Stroke

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Stroke

NIH - Medical Encyclopedia: Stroke

"The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began."

Highlighted Article

Transient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005)

"Transient ischemic attack (TIA) and ischemic stroke are both characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but they are distinguished by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours and stroke reserved for symptoms of longer duration. ... The short-term risk of ischemic stroke after TIA is very high ..."

Stroke

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Stent-assisted Intracranial Recanalization for Acute Stroke: Early Results. (Neurosurgery. 2006) "CONCLUSION: Stent-assisted recanalization for acute stroke resulting from intracranial thrombotic occlusion is associated with a high recanalization rate and low intracranial hemorrhage rate. These initial results suggest that stenting may be an option for recalcitrant cerebral arterial occlusions."

Advancements in carotid stenting leading to reductions in perioperative morbidity among patients 80 years and older. (Neurosurgery. 2006)

Carotid artery stenting - Current status and future directions. (Minerva Cardioangiol. 2006)

[Long Term Follow-up after Intracranial Vertebro-Basilar Artery Stenting.] (Rofo. 2006) "CONCLUSION: Based on this limited series, we believe that in patients, with recurrent symptoms despite aggressive medical treatment, endovascular stent placement in intracranial high-grade vertebrobasilar artery stenoses can be an effective and safe treatment option."

Drug Side-Effects and Interactions

[Widespread subcutaneous haematoma after thrombolytic therapy in stroke patients. Mild falls at stroke onset may be dangerous.] (Neurol Neurochir Pol. 2006)

Corticosteroids in Patients With Hemorrhagic Stroke (Stroke. 2006) "At present, there is no evidence to support the routine use of corticosteroids (mineralocorticoids or glucocorticoids) in patients with hemorrhagic stroke (SAH or PICH). Treatment of these patients with corticosteroids may be associated with an increased risk of adverse effects."

Not All Patients With Atrial Fibrillation-Associated Ischemic Stroke Can Be Started on Anticoagulant Therapy. (Stroke. 2006) "BACKGROUND AND PURPOSE: Ischemic stroke patients in atrial fibrillation (AF) have a 10% to 20% risk of recurrent stroke. Warfarin reduces this risk by two thirds. However, warfarin is underutilized in this patient group. We performed a prospective study to determine the reasons why warfarin is not started in these patients. . CONCLUSIONS: In this cohort of patients with AF, warfarin was primarily underutilized before stroke onset, and it was too late to use anticoagulation, in approximately half, once a stroke had occurred. The decision to start or continue anticoagulation requires clinical judgment and should be made on a case by case basis after a complete risk benefit assessment."

Outcome and Symptomatic Bleeding Complications of Intravenous Thrombolysis Within 6 Hours in MRI-Selected Stroke Patients (Stroke. 2006)

Hemorrhage in the Interventional Management of Stroke study. (Stroke. 2006) "BACKGROUND AND PURPOSE: The incidence of hemorrhage after combined intravenous (IV) and intra-arterial (IA) recombinant tissue plasminogen activator (rt-PA) was examined in patients entered into the Interventional Management of Stroke (IMS) trial. We also analyzed factors predicting symptomatic and asymptomatic intracerebral hemorrhage (ICH). . CONCLUSIONS: Symptomatic and asymptomatic hemorrhage with combined IV and IA rt-PA occurred at rates similar to previous thrombolytic trials. Site of vascular occlusion and atrial fibrillation may be risk factors for hemorrhagic transformation."

The risks of sumatriptan administration in patients with unrecognized subarachnoid haemorrhage (SAH). (Cephalalgia. 2006) "Administration of sumatriptan in subarachnoid haemorrhage (SAH) patients, misdiagnosed as migraine patients, may induce symptomatic cerebral vasospasm with potentially dangerous consequences."

Nimotop (nimodipine) "Nimodipine is approved for oral administration to improve neurological outcome after subarachnoid hemorrhage. When administered intravenously or parenterally, it can cause serious adverse events, including death. Nimodipine must not be administered intravenously or by any parenteral route."

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients (Stroke 2006)

Results of the management of atherothrombosis with clopidogrel in high-risk patients trial: implications for the neurologist. (Arch Neurol. 2006) "The secondary prevention of ischemic stroke is aided by the use of antiplatelet therapy, and the predominant current choices are aspirin, aspirin plus extended-release dipyridamole, and clopidogrel. The potential utility of combining platelet antiaggregants with different mechanisms of action proved successful with aspirin plus extended-release dipyridamole, and this approach has been explored with the combination of clopidogrel and aspirin. . The frequency of serious, life-threatening bleeding adverse effects was almost doubled in the combination arm. Neurologists need to be aware of these results and avoid the use of clopidogrel plus aspirin in patients with stroke or transient ischemic attack until evidence that the combination is safe in this population is provided. Neurologists faced with patients who have had a stroke or transient ischemic attack and are receiving this combination of antiplatelet agents after coronary stenting should inform their cardiology colleagues of the reported bleeding risk, and they should encourage the use of the combination for as short a time period as possible after such coronary intervention."

Drugs

Seizures during stroke thrombolysis heralding dramatic neurologic recovery (NEUROLOGY 2006) "Conclusion: Seizures spontaneously remit in approximately one third of children with new-onset TLE. A lesion on MRI predicts intractable seizures in TLE and the potential need for epilepsy surgery."

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants. Results From a Danish Quality-Control Registry of 22 179 Patients With Ischemic Stroke. (Stroke. 2006) "CONCLUSIONS: Our data suggest that anticoagulation treatment reduces poststroke mortality in patients with ischemic stroke and AF."

Antiplatelet Therapy and Secondary Stroke Prevention—Part II (Clinical Geriatrics 2006)

The Stroke-Thrombolytic Predictive Instrument. A Predictive Instrument for Intravenous Thrombolysis in Acute Ischemic Stroke. (Stroke. 2006) "RESULTS: To predict good outcome, in addition to rt-PA treatment, 7 variables significantly affected prognosis and/or the treatment-effect of rt-PA: age, diabetes, stroke severity, sex, previous stroke, systolic blood pressure, and time from symptom onset. To predict catastrophic outcome, only age, stroke severity, and serum glucose were significant; rt-PA treatment was not. For patients treated within 3 hours, the median predicted probability of a good outcome with rt-PA was 42.9% (interquartile range [IQR]=18.6% to 64.7%) versus 25.3% (IQR=9.8% to 46.2%) without rt-PA; the median predicted absolute benefit was 12.5% (IQR=5.1% to 21.0%). The median probability for a catastrophic outcome, with or without, rt-PA was 15.2% (IQR=8.0% to 31.2%)."

Long-Term Effect of Intra-Arterial Thrombolysis in Stroke. (Stroke. 2006) "CONCLUSIONS: The present study provides evidence for a sustained effect of IAT when assessed 2 years after the stroke."

Intravenous thrombolysis in stroke patients of 80 versus <80 years of age—a systematic review across cohort studies (Age and Ageing 2006) "Compared with younger patients, older patients had a 3.09-time (95% CI = 2.37–4.03; P < 0.001) higher 3-month mortality and were less likely to regain a ‘favourable outcome’ … Conclusion: intravenous rtPA-treated stroke patients of 80 years of age have a less favourable outcome than younger ones. Imbalances in predictive baseline variables to the disadvantage of the older patients may contribute to this finding. Compared with the younger cohort, rtPA-treated stroke patients aged 80 years do not seem exceedingly prone to sICH. Thus, there is scope for benefit from thrombolysis for the older age group."

Discontinuation of Statin Treatment in Stroke Patients. (Stroke. 2006) "CONCLUSIONS: We propose that in all acute ischemic stroke patients chronically treated with statins before the event, treatment should be continued and the patient should receive medication at the day of the stroke."

Secondary prevention of stroke by blood pressure-lowering treatment. (Curr Hypertens Rep. 2006)

Early Recurrent Stroke Linked to Tissue Plasminogen Activator "Early recurrent ischemic stroke (ERIS) has been linked to intravenous thrombolysis (IVT) with tissue-type plasminogen activator (tPA) in a report by researchers at the University of Zurich in Switzerland. . According to the authors, these findings should alert treating physicians to the fact that deterioration of patients during thrombolysis therapy is not necessarily due to ICH but can also be caused by ERIS. . In addition, they write that exclusion of ICH 'should by no means prompt a wait-and-see attitude but rather should lead to urgent MRI studies and possibly additional therapeutic interventions such as local thrombolysis.' "

[Thrombolysis of stroke patients: a year's experience and results in Aarhus Hospital, Denmark] (Ugeskr Laeger. 2006) "INTRODUCTION: Treatment of acute stroke with thrombolysis within three hours is a challenging aspect of the organization of state-of-the-art stroke care. Indication for thrombolysis is based on studies where CT was used as a diagnostic tool. MR-based techniques are in some aspects superior to CT, though the scan times are longer. In this study, the feasibility and effectiveness of MR-based thrombolysis was examined. . CONCLUSION: Effective organization of treatment with thrombolysis using MR imaging is feasible. The MR techniques were beneficial in decision making and did not cause delay of treatment. Thrombolysis in this setup was as efficient with respect to outcome and complications ."

Thrombolysis (Tissue Plasminogen Activator) in Stroke (Stroke. 2006) "Background and Purpose- Despite the success of the 1995 National Institutes of Neurological Disorders and Stroke (NINDS) study using IV recombinant tissue plasminogen activator (tPA) within 3 hours in acute stroke and its subsequent FDA approval, there has been a reluctance to use tPA because of safety and efficacy issues with high incidence of intracerebral hemorrhage, and protocol violations."

Could Discontinuation of Aspirin Therapy be a Trigger for Stroke? (Nat Clin Pract Neurol. 2006) "Conclusion: The findings suggest that aspirin discontinuation could increase the risk of stroke during the first 4 weeks after treatment interruption."

Mortality of stroke patients treated with thrombolysis: Analysis of nationwide inpatient sample (Neurology 2006) "US community experience in the use of thrombolysis has higher rates of complications and mortality than in controlled clinical trials."

Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. (Lancet. 2006) "INTERPRETATION: The ESPRIT results, combined with the results of previous trials, provide sufficient evidence to prefer the combination regimen of aspirin plus dipyridamole over aspirin alone as antithrombotic therapy after cerebral ischaemia of arterial origin."

Role of heparin and low-molecular-weight heparins in the management of acute ischemic stroke The efficacy of heparins has not been adequately tested in patients with defined stroke subtypes and occlusive vascular lesions. Heparins should not be indiscriminately given to all patients with acute ischemic stroke."

Reasons Why Few Patients With Acute Stroke Receive Tissue Plasminogen Activator (Arch Neurol. 2006)

Comparison of Warfarin versus Aspirin for the Prevention of Recurrent Stroke or Death: Subgroup Analyses from the Warfarin-Aspirin Recurrent Stroke Study. (Cerebrovasc Dis. 2006) "In a multivariate model, warfarin was associated with greater hazard among patients with moderate stroke severity . and a greater benefit among those with posterior circulation location without brainstem infarction. In post-hoc analyses of the cryptogenic subgroup, warfarin was associated with worse outcomes among patients with moderate stroke severity and better outcomes among those without baseline hypertension or with posterior circulation infarcts sparing the brainstem. Conclusions: In the WARSS, the majority of subgroup analyses showed no benefit of warfarin over aspirin. Warfarin benefit was limited to brainstem-sparing posterior circulation infarcts and select cryptogenic stroke subgroups. Pending future clinical trial evidence to the contrary, antiplatelets are recommended for survivors of noncardioembolic stroke."

Good Outcomes in Ischemic Stroke Patients Treated With Intravenous Thrombolysis Despite Regressing Neurological Symptoms. (Stroke. 2006)

Thrombolysis for acute ischemic stroke patients aged 80 years and older: Canadian Alteplase for Stroke Effectiveness Study. (J Neurol Neurosurg Psychiatry. 2006) "CONCLUSION: In carefully selected elderly patients, the use of intravenous tPA is not associated with an increased risk of symptomatic intracerebral hemorrhage. There are age related differences in the clinical characteristics and outcome in the elderly population."

Clot-busting method boosts stroke recovery

IV tissue plasminogen activator use in acute stroke (NEUROLOGY 2006)

Are There Patients With Acute Ischemic Stroke and Atrial Fibrillation That Benefit From Low Molecular Weight Heparin? (Stroke 2006) "Conclusions- Our study does not support the use of treatment doses of LMWH in any of the studied subgroups of patients with acute ischemic stroke and atrial fibrillation."

Sex-Related Differences in Response to Aspirin in Cardiovascular Disease: An Untested Hypothesis (Nat Clin Pract Cardiovasc Med. 2006) "It is our view, however, that any conclusion that there are sex-related differences in response to aspirin for the prevention of cardiovascular disease in apparently healthy men and women might be premature. . In summary, the hypothesis formulated in the editorial accompanying the aspirin component of the WHS warrants further investigation; however, it is not supported by evidence from randomized trials in secondary prevention, nor is it plausibly explained by differences in the sex-specific pharmacokinetic or pharmacodynamic profile of aspirin. To paraphrase TH Huxley, the idea might yet prove to be another beautiful hypothesis slain by ugly facts,[10] but this will not emerge until we have the results of large-scale, randomized trials of aspirin versus placebo in primary prevention of cardiovascular disease in elderly people."

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients. An Analysis of the Nationwide Inpatient Sample 1999 to 2002. (Stroke. 2006) ". The thrombolysis cohort had a higher in-hospital mortality rate compared with the nonthrombolysis patients (11.4% versus 6.8%). The rate of intracerebral hemorrhage was 4.4% for the thrombolysis cohort and 0.4% for nonthrombolysis patients. Multivariate logistic regression showed advanced age, Asian/Pacific Islander race, congestive heart failure, and atrial fibrillation/flutter to be independent predictors of in-hospital mortality after thrombolysis. Thrombolysis volume, overall ischemic stroke volume, and teaching status were not significant predictors of in-hospital mortality after thrombolysis. CONCLUSIONS: Thrombolysis, as it is used in the community, has a safety profile that is similar to that observed in the large, prospective clinical trials."

The use of intravenous recombinant tissue plasminogen activator in acute ischemic stroke. (J Emerg Med. 2005) "In conclusion, i.v. rt-PA can be administered for AIS within the 3-h window if a hospital is committed to providing this treatment. Thrombolysis remains a treatment for a minority of AIS patients."

Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke (Stroke. 2005) "Conclusion: A substantial minority of patients deemed too good for intravenous tPA were unable to be discharged home. A re-evaluation of the stroke severity criteria for tPA eligibility may be indicated."

Intravenous Heparin Started Within the First 3 Hours After Onset of Symptoms as a Treatment for Acute Nonlacunar Hemispheric Cerebral Infarctions (Stroke. 2005) "Background and Purpose: Heparin is widely used for acute stroke to prevent thrombus propagation and/or multiple emboli generation, although there is, as yet, no demonstrated efficacy. However, all of the available clinical studies allowed long intervals from stroke to treatment. The purpose of this study was to try an intravenous regimen of unfractionated heparin the acute cerebral infarction starting treatment within the first 3 hours of the onset of symptoms. ... Conclusions: Intravenous heparin sodium could be of help in the earliest treatment of acute nonlacunar hemispheric cerebral infarction, even keeping into account an increased frequency of intracranial symptomatic brain hemorrhages."

Treatment With Tissue Plasminogen Activator Is Not Associated With Increased Use of Neurosurgery (Journal of Stroke and Cerebrovascular Diseases 2005) "Conclusions: In this large sample of US hospital admissions as a result of acute ischemic stroke with overlapping hemorrhage, the use of rtPA was not associated with an increased number of neurosurgical interventions. This lack of association, which needs to be confirmed in prospective studies, argues against withholding treatment with rtPA in patients with stroke based on neurosurgical availability."

Thrombolysis in stroke patients aged 80 years and older: Swiss survey of IV Thrombolysis (Neurology 2005)

Exercise

General Information

Secondary Prevention Measures After a Stroke-Should They Target Stroke or Heart Disease? (Nat Clin Pract Neurol. 2006) "The most likely outcome event after a first stroke was a recurrent stroke, with a cumulative risk for a nonfatal or fatal recurrent stroke of 1.5% (95% CI 0.6-2.5%) after 30 days and 18.3% (95% CI 14.8-21.7%) after 5 years. … Conclusion In the long term, patients with ischemic stroke are more likely to have a recurrent stroke than to have an MI. Cardiac events are, however, the most important vascular cause of death in these patients."

Increased Body Iron Stores Are Associated With Poor Outcome After Thrombolytic Treatment in Acute Stroke. (Stroke. 2006) "CONCLUSIONS: Increased body iron stores are associated with poor outcome, symptomatic hemorrhagic transformation, and severe edema in patients treated with tissue plasminogen activator after ischemic stroke. These findings suggest that iron overload may offset the beneficial effect of thrombolytic therapies."

Red wine may help prevent stroke damage "They discovered that the animals suffered less brain damage than similarly damaged mice who were not treated with the compound, which is called resveratrol."

Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: comparative population based study (BMJ 2006) "Conclusions Incidence of symptomatic carotid stenosis increases steeply with age, but, despite good evidence of major benefit from endarterectomy in elderly patients and a willingness to have surgery, there is substantial underinvestigation in routine clinical practice in patients aged 80 with transient ischaemic attack or ischaemic stroke."

High-Dose Atorvastatin after Stroke or Transient Ischemic Attack (NEJM 2006) "Conclusions In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke."

What is the best management for patients who have a TIA while on aspirin therapy? (J Fam Pract. 2006)

Multispecialty stroke services in California hospitals are associated with reduced mortality (NEUROLOGY 2006) "Conclusions: Dedicated, multispecialty stroke services are underutilized despite their association with reduced stroke mortality at both academic and non-academic hospitals."

Changing attitudes to the management of ischaemic stroke between 1997 and 2004: a survey of New Zealand physicians (Internal Medicine Journal 2006)

Prevention and Treatment of Urinary Incontinence After Stroke in Adults (Stroke. 2006) "Urinary incontinence can affect 40% to 60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and 15% remaining incontinent at 1 year. . "

Patient Recognition of and Response to Symptoms of TIA or Stroke. (Neuroepidemiology. 2006) "Results: The median delay time from symptom onset to admission to hospital was 4.5 h. While 41% of participants delayed less than 3 h, more than 45% delayed greater than 6 h. Independent predictors of delay time included mode of arrival at hospital with those taking an ambulance having a median delay time of 2.7 h vs. 15.4 h for those arriving by private car (p = 0.04). Gender also predicted delay with women delaying longer (p = 0.001). The first response of others was also an independent predictor of delay time (p = 0.003) with those who called the emergency services number or took the patient to hospital resulting in the shortest patient delays. Finally, if the patient appraised their symptoms as serious they had a shorter delay time (p = 0.02)."

Early CT Findings in Unknown-Onset and Wake-Up Strokes. (Cerebrovasc Dis. 2006) "Background: Approximately one quarter of the acute ischemic stroke patients notice the event at awakening. Such patients with stroke at awakening are usually excluded from thrombolysis, since the time of stroke onset cannot be definitely identified. We compared the hyperacute CT findings of awakening stroke patients with those of stroke patients with known onset to assess whether the time of stroke onset is shortly before awakening. . Conclusion: Based on our CT findings, stroke at awakening seems to be developing shortly before in a large subset of patients, making them potential candidates for acute stroke therapies."

Time is brain--quantified. (Stroke. 2006) "CONCLUSIONS: Quantitative estimates of the pace of neural circuitry loss in human ischemic stroke emphasize the time urgency of stroke care. The typical patient loses 1.9 million neurons each minute in which stroke is untreated."

Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study (BMJ 2006)

Lipid testing and lipid-lowering therapy in hospitalized ischemic stroke and transient ischemic attack patients: results from a statewide stroke registry. (Stroke. 2006)

Premorbid antiplatelet use and ischemic stroke outcomes (NEUROLOGY 2006)"Conclusions: Prestroke use of antiplatelet may be associated with reduced severity of incident ischemic strokes in those with no prior history of stroke or TIA, and with an increased likelihood of a good discharge outcome regardless of prior cerebrovascular event history."

Blood pressure management during acute ischaemic stroke. (Expert Opin Pharmacother. 2006)

Decreased Mortality by Normalizing Blood Glucose after Acute Ischemic Stroke. (Acad Emerg Med. 2006) "CONCLUSIONS: Admission hyperglycemia is associated with a worse outcome after stroke than is euglycemia. Normalization of blood glucose during the first 48 hours of hospitalization appears to confer a potent survival benefit in patients with thromboembolic stroke."

Acute Ischemic Stroke: Evaluation and Management Strategies (Topics in Advanced Practice Nursing eJournal. 2005)

Cerebral microbleeds are common in ischemic stroke but rare in TIA (NEUROLOGY 2005) "Conclusions: Microbleeds are common in ischemic stroke but rare in TIA, an observation not explained by differences in vascular risk factors or severity of white matter disease seen on T2 MRI. This finding has implications for the safety of antithrombotic therapy and clinical trial design in the two groups. Microbleeds may also be a new marker for severe microvascular pathology with increased risk of permanent cerebral infarction."

Homeostasis as basis of acute stroke treatment: stroke units are the key. (Cerebrovasc Dis. 2005) "Results: The maintenance of homeostasis forms the basis of acute stroke treatment, in what is termed nonpharmacological neuroprotection. Stroke units (SU) are the ideal environment for this therapeutic approach since their favorable influence on the correct management of BP, body temperature, oxygen saturation, and blood glucose in the progress of stroke patients have been proved. Conclusions: The proper management of physiological variables (homeostasis) such as BP, body temperature, blood glucose, and oxygen saturation is the basis of acute stroke treatment, and SU are the key to this approach."

Guidelines

NGC - Diagnosis and initial treatment of ischemic stroke. (2006)

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack (Stroke. 2006) "The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. . Survivors of a transient ischemic attack (TIA) or stroke have an increased risk of another stroke, which is a major source of increased mortality and morbidity. Among the estimated 700 000 people with stroke in the United States each year, 200 000 of them are among persons with a recurrent stroke. The number of people with TIA, and therefore at risk for stroke, is estimated to be much greater."

Stroke Guidelines Help Improve Care

Modern treatment options for intracerebral hemorrhage. (Curr Treat Options Neurol. 2006)

Guidelines Abstracted From the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Stroke Rehabilitation (J Am Geriatr Soc. 2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke. (Cochrane Database Syst Rev. 2006) "AUTHORS' CONCLUSIONS: There is currently not enough evidence from randomised controlled trials regarding the efficacy or safety of GP IIb-IIIa inhibitors therapy in acute ischaemic stroke. Results from ongoing trials will help to understand the risk to benefit ratio of these agents."

Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. (Stroke. 2006) "CONCLUSIONS: Mechanical recanalization was effective in half of the patients and at least as safe as local intra-arterial thrombolysis. It allowed to save r-tPA and time. Although the low success rate remains a limit, the excellent and quick anatomical recanalization obtained after successful procedures makes this approach promising."

Endovascular Recanalization Therapy in Acute Ischemic Stroke. (Stroke. 2005) "BACKGROUND AND PURPOSE: To assess the outcome in acute ischemic stroke patients not eligible for systemic thrombolysis (outside the 3-hour time window, after surgery, or on anticoagulant) undergoing endovascular recanalization therapy (ERT) at the Columbia University Medical Center (CUMC) and to determine US nationwide usage and outcome of ERT in acute ischemic stroke. ... CONCLUSIONS: Despite significant variability in patient characteristics and treatment methods among 2 sources of data analyzed, ERT in stroke patients not eligible for intravenous thrombolysis appears to be a relatively safe and effective treatment alternative that is being used increasingly nationwide."

Experimental

Dietary phytoestrogens improve stroke outcome after transient focal cerebral ischemia in rats (European Journal of Neuroscience 2006)

Radiotherapy

Supplements-Vitamins-CAM

Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. (JPEN J Parenter Enteral Nutr. 2006) "CONCLUSIONS: Antioxidants supplementation with or without B-group vitamins enhances antioxidant capacity, mitigates oxidative damage, and may have an anti-inflammatory effect immediately postinfarct in stroke disease."

Ginkgo Biloba for Acute Ischemic Stroke (Stroke 2006) "There is no scientific support from high-quality studies for the routine use of Ginkgo biloba extract in the treatment of patients with acute ischemic stroke."

Surgery

Impact of Carotid Endarterectomy on Medical Secondary Prevention After a Stroke or a Transient Ischemic Attack. Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry. (Stroke. 2006) "CONCLUSIONS: Carotid endarterectomy is associated with a higher use of antiplatelet agents and statins in stroke/TIA patients. The absence of such an association with blood pressure and blood glucose control suggests that the individual determinants of the quality of the secondary medical prevention vary from one risk factor to another and from one class of drugs to another."

Primary Stroke Unit Treatment Followed by Very Early Carotid Endarterectomy for Carotid Artery Stenosis after Acute Stroke. (Cerebrovasc Dis. 2006) "Conclusions: After careful selection and preparation in a stroke unit, patients with acute stroke due to carotid stenosis can undergo very early CEA under local anesthesia with a perioperative risk comparable with the risk of later endarterectomy, therefore preventing very early stroke recurrences."

Endovascular Recanalization Therapy in Acute Ischemic Stroke (Stroke. 2006) "Background and Purpose- To assess the outcome in acute ischemic stroke patients not eligible for systemic thrombolysis (outside the 3-hour time window, after surgery, or on anticoagulant) undergoing endovascular recanalization therapy (ERT). ERT in stroke patients not eligible for intravenous thrombolysis appears to be a relatively safe and effective treatment alternative that is being used increasingly nationwide. CONCLUSIONS: Despite significant variability in patient characteristics and treatment methods among 2 sources of data analyzed, ERT in stroke patients not eligible for intravenous thrombolysis appears to be a relatively safe and effective treatment alternative that is being used increasingly nationwide."

Transplantation

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