacy of early initiation of anticoagulation remains to be determined from larger pivotal trials. Registration: URL: https://www.clinicaltrials.gov/ ; Unique identifier: NCT02283294.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030042
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Validity and Reliability of the Thrombolysis in Brain Infarction (TIBI) Flow Grades
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 324-325
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 324-325
    Abstract: 48 Background: In patients eligible for thrombolytic therapy, the TIBI grading system defines residual transcranial Doppler (TCD) flow signals at the site of clot location. In addition, TIBI flow grades correlate with angiography and predict short-term improvement following TPA therapy. The aim of this study was to develop a valid and reliable instrument to assess how accurately health professionals determine TIBI flow grades. Methods: Two expert sonographers developed a 60 question computerized examination of the 6 TIBI flow grades. Gold standard interpretation was determined by a consensus interpretation by a pool of expert sonographers. All items were equally weighted and written in a standard format. A computerized TIBI grading tutorial and standard interpretation rules were available for all test-takers. To assess content validity and reliability, a blinded panel of 3 experts independently took the examination. Inter-rater agreement was determined among experienced sonographers, stroke neurologists, and other health professionals (N=11). Results: Expert assessment of each test item measured objective congruence at 1.0, overall test validity coefficient of 0.996 (95%CI 0.993–0.997), and an item/TIBI flow grade validity coefficient of 0.992 (95%CI 0.996–0.997). Overall test and individual item reliability had coefficients of 0.98(95%CI 0.97–0.99) and 0.97 (95%CI 0.95–0.98, p 〈 0.0001) respectively. Inter-rater agreement was 0.89 (coefficient of contingency) and 0.86 (kappa) for all participants. Kappa range included 0.98 for an experienced interpreter, 0.81–0.89 for stroke neurologists with beginner experience in TCD and 0.65 for those without previous TCD experience (66% of correct answers after 1 hour tutorial). Conclusions: Our computerized examination is a valid and reliable tool to assess an individuals ability to score TIBI flow grades. In addition, TIBI flow grade evaluation has a high degree of inter-rater reliability, even among those with limited experience in ultrasound.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.324-e
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China : A Real-World Nationwide Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 4 ( 2021-04), p. 1203-1212
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 4 ( 2021-04), p. 1203-1212
    Abstract: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population. Methods: We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome. Results: Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56–73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55–72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; P =0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age 〈 66 years (odds ratio [OR], 1.733 [95% CI, 1.213–2.476] ), time from onset to puncture 〉 6 hours (OR, 1.536 [95% CI, 1.065–2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325–3.633] ), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085–3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098–2.413] ), and National Institutes of Health Stroke Scale score 24 hours after the procedure 〈 11 (OR, 9.126 [95% CI, 6.222–13.385]). Conclusions: Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03370939.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.031869
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Online Resource
    Timing of Recanalization After Tissue Plasminogen Activator Therapy Determined by Transcranial Doppler Correlates With Clinical Recovery From Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2000
    In:  Stroke Vol. 31, No. 8 ( 2000-08), p. 1812-1816
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 8 ( 2000-08), p. 1812-1816
    Abstract: Background —The duration of cerebral blood flow impairment correlates with irreversibility of brain damage in animal models of cerebral ischemia. Our aim was to correlate clinical recovery from stroke with the timing of arterial recanalization after therapy with intravenous tissue plasminogen activator (tPA). Methods —Patients with symptoms of cerebral ischemia were treated with 0.9 mg/kg tPA IV within 3 hours after stroke onset (standard protocol) or with 0.6 mg/kg at 3 to 6 hours (an experimental institutional review board–approved protocol). National Institutes of Health Stroke Scale (NIHSS) scores were obtained before treatment, at the end of tPA infusion, and at 24 hours; Rankin Scores were obtained at long-term follow-up. Transcranial Doppler (TCD) was used to locate arterial occlusion before tPA and to monitor recanalization (Marc head frame, Spencer Technologies; Multigon 500M, DWL MultiDop-T). Recanalization on TCD was determined according to previously developed criteria. Results —Forty patients were studied (age 70±16 years, baseline NIHSS score 18.6±6.2). A tPA bolus was administered at 132±54 minutes from symptom onset. Recanalization on TCD was found at the mean time of 251±171 minutes after stroke onset: complete recanalization occurred in 12 (30%) patients and partial recanalization occurred in 16 (40%) patients (maximum observation time 360 minutes). Recanalization occurred within 60 minutes of tPA bolus in 75% of patients who recanalized. The timing of recanalization inversely correlated with early improvement in the NIHSS scores within the next hour (polynomial curve, third order r 2 =0.429, P 〈 0.01) as well as at 24 hours. Complete recanalization was common in patients who had follow-up Rankin Scores if 0 to 1 ( P =0.006). No patients had early complete recovery if an occlusion persisted for 〉 300 minutes. Conclusions —The timing of arterial recanalization after tPA therapy as determined with TCD correlates with clinical recovery from stroke and demonstrates a 300-minute window to achieve early complete recovery. These data parallel findings in animal models of cerebral ischemia and confirm the relevance of these models in the prediction of response to reperfusion therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.31.8.1812
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2000
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Deterioration Following Spontaneous Improvement : Sonographic Findings in Patients With Acutely Resolving Symptoms of Cerebral Ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2000
    In:  Stroke Vol. 31, No. 4 ( 2000-04), p. 915-919
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 4 ( 2000-04), p. 915-919
    Abstract: Background and Purpose —Some stroke patients will deteriorate following improvement (DFI), but the cause of such fluctuation is often unclear. While resolution of neurological deficits is usually related to spontaneous recanalization or restoration of collateral flow, vascular imaging in patients with DFI has not been well characterized. Methods —We prospectively studied patients who presented with a focal neurological deficit that resolved spontaneously within 6 hours of symptom onset. Patients were evaluated with bedside transcranial Doppler (TCD). Digital subtraction angiography (DSA), computed tomographic angiography (CTA), or magnetic resonance angiography (MRA) were performed when feasible. DFI was defined as subsequent worsening of the neurological deficit by ≥4 National Institutes of Health Stroke Scale points within 24 hours of the initial symptom onset. Results —We studied 50 consecutive patients presenting at 165±96 minutes from symptom onset. Mean age was 61±14 years; 50% were females. All patients had TCD at the time of presentation, and 68% had subsequent angiographic examinations (DSA 10%, CTA 4%, and MRA 44%). Overall, large-vessel occlusion on TCD was found in 16% of patients (n=8); stenosis was found in 18% (n=9); 54% (n=27) had normal studies; and 6 patients (12%) had no temporal windows. DFI occurred in 16% (n=8) of the 50 patients: in 62% of patients with TCD and angiographic evidence of occlusion, in 22% with stenosis, and in 4% with normal vascular studies ( P 〈 0.001, Φ=0.523, χ 2 =12.05). DFI occurred in 31% of patients with large-vessel atherosclerosis, 23% with cardioembolism, and 9% with small-vessel disease when stroke mechanisms were determined within 2 to 3 days after admission ( P =0.2, NS). Conclusions —DFI is strongly associated with the presence of large-vessel occlusion or stenosis of either atherosclerotic or embolic origin. Normal vascular studies and lacunar events were associated with stable spontaneous resolution without subsequent fluctuation. Urgent vascular evaluation may help identify patients with resolving deficits and vascular lesions who may be candidates for new therapies to prevent subsequent deterioration.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.31.4.915
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2000
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Online Resource
    High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring
    Ovid Technologies (Wolters Kluwer Health) ; 2000
    In:  Stroke Vol. 31, No. 3 ( 2000-03), p. 610-614
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 3 ( 2000-03), p. 610-614
    Abstract: Background and Purpose —Clot dissolution with tissue plasminogen activator (tPA) can lead to early clinical recovery after stroke. Transcranial Doppler (TCD) with low MHz frequency can determine arterial occlusion and monitor recanalization and may potentiate thrombolysis. Methods —Stroke patients receiving intravenous tPA were monitored during infusion with portable TCD (Multigon 500M; DWL MultiDop-T) and headframe (Marc series; Spencer Technologies). Residual flow signals were obtained from the clot location identified by TCD. National Institutes of Health Stroke Scale (NIHSS) scores were obtained before and after tPA infusion. Results —Forty patients were studied (mean age 70±16 years, baseline NIHSS score 18.6±6.2, tPA bolus at 132±54 minutes from symptom onset). TCD monitoring started at 125±52 minutes and continued for the duration of tPA infusion. The middle cerebral artery was occluded in 30 patients, the internal carotid artery was occluded in 11 patients, the basilar artery was occluded in 3 patients, and occlusions were multiple in 7 patients; 4 patients had no windows; and 1 patient had a normal TCD. Recanalization on TCD was found at 45±20 minutes after tPA bolus: recanalization was complete in 12 (30%) and partial in 16 (40%) patients. Dramatic recovery during tPA infusion (total NIHSS score 〈 3) occurred in 8 (20%) of all patients (baseline NIHSS range 6 to 22; all 8 had complete recanalization). Lack of improvement or worsening was associated with no recanalization, late recanalization, or reocclusion on TCD (C=0.811, P ≤0.01). Improvement by ≥10 NIHSS points or complete recovery was found in 30% of all patients at the end of tPA infusion and in 40% at 24 hours. Improvement by ≥4 NIHSS points was found in 62.5% of patients at 24 hours. Conclusions —Dramatic recovery during tPA therapy occurred in 20% of all patients when infusion was continuously monitored with TCD. Recovery was associated with recanalization on TCD, whereas no early improvement indicated persistent occlusion or reocclusion. At 24 hours, 40% of all patients improved by ≥10 NIHSS points or recovered completely. Ultrasonic energy transmission by TCD monitoring may expose more clot surface to tPA and facilitate thrombolysis and deserves a controlled trial as a way to potentiate the effect of tPA therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.31.3.610
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2000
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Online Resource
    NIH Stroke Scale as a Predictor of Clot Presence, Location, and Persisting Occlusion in Candidates for Thrombolysis
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 324-324
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 324-324
    Abstract: 46 Background: In acute stroke, few tools are readily available to determine clot presence and location before thrombolysis, nor whether occlusion persists after intravenous TPA. Because the NIH Stroke Scale (NIHSS) is easily obtained in the Emergency Department, we correlated sequential NIHSS scores and arterial occlusion in prospective candidates for IV TPA. Methods: Potential thrombolysis patients evaluated with transcranial Doppler (TCD) ultrasound and the NIHSS at the time of presentation were studied. TCD was performed using previously validated criteria for clot detection, localization, and subsequent degree of recanalization after thrombolysis. In patients treated at 〈 180 minutes with conventional dose TPA (0.9 mg/kg), repeat NIHSS scores and diagnostic TCD were performed at the end of infusion. Results: 119 ischemic stroke patients met inclusion criteria (age 68±15, NIHSS 15±7, median 14, range 2–36), with 83% having occlusion consistent with symptoms. Occlusion was present in all patients with NIHSS ≥22, none with NIHSS 〈 4, and there was a direct relationship between baseline NIHSS and clot presence (p 〈 0.0001). Each additional NIHSS point increased the odds of occlusion by 1.33(95%CI 1.17–1.51). In patients with anterior circulation symptoms (N=80), increasing NIHSS corresponded with increasing M1 MCA and/or ICA occlusion, and decreasing vascular patency or M2 occlusion (p 〈 0.001). In thrombolysed patients with initial vascular occlusion (N=55), end-of-infusion NIHSS was less predictive of persisting occlusion, with 70% of patients with scores ≥6 having persisting occlusion and 20% of patients with scores ≥16 having complete recanalization. The odds of persisting occlusion per end-of-infusion NIHSS point were 1.14 (95%CI 1.06–1.24,p 〈 0.0008). Conclusions: Baseline NIHSS accurately predicts clot presence with increasing scores corresponding to increasing clot burden. However, NIHSS becomes less predictive of clot persistence at the end of TPA infusion and may less accurately identify patients for further revascularization efforts.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.324-c
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Paradoxical Emboli from Calf and Pelvic Veins in Cryptogenic Stroke
    Wiley ; 2003
    In:  Journal of Neuroimaging Vol. 13, No. 3 ( 2003-07), p. 218-223
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 13, No. 3 ( 2003-07), p. 218-223
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.2003.13.issue-3
    DOI: 10.1111/j.1552-6569.2003.tb00181.x
    Language: English
    Publisher: Wiley
    Publication Date: 2003
    detail.hit.zdb_id: 2035400-9
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  • 9
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    Online Resource
    A Broad Diagnostic Battery for Bedside Transcranial Doppler to Detect Flow Changes With Internal Carotid Artery Stenosis or Occlusion
    Wiley ; 2001
    In:  Journal of Neuroimaging Vol. 11, No. 3 ( 2001-07), p. 236-242
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 11, No. 3 ( 2001-07), p. 236-242
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.2001.11.issue-3
    DOI: 10.1111/j.1552-6569.2001.tb00040.x
    Language: English
    Publisher: Wiley
    Publication Date: 2001
    detail.hit.zdb_id: 2035400-9
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  • 10
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    Online Resource
    Hemorrhagic stroke following use of the synthetic marijuana “spice”
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Neurology Vol. 85, No. 13 ( 2015-09-29), p. 1177-1179
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 85, No. 13 ( 2015-09-29), p. 1177-1179
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000001973
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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