المؤلفون: Durnford, Andrew J, Akarca, Danyal, Culliford, David, Millar, John, Guniganti, Ridhima, Giordan, Enrico, Brinjikji, Waleed, Chen, Ching-Jen, Abecassis, Isaac Josh, Levitt, Michael, Polifka, Adam J, Derdeyn, Colin P, Samaniego, Edgar A, Kwasnicki, Amanda, Alaraj, Ali, Potgieser, Adriaan RE, Chen, Stephanie, Tada, Yoshiteru, Phelps, Ryan, Abla, Adib, Satomi, Junichiro, Starke, Robert M, van Dijk, J Marc C, Amin-Hanjani, Sepideh, Hayakawa, Minako, Gross, Bradley, Fox, W Christopher, Kim, Louis, Sheehan, Jason, Lanzino, Giuseppe, Kansagra, Akash P, Du, Rose, Lai, Rosalind, Zipfel, Gregory J, Bulters, Diederik O, Piccirillo, Jay F, Raman, Hari, Lipsey, , Kim, Vine, Roanna, Cloft, Harry J, Kallmes, David F, Pollock, Bruce E, Link, Michael J, Patibandla, Mohana Rao, Ding, Dale, Buell, Thomas, Paisan, Gabriella, Meyer, R Michael, Kelly, , Cory, Duffill, Jonathan, Ditchfield, Adam, Macdonald, Jason, Laurent, Dimitri, Hoh, Brian, Smith, Jessica, Lockerman, Ashley, Lunsford, L Dade, Jankowitz, Brian T, Gutierrez, Santiago Ortega, Hasan, David, Roa, Jorge A, Rossen, James, Guerrero, Waldo, McGruder, Allen, Charbel, Fady T, Aletich, Victor A, Rose-Finnell, Linda, Peterson, Eric C, Yavagal, Dileep R, Sur, Samir, Kanematsu, Yasuhisa, Yamamoto, Nobuaki, Kinouchi, Tomoya, Korai, Masaaki, Yamaguchi, Izumi, Yamamoto, Yuki, Winkler, Ethan, Lawton, Michael, Rutkowski, Martin, Sultan, M Ali Aziz, Patel, Nirav, Frerichs, Kai U

المصدر: Stroke. 53(7)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Kidney Disease, Central Nervous System Vascular Malformations, Cerebral Angiography, Drainage, Embolization, Therapeutic, Humans, Outcome Assessment, Health Care, drainage, fistula, hemorrhage, incidence, natural history, CONDOR Investigators, Cardiorespiratory Medicine and Haematology, Neurosciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science

الوصف: BackgroundCranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.MethodsPatients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.ResultsOf 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2-14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3-5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7-12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4-37.7; P, 0.026).ConclusionsThe risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/17j4k3v9Test

المؤلفون: Kim, Helen, Nelson, Jeffrey, Krings, Timo, terBrugge, Karel G, McCulloch, Charles E, Lawton, Michael T, Young, William L, Faughnan, Marie E, Brain Vascular Malformation Consortium HHT Investigator Group

المصدر: Stroke. 46(5)

مصطلحات موضوعية: Brain Vascular Malformation Consortium HHT Investigator Group, Humans, Intracranial Arteriovenous Malformations, Intracranial Hemorrhages, Aneurysm, Ruptured, Telangiectasia, Hereditary Hemorrhagic, Recurrence, Survival Analysis, Retrospective Studies, Cohort Studies, Socioeconomic Factors, Adolescent, Adult, Aged, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Female, Male, Young Adult, arteriovenous malformations, cerebral hemorrhage, natural history, telangiectasia, hereditary hemorrhagic, Neurosciences, Prevention, Rare Diseases, Stroke, Brain Disorders, Pediatric, Congenital Structural Anomalies, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery

الوصف: Background and purposeHereditary hemorrhagic telangiectasia (HHT) is a systemic disease characterized by mucocutaneous telangiectasias, epistaxis, and arteriovenous malformations (AVMs). Intracranial hemorrhage (ICH) rates in this population are not well described. We report ICH rates and characteristics in HHT patients with brain AVMs (HHT-BAVMs).MethodsWe studied the first 153 HHT-BAVM patients with follow-up data enrolled in the Brain Vascular Malformation Consortium HHT Project. We estimated ICH rates after BAVM diagnosis.ResultsThe majority of patients were women (58%) and white (98%). The mean age at BAVM diagnosis was 31±19 years (range, 0-70), with 61% of cases diagnosed on asymptomatic screening. Overall, 14% presented with ICH; among symptomatic cases, 37% presented ruptured. During 493 patient-years of follow-up, 5 ICH events occurred yielding a rate of 1.02% per year (95% confidence interval, 0.42-2.44%). ICH-free survival differed significantly by ICH presentation (P=0.003); ruptured cases had a higher ICH rate (10.07%; 95% confidence interval, 3.25-31.21%) than unruptured cases (0.43%; 95% confidence interval, 0.11-1.73%).ConclusionsPatients with HHT-BAVM who present with hemorrhage are at a higher risk for rehemorrhage compared with patients with BAVM detected presymptomatically.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6w48f3xpTest

المؤلفون: Hongqi Zhang, Nan Jiang, Tao Hong, Ming Ye, Yue-Shan Feng, Chuan He, Liyong Sun, Feng Ling, Jian-Kun Xu, Li-Song Bian, Guilin Li, Peng Hu, Jia-Xing Yu

المصدر: Stroke. 52:3873-3882

مصطلحات موضوعية: Adult, Central Nervous System Vascular Malformations, Male, Advanced and Specialized Nursing, Microsurgery, medicine.medical_specialty, business.industry, Middle Aged, Embolization, Therapeutic, Gait, Surgery, Natural history, Spinal Cord, Arteriovenous Fistula, medicine, Humans, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Aged, Retrospective Studies

الوصف: Background and Purpose: Paravertebral arteriovenous shunts (PVAVSs) are rare. Whether the intradural venous system is involved in drainage may lead to differences in clinical characteristics through specific pathophysiological mechanisms. This study aims to comprehensively evaluate the natural history and clinical outcomes of PVAVSs with or without intradural drainage. Methods: Sixty-four consecutive patients with PVAVSs from 2 institutes were retrospectively reviewed. Lesions were classified as type A (n=28) if the intradural veins were involved in drainage; otherwise, they were classified as type B (n=36). The clinical course from initial presentation to the last follow-up was analyzed. Results: The patients with type A shunts were older at presentation (52.5 versus 35.5 years, P P =0.00006). After presentation, the deterioration rates related to gait and sphincter dysfunction were significantly higher in patients with type A than type B shunts (gait dysfunction: 71.8%/y versus 17.0%/y, P =0.0006; sphincter dysfunction: 63.7%/y versus 11.3%/y, P =0.0002). According to the angiogram at the end of the latest treatment, 79% of type A and 75% of type B PVAVSs were completely obliterated. If the lesions were partially obliterated, a significantly higher clinical deterioration rate was observed in patients with type A shunts than those with type B shunts (69.9%/y versus 3.2%/y, P =0.0253). Conclusions: Type A PVAVSs feature rapid progressive neurological deficits; therefore, early clinical intervention is necessary. For complex lesions that cannot be completely obliterated, surgical disconnection of all refluxed radicular veins is suggested.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e7bec43a6b5d80370ae6a12666b75a4dTest
https://doi.org/10.1161/strokeaha.120.033963Test

المؤلفون: Linda Rose-Finnell, Fady T. Charbel, Yi-Fan Chen, Gregory J. Zipfel, Sepideh Amin-Hanjani, Xinjian Du, Colin P. Derdeyn, Alfred P See, Scott E. Kasner, Mitchell S.V. Elkind, Dilip K. Pandey, Frank L. Silver, David S Liebeskind, Philip B. Gorelick

المصدر: Stroke

مصطلحات موضوعية: Male, medicine.medical_specialty, Hemodynamics, Magnetic resonance angiography, Article, Cohort Studies, Internal medicine, medicine, Vertebrobasilar Insufficiency, Humans, Prospective Studies, Vertebrobasilar insufficiency, Stroke, Aged, Ischemic Stroke, Proportional Hazards Models, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Intracranial Arteriosclerosis, Natural history, Blood pressure, Cerebrovascular Circulation, Cohort, Cardiology, Observational study, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Magnetic Resonance Angiography

الوصف: Background and Purpose: The role of regional hypoperfusion as a contributor to stroke risk in atherosclerotic vertebrobasilar disease has recently been confirmed by the observational VERiTAS (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke) Study. We examined the stability of hemodynamic status over time and its relationship to stroke risk in patients from this prospective cohort. Methods: VERiTAS enrolled patients with recently symptomatic ≥50% atherosclerotic stenosis/occlusion of vertebral and/or basilar arteries. Large vessel flow in the vertebrobasilar territory was assessed using quantitative magnetic resonance angiography, and patients were designated as low or normal flow based on distal territory regional flow, incorporating collateral capacity. Patients underwent standard medical management and follow-up for primary outcome event of vertebrobasilar territory stroke. Quantitative magnetic resonance angiography imaging was repeated at 6, 12, and 24 months. Flow status over time was examined relative to baseline and relative to subsequent stroke risk using a cause-specific proportional hazard model, with flow status treated as a time-varying covariate. Mean blood pressure was examined to assess for association with changes in flow status. Results: Over 19±8 months of follow-up, 132 follow-up quantitative magnetic resonance angiography studies were performed in 58 of the 72 enrolled patients. Of the 13 patients with serial imaging who had low flow at baseline, 7 (54%) had improvement to normal flow at the last follow-up. Of the 45 patients who had normal flow at baseline, 3 (7%) converted to low flow at the last follow-up. The mean blood pressure did not differ in patients with or without changes in flow status. The time-varying flow status remained a strong predictor of subsequent stroke (hazard ratio, 10.3 [95% CI, 2.2–48.7]). Conclusions: There is potential both for improvement and worsening of hemodynamics in patients with atherosclerotic vertebrobasilar disease. Flow status, both at baseline and over time, is a risk factor for subsequent stroke, thus serving as an important prognostic marker. Registration: URL: https://clinicaltrials.govTest . Unique identifier: NCT00590980.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::10dd99a6727219485f4963e555faf2abTest
https://pubmed.ncbi.nlm.nih.gov/33032489Test

المؤلفون: Yudai Hirano, Kenta Ohara, Satoru Miyawaki, Hirofumi Nakatomi, Yu Teranishi, Hiroki Hongo, Nobuhito Saito, Hideaki Imai, Shogo Dofuku

المصدر: Stroke. 51(10)

مصطلحات موضوعية: Adult, Male, Pediatrics, medicine.medical_specialty, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 0502 economics and business, medicine, Humans, Moyamoya disease, Stroke, Retrospective Studies, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, 05 social sciences, Brain, Magnetic resonance imaging, Cerebral Arteries, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Natural history, 050211 marketing, Female, Neurology (clinical), Moyamoya Disease, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Magnetic Resonance Angiography

الوصف: Background and Purpose: Few previous studies have comprehensively explored the relationship between the onset pattern of adult moyamoya disease and risk factors for stroke. We performed a retrospective analysis focusing on risk factors for stroke and related findings on magnetic resonance imaging/angiography with respect to the pattern of disease onset. We also examined whether risk factors for stroke were associated with an increased risk for symptomization in asymptomatic patients. Methods: A total of 178 adult patients with moyamoya disease (asymptomatic, n=84; ischemic, n=71; hemorrhagic, n=23) at the University of Tokyo Hospital from 2000 to 2018 were included in this study. Data pertaining to patient background and magnetic resonance imaging findings were analyzed retrospectively. In the asymptomatic group, the effects of stroke-associated risk factors on symptom onset were analyzed. Results: Comparisons among the 3 groups revealed no significant difference in the frequency of risk factors for stroke. The proportion of patients with magnetic resonance imaging/angiography findings indicating anterior choroidal artery anastomosis or microbleeds was significantly higher in the hemorrhagic group than in the asymptomatic or ischemic group. Among asymptomatic patients, the hazard ratios for symptomization with hypertension and dyslipidemia were 6.69 ([95% CI, 1.23–36.4] P =0.028) and 8.14 ([95% CI, 1.46–45.2] P =0.017), respectively. Conclusions: The development of anterior choroidal artery anastomosis and microbleeds on magnetic resonance imaging/angiography was significantly associated with hemorrhagic onset. Hypertension and dyslipidemia may increase the risk of cerebrovascular events in asymptomatic patients, and thus, early intervention to these factors may be important.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d63b869d159de1edd4b0feee6861abd8Test
https://pubmed.ncbi.nlm.nih.gov/32867597Test

المؤلفون: Hanna Lehto, Behnam Rezai Jahromi, Miikka Korja, Riku Kivisaari

المصدر: Stroke. 48:1081-1084

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Adolescent, Aneurysm, Ruptured, 030218 nuclear medicine & medical imaging, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine, Humans, Registries, Symptom onset, Child, Finland, Aged, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Mortality rate, Intracranial Aneurysm, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Hospitals, 3. Good health, Surgery, Natural history, Cohort, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Historical Cohort, Cohort study

الوصف: Background and Purpose— Knowledge on a natural history of untreated ruptured intracranial aneurysms is based on a small historical cohort from 1960s. We calculated mortality rates for patients with untreated ruptured intracranial aneurysms using a more recent and relatively large hospital cohort. Methods— Patients admitted to the study hospital between 1968 and 2007 with saccular but untreated ruptured intracranial aneurysms were identified from the hospital aneurysm registry of 6850 patients. The study cohort included only patients who were followed up until death and for whom the date of symptom onset and the date of hospital admission were available. Results— For 510 patients identified, the median survival time from symptom onset to death was 20 days. The 1-year mortality rate was 65%, but varied substantially by admission delays and clinical status on admission, being lowest (13%) for patients admitted later than a month after symptom onset and highest (89%) for poor-grade patients. The 1-year mortality rate was 75% for good-grade patients admitted within a week. Conclusions— Mortality rates for patients with untreated ruptured intracranial aneurysms are even worse than presented in the historical study. When discussing with subarachnoid hemorrhage patients and their relatives about treatment options, the presented natural history figures are of use.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ee8b4b342a36d5d129d9bcfba9e4e729Test
https://doi.org/10.1161/strokeaha.116.015933Test

المؤلفون: Seppo Juvela

المساهمون: Clinicum, HUS Neurocenter, Neurokirurgian yksikkö, Department of Neurosciences, University Management, University of Helsinki

المصدر: Stroke. 50(9)

مصطلحات موضوعية: Male, ALCOHOL-CONSUMPTION, 030204 cardiovascular system & hematology, Aneurysm, Ruptured, Severity of Illness Index, 3124 Neurology and psychiatry, 0302 clinical medicine, RUPTURE, Interquartile range, Surveys and Questionnaires, risk factors, Medicine, Finland, Smoking, Area under the curve, Middle Aged, Anterior communicating artery, Treatment Outcome, GROWTH, Female, history, Cardiology and Cardiovascular Medicine, EMPHASIS, Adult, medicine.medical_specialty, Subarachnoid hemorrhage, Scoring system, Adolescent, subarachnoid hemorrhage, REGION, 03 medical and health sciences, Young Adult, AGE, Aneurysm, medicine.artery, Humans, Posterior communicating artery, Advanced and Specialized Nursing, Receiver operating characteristic, business.industry, 3112 Neurosciences, Intracranial Aneurysm, NATURAL-HISTORY, medicine.disease, Surgery, 3121 General medicine, internal medicine and other clinical medicine, aneurysm, RISK-FACTORS, Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies

الوصف: Background and Purpose— The purpose was to obtain a reliable treatment score for unruptured intracranial aneurysms (UIAs) from variables known at baseline. Methods— The series included 142 patients with UIAs diagnosed between 1956 and 1978 when UIAs were not treated and were followed up until the first aneurysm rupture, death, or the last contact. Previously published UIA treatment score was recorded, and finally, a new treatment score was constructed. Results— The median follow-up time was 21.0 years (interquartile range, 10.4–31.8 years). A total of 34 patients had an aneurysm rupture during 3064 person-years of follow-up. The UIA treatment score differed slightly between those with and without an aneurysm rupture (9.4±2.8 versus 8.3±3.1, P =0.082). The receiver operating characteristics curve of the UIA treatment score for predicting rupture showed a modest area under the curve (AUC; 0.618, 95% CI, 0.502–0.733; P =0.059). The best new treatment score consisted of 4 variables: age P P =0.02). Conclusions— This new simple and rapid scoring system is reliable for evaluating treatment indications with regard to the lifelong prevention of aneurysm rupture.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5e9db03b89f0117f3ff70e08ded6bf5fTest
https://pubmed.ncbi.nlm.nih.gov/31587662Test

المؤلفون: Max Wintermark, Achala Vagal, Richard I. Aviv

المصدر: Stroke. 49

مصطلحات موضوعية: medicine.medical_specialty, Collateral, Ischemia, MEDLINE, Brain Ischemia, 030218 nuclear medicine & medical imaging, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, medicine, Humans, Stroke, Advanced and Specialized Nursing, business.industry, Ischemic strokes, medicine.disease, Cardiology, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Natural history study

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4071da021dcbff8a8cfdcb4963a971eaTest
https://doi.org/10.1161/strokeaha.118.023440Test

المؤلفون: Seppo Juvela, Timo Koivisto, Julian Spears, Michael T. Lawton, J Mocco, Daniel Hänggi, David Hasan, Isabel Wanke, Peter D. LeRoux, Colin P. Derdeyn, John H. Wong, Nima Etminan, Yuichi Murayama, Daniel L. Barrow, Kentaro Mori, Shinji Nagahiro, Andreas Raabe, Gabriel J.E. Rinkel, Joshua B. Bederson, Hans Jakob Steiger, Daniel A. Rüfenacht, Edward W. Mee, Cameron G. McDougall, Peter J. Kirkpatrick, Alberto Pasqualin, Robert Brown, George K.C. Wong, Andrew J. Molyneux, Peter Vajkoczy, Giuseppe Lanzino, Volker Seifert, Jean Raymond, E. Sander Connolly, Kerim Beseoglu, Akio Morita, R. Loch Macdonald, Helmuth Steinmetz, James C. Torner, Neville W. Knuckey, Hidetoshi Kasuya, Michael Kerin Morgan

المساهمون: Clinicum, Department of Neurosciences

المصدر: Stroke. 45:1523-1530

مصطلحات موضوعية: Adult, medicine.medical_specialty, Subarachnoid hemorrhage, education, Population, Medizin, Delphi method, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, RUPTURE, LESS-THAN-7 MM YES, Multidisciplinary approach, Delphi technique, therapeutics, Humans, Medicine, Family history, Psychiatry, SUBARACHNOID HEMORRHAGE, METAANALYSIS, POPULATION, Advanced and Specialized Nursing, education.field_of_study, business.industry, Intracranial Aneurysm, NATURAL-HISTORY, CEREBRAL ANEURYSMS, medicine.disease, 3. Good health, incidental aneurysm, Natural history, cerebral aneurysm, consensus, natural history, ENDOVASCULAR TREATMENT, Emergency medicine, Life expectancy, Neurology (clinical), TIME TRENDS, Cardiology and Cardiovascular Medicine, business, EMPHASIS, 030217 neurology & neurosurgery

الوصف: Background and Purpose— To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. Methods— After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. Results— Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. Conclusions— Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::99604bf5858b8c24d4214bd10358d1d6Test
https://doi.org/10.1161/strokeaha.114.004519Test

المؤلفون: Carlos A. Molina, Kennedy R. Lees, Joseph P. Broderick, Magdy Selim

المصدر: Stroke. 47:1416-1419

مصطلحات موضوعية: medicine.medical_specialty, Endpoint Determination, Disease, 030204 cardiovascular system & hematology, Article, law.invention, Treatment and control groups, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, medicine, Humans, Adverse effect, Stroke, Aged, Randomized Controlled Trials as Topic, Advanced and Specialized Nursing, business.industry, medicine.disease, Natural history, Clinical trial, Early Diagnosis, Treatment Outcome, Emergency medicine, Physical therapy, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery

الوصف: What is the best timing for outcome assessment in patients with severe stroke in randomized controlled trials; early assessment at 3 months versus later at 6 to 12 months? Kennedy R. Lees The purpose of a clinical trial is usually to assess whether and to what extent a treatment improves outcome and to identify the type and frequency of any associated risks. The question that is posed here refers only to acute trials, in which enrollment occurs within hours after stroke onset and treatment is exhibited and probably completed within at most a few days. We can reasonably assume that the treatment exerts its beneficial effect only while it is being administered and that any adverse effects are similarly acute in onset. Patients with acute stroke, and especially patients with severe stroke, are typically elderly and have elevated risk of cardiovascular disease; indeed, stroke survivors are more likely to die from cardiovascular disease than recurrent stroke. Long-term follow-up will dilute effects of treatment with other events that are part of the natural history of the condition. Any benefit may be revealed reasonably quickly, but with extended follow-up, there is an inevitable convergence of outcomes between treatment groups as complications of age, and associated risk factors come into play. We must, therefore, look at the natural history of outcomes after stroke, especially among patients with initially severe stroke, to see when recovery typically reaches its plateau at the group level. Data from the Virtual International Stroke Trials Archive, 2015 (Dr Rachael MacIsaac, personal communication) on the distribution of outcomes across 1 year assessed by modified Rankin Scale (mRS) among 159 ischemic stroke patients with admission National Institutes of Health Stroke Scale score of ≥20 indicate that the proportions of patients with good outcomes—mRS scores of 0, 1, 2, 3, or 4—each …

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e281ad89f68b3e6320a9e038939d95aaTest
https://doi.org/10.1161/strokeaha.115.011153Test