A5013528021- Acute Ischemic Stroke Management
- Cerebrovascular and Carotid Artery Diseases
- Stroke Rehabilitation and Recovery
- Health Systems, Economic Evaluations, Quality of Life
- Intracerebral and Subarachnoid Hemorrhage Research
- Meta-analysis and systematic reviews
- Traumatic Brain Injury and Neurovascular Disturbances
- Health and Medical Research Impacts
- Venous Thromboembolism Diagnosis and Management
- Antiplatelet Therapy and Cardiovascular Diseases
- Innovations in Medical Education
- Cardiac Valve Diseases and Treatments
- Cardiac, Anesthesia and Surgical Outcomes
- Statistical Methods in Clinical Trials
- Diversity and Career in Medicine
- Neurological Disorders and Treatments
- Clinical practice guidelines implementation
- Intracranial Aneurysms: Treatment and Complications
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Cardiac pacing and defibrillation studies
- Advanced Causal Inference Techniques
- Cardiovascular Health and Risk Factors
- S100 Proteins and Annexins
- Blood Pressure and Hypertension Studies
- Cardiovascular Function and Risk Factors
University of Virginia
2012-2024
Urology of Virginia
2024
Medical University of South Carolina
2005-2024
Brown University
2006-2024
Northwestern University
1999-2024
Arcadia
2024
New York Medical College
2024
University of Kentucky
2024
Lancaster General Hospital
2024
University of Pennsylvania Health System
2024
Purpose— The aim of this guideline is to provide a focused update the current recommendations for endovascular treatment acute ischemic stroke. When there overlap, made here supersede those previous guidelines. Methods— This analyzes results from 8 randomized, clinical trials and other relevant data published since 2013. It not intended be complete literature review date publication but rather include pivotal new evidence that justifies changes in recommendations. Members writing committee...
Background and Purpose —Medical neurological complications after acute ischemic stroke may adversely impact outcome in some cases be preventable. Limited data exist regarding the frequency of such occurring first days ictus relationship these to outcome. Our objective was identify types, severity, medical following determine their role mortality functional Methods —Rates serious (life-threatening) nonserious were derived from placebo limb Randomized Trial Tirilazad Mesylate Acute Stroke...
Hyperglycemia during acute ischemic stroke is common and associated with worse outcomes. The efficacy of intensive treatment hyperglycemia in this setting remains unknown.To determine the stroke.The Stroke Insulin Network Effort (SHINE) randomized clinical trial included adult patients (glucose concentration >110 mg/dL if had diabetes or ≥150 did not have diabetes) who were enrolled within 12 hours from onset at 63 US sites between April 2012 August 2018; follow-up ended November 2018. 1151...
Background and Purpose— Intravenous alteplase (rtPA) remains the only approved treatment for acute ischemic stroke, but its use limited. In a previous pilot dose-escalation study, intravenous tenecteplase showed promise as potentially safer alternative. Therefore, Phase IIB clinical trial was begun to (1) choose best dose of carry forward; (2) provide evidence either or futility further testing versus rtPA. If established, then would continue III efficacy comparing selected standard Methods—...
Background and Purpose —Reduction in infarct volume is the standard measure of therapeutic success animal stroke models. Reduction has been advocated as a biological surrogate or auxiliary outcome for human clinical trials to replace supplement deficit, disability, global scales. However, few studies have investigated correlations between end points acute ischemic patients. Methods —CT scans at days 6 11 were acquired prospectively 191 fully eligible patients enrolled Randomized Trial...
Background and Purpose— Recombinant tissue-type plasminogen activator (rtPA) is the only approved treatment in acute ischemic stroke. However, intracerebral hemorrhage (ICH) occurs 6.4% of patients treated with rtPA limits its use. Tenecteplase (TNK) a modified form rtPA, longer half-life greater fibrin specificity. Patients after myocardial infarction had fewer systemic hemorrhages when TNK compared rtPA. This open-label, dose-escalation safety study was conducted to develop initial...
Prior studies have shown that patients with mild ischemic stroke substantial disability rates at hospital discharge. We sought to determine 90 days among not treated thrombolytic therapy and explore the role of early neurological worsening.We reviewed a prospective cohort 136 consecutive deficits (National Institutes Health Stroke Scale score ≤ 5) presenting within 24 hours onset no baseline disability. Baseline MRIs were performed on all subjects. Five-day prespecified subcohort.Among...
Hyperglycemia is associated with worse outcome in patients acute stroke.We conducted a prospective, randomized, multicenter, 3-arm trial (tight control [target 70 to 110 mg/dL], loose 200 and usual care [70 300 mg/dL]) assess the feasibility safety of 2 insulin infusion protocol targets ischemic stroke. The planned sample was 72 subjects.A total 74 subjects were enrolled. Seventy-two (97%) had data available for primary analyses 73 (99%) 3-month clinical data. Median age 67 years, median...
The Stroke Therapy Academic Industry Roundtable (STAIR) meetings focus on helping to advance the development of acute stroke therapies. Further extending time window for therapies is an important endeavor increasing number patients who might benefit from treatment. STAIR group recommends that future extended trials initially should selected patient groups most likely respond investigational and penumbral imaging one tool may identify such patients. control in these receive best locally...
Background and Purpose— The National Institute of Neurological Disorders Stroke initiated development stroke-specific Common Data Elements (CDEs) as part a project to develop data standards for funded clinical research in all fields neuroscience. Standardizing elements translational, clinical, population cerebrovascular disease could decrease study start-up time, facilitate sharing, promote well-informed practice guidelines. Methods— A working group diverse experts trials, epidemiology,...
Background and Purpose— On the basis of phase II trials, we considered that transcranial laser therapy could have neuroprotective effects in patients with acute ischemic stroke. Methods— We studied a double-blind, sham-controlled randomized clinical trial intended to enroll 1000 stroke treated ≤24 hours after onset who did not undergo thrombolytic therapy. The primary efficacy measure was 90-day functional outcome as assessed by modified Rankin Scale, hierarchical Bayesian analysis...
<h3>Background and Objectives</h3> In patients with ischemic stroke (IS), IV alteplase (tissue plasminogen activator [tPA]) endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research also demonstrated disparities in the use of tPA EVT specific to sex, race/ethnicity, socioeconomic status, geographic location. We sought determine United States from 2016–2018 if persist. <h3>Methods</h3> This is a retrospective, longitudinal...
Background and Purpose —The great variability of outcome seen in stroke patients has led to an interest identifying predictors outcome. The combination clinical imaging variables as a multivariable risk adjustment model may be more powerful than either alone. purpose this study was determine the relationship between infarct volume, 6 variables, 3-month outcomes ischemic patients. Methods —Included were 256 eligible from Randomized Trial Tirilazad Mesylate Acute Stroke (RANTTAS). Six 1-week...
In the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Study, major neurological improvement within 24 hours (MNI) occurred significantly more frequently with recombinant tissue plasminogen activator (rtPA) treatment than placebo. We explored relationship between MNI 3-month favorable outcome sought clinical predictors MNI.Data from 312 rtPA-treated patients NINDS trial were used to assess ability predict at 3 months as defined by a modified Rankin Scale score 0 1....
Prediction models for ischemic stroke outcome have the potential to contribute prognostic information in clinical and/or research setting. The importance of diffusion-weighted magnetic resonance imaging (DWI) prediction outcome, however, is unclear. purpose this study was combine acute data and DWI lesion volume patients determine whether improves outcome.Patients (N=382) with baseline from Glycine Antagonist In Neuroprotection citicoline (010 018) trials were used develop by multivariable...
Rationale Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during is feasible can be accomplished safely but has not been fully assessed for efficacy. Aims The Stroke Hyperglycemia Insulin Network Effort trial aims to determine the safety efficacy of standard vs. intensive insulin in hyperglycemic patients. Design This a randomized, blinded, multicenter, phase III approximately 1400 patients who receive...
Background and Purpose— Predictive models of outcome after ischemic stroke have incorporated acute diffusion-weighted MRI (DWI) information with mixed results. We hypothesized that serial measurements DWI infarct volume would be predictive functional stroke. Methods— The prospective Acute Stroke Accurate Prediction (ASAP) Study included a prespecified imaging subgroup who underwent studies at baseline (<24 hours symptom onset) Day 5 (±2 days). volumes were calculated using the Analyze...