المؤلفون: Cheng, Suk Fun, van Velzen, Twan J, Gregson, John, Richards, Toby, Jaeger, Hans Rolf, Simister, Robert, Kooi, M Eline, de Borst, Gert J, Pizzini, Francesca B, Nederkoorn, Paul J, Brown, Martin M, Bonati, Leo H

المصدر: Trials , 23 (1) , Article 606. (2022)

مصطلحات موضوعية: Carotid stenosis, Ischaemic stroke, Carotid endarterectomy, Carotid stenting, Risk prediction, Magnetic resonance imaging, Plaque imaging, Randomised controlled trial

الوصف: BACKGROUND: Carotid endarterectomy is currently recommended for patients with recently symptomatic carotid stenosis ≥50%, based on randomised trials conducted 30 years ago. Several factors such as carotid plaque ulceration, age and associated comorbidities might influence the risk-benefit ratio of carotid revascularisation. A model developed in previous trials that calculates the future risk of stroke based on these features can be used to stratify patients into low, intermediate or high risk. Since the original trials, medical treatment has improved significantly. Our hypothesis is that patients with carotid stenosis ≥50% associated with a low to intermediate risk of stroke will not benefit from additional carotid revascularisation when treated with optimised medical therapy. We also hypothesise that prediction of future risk of stroke in individual patients with carotid stenosis can be improved using the results of magnetic resonance imaging (MRI) of the carotid plaque. METHODS: Patients are randomised between immediate revascularisation plus OMT versus OMT alone. Suitable patients are those with asymptomatic or symptomatic carotid stenosis ≥50% with an estimated 5-year risk of stroke of <20%, as calculated using the Carotid Artery Risk score. MRI of the brain at baseline and during follow-up will be used as a blinded measure to assess the incidence of silent infarction and haemorrhage, while carotid plaque MRI at baseline will be used to investigate the hypotheses that plaque characteristics determine future stroke risk and help identify a subgroup of patients that will benefit from revascularisation. An initial analysis will be conducted after recruitment of 320 patients with baseline MRI and a minimum of 2 years of follow-up, to provide data to inform the design and sample size for a continuation or re-launch of the study. The primary outcome measure of this initial analysis is the combined 2-year rate of any clinically manifest stroke, new cerebral infarct on MRI, myocardial infarction or periprocedural ...

وصف الملف: text

العلاقة: https://discovery.ucl.ac.uk/id/eprint/10156181/1/Cheng_et_al-2022-Trials.pdfTest; https://discovery.ucl.ac.uk/id/eprint/10156181Test/

الإتاحة: https://discovery.ucl.ac.uk/id/eprint/10156181/1/Cheng_et_al-2022-Trials.pdfTest
https://discovery.ucl.ac.uk/id/eprint/10156181Test/

المؤلفون: Kelly, Peter, Weimar, Christian, Lemmens, Robin, Murphy, Sean, Purroy, Francisco, Arsovska, Anita, Bornstein, Natan M., Czlonkowska, Anna, Fischer, Urs, Fonseca, Ana Catarina, Forbes, John, Hill, Michael D., Jatuzis, Dalius, Kõrv, Janika, Kruuse, Christina, Mikulik, Robert, Nederkoorn, Paul J., O’Donnell, Martin, Sandercock, Peter, Tanne, David, Tsivgoulis, Georgios, Walsh, Cathal, Williams, David, Zedde, Marialuisa, Price, Christopher I.

مصطلحات موضوعية: ScholarlyArticle, ddc:610, Medizinische Fakultät » Universitätsklinikum Essen » Institut für Medizinische Informatik, Biometrie und Epidemiologie, Ischaemic stroke, inflammation, colchicine, randomised controlled trial

الوصف: Background: Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events. Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone. Design: CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat. Outcome: The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal). Summary: CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke. Schedule First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.

العلاقة: https://doi.org/10.1177/2396987320972566Test; https://nbn-resolving.org/urn:nbn:de:hbz:465-20230803-094634-3Test; https://duepublico2.uni-due.de/receive/duepublico_mods_00075729Test; https://duepublico2.uni-due.de/servlets/MCRFileNodeServlet/duepublico_derivate_00075465/European_Stroke_Journal_2021_6_222-228.pdfTest

الإتاحة: https://doi.org/10.1177/2396987320972566Test
https://nbn-resolving.org/urn:nbn:de:hbz:465-20230803-094634-3Test
https://duepublico2.uni-due.de/receive/duepublico_mods_00075729Test
https://duepublico2.uni-due.de/servlets/MCRFileNodeServlet/duepublico_derivate_00075465/European_Stroke_Journal_2021_6_222-228.pdfTest

المؤلفون: van den Berg, Nils S., de Haan, Edward H. F., Huitema, Rients B., Spikman, Jacoba M., de Leeuw, Frank Erik, Luijckx, Gert Jan, Raemaekers, Matthijs A.H.L.L., Smits, Anouk R, Schmand, Ben A, Scholte, H Steven, Spikman, Jacoba M, Kappelle, L Jaap, Geerligs, Linda, van Zandvoort, Martine J.E., Caan, Matthan W.A., Prokop, Mathias, Ramsey, Nick F, Lammers, Nikki A, Seijdel, Noor, Nederkoorn, Paul J

المصدر: Journal of Neuropsychology; Sep2021, Vol. 15 Issue 3, p516-532, 17p

مصطلحات موضوعية: EMOTION recognition, ISCHEMIC stroke, PREFRONTAL cortex, STROKE patients, EMOTIONS, FACIAL expression & emotions (Psychology)

مستخلص: Deficits in facial emotion recognition occur frequently after stroke, with adverse social and behavioural consequences. The aim of this study was to investigate the neural underpinnings of the recognition of emotional expressions, in particular of the distinct basic emotions (anger, disgust, fear, happiness, sadness and surprise). A group of 110 ischaemic stroke patients with lesions in (sub)cortical areas of the cerebrum was included. Emotion recognition was assessed with the Ekman 60 Faces Test of the FEEST. Patient data were compared to data of 162 matched healthy controls (HC's). For the patients, whole brain voxel‐based lesion–symptom mapping (VLSM) on 3‐Tesla MRI images was performed. Results showed that patients performed significantly worse than HC's on both overall recognition of emotions, and specifically of disgust, fear, sadness and surprise. VLSM showed significant lesion–symptom associations for FEEST total in the right fronto‐temporal region. Additionally, VLSM for the distinct emotions showed, apart from overlapping brain regions (insula, putamen and Rolandic operculum), also regions related to specific emotions. These were: middle and superior temporal gyrus (anger); caudate nucleus (disgust); superior corona radiate white matter tract, superior longitudinal fasciculus and middle frontal gyrus (happiness) and inferior frontal gyrus (sadness). Our findings help in understanding how lesions in specific brain regions can selectively affect the recognition of the basic emotions. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Neuropsychology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: van Velzen, Twan J, Kuhrij, Laurien S, Westendorp, Willeke F, van de Beek, Diederik, Nederkoorn, Paul J

المصدر: BMC Neurology; 1/12/2021, Vol. 21 Issue 1, p1-6, 6p

مصطلحات موضوعية: CAROTID artery stenosis, INTERNAL carotid artery, LOGISTIC regression analysis, ANTIBIOTICS, STROKE, CAROTID artery, CONVALESCENCE, RETROSPECTIVE studies, TREATMENT effectiveness, DISEASE prevalence, DISEASE complications

مستخلص: Background: The prevalence of carotid artery stenosis (CAS) in acute ischaemic stroke (AIS) patients is historically reported at 15-20%, but an up-to-date estimate is lacking. We hypothesise it is lower than historically reported, due to better risk management to date. The study aims to study prevalence, predictors and survival of CAS in AIS patients.Methods: We included patients with AIS from the Preventive Antibiotics in Stroke Study (PASS), a large Dutch randomized, multicentre, open-label phase III trial that included 2538 patients with acute stroke and randomised between standard care or preventive ceftriaxone. Patients with stroke in the anterior circulation that underwent diagnostic testing of the internal carotid artery (ICA) were eligible for this sub study and used in these secondary analyses. Logistic regression analyses were performed to identify predictors for CAS ≥ 50%. Additionally, an ordinal regression was performed to assess the association between presence of CAS at baseline and functional outcome at three months on the modified Rankin scale (mRS).Results: 1480 patients with AIS were included; 277 had CAS (18.7%; 95%CI:17.7-19.7). Age, hypertension, smoking and male gender were found as best-fit predictors for presence of CAS. Significant shift in mRS score after 90 days for CAS ≥50% towards a higher mRS score with an OR of 1.66 (95% CI 1.30-2.10) was found.Conclusions: Current prevalence of CAS is 18.7%, which is higher than we expected. Gender, smoking and hypertension are important factors associated with CAS. Patients with CAS had a significantly higher mRs score after 90 days.Trial Registration: Unique identifier: ISRCTN66140176. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Neurology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)