دسترسی یکساله به بیش از ۵۰۰ ژورنال روز جهان موجود در سامانه
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http://medilib.ir
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قیمت : 3,800,000 تومان- قیمت ویژه : 1,900,000تومان
PRESERVE: Randomized Trial of Intensive Versus Standard Blood Pressure Control in Small Vessel Disease
Hugh S. Markus, Marco Egle, Iain D. Croall, Hasan Sari, Usman Khan, Ahamad Hassan, Kirsty Harkness, Andrew MacKinnon, John T. O’Brien, Robin G. Morris, Thomas R. Barrick, Andrew M. Blamire, Daniel J. Tozer, Gary A. Ford, and on behalf of the PRESERVE Study Team
doi : 10.1161/STROKEAHA.120.032054
Stroke. 2021;52:2484–2493
In cerebral small vessel disease, cerebral blood flow and autoregulation are impaired and therefore excessive blood pressure reduction could possibly accelerate white matter damage and worsen outcome. The trial determined, in severe symptomatic cerebral small vessel disease, whether intensive blood pressure lowering resulted in progression of white matter damage assessed using diffusion tensor imaging.
Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial
Jackie Bosch, Eva M. Lonn, Gilles R. Dagenais, Peggy Gao, Patricio Lopez-Jaramillo, Jun Zhu, Prem Pais, Alvaro Avezum, Karen Sliwa, Irina E. Chazova, Ron J.G. Peters, Claes Held, Khalid Yusoff, Basil S. Lewis, William D. Toff, Kamlesh Khunti, Christopher M. Reid, Lawrence A. Leiter, Salim Yusuf, Robert G. Hart, for the HOPE-3 Investigators
doi : 10.1161/STROKEAHA.120.030790
Stroke. 2021;52:2494–2501
The HOPE-3 trial (Heart Outcomes Prevention Evaluation–3) found that antihypertensive therapy combined with a statin reduced first stroke among people at intermediate cardiovascular risk. We report secondary analyses of stroke outcomes by stroke subtype, predictors, treatment effects in key subgroups.
Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke: AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration
Graeme J. Hankey, Maree L. Hackett, Osvaldo P. Almeida, Leon Flicker, Gillian E. Mead, Martin S. Dennis, Christopher Etherton-Beer, Andrew H. Ford, Laurent Billot, Stephen Jan, Thomas Lung, Erik Lundstr?m, Katharina S. Sunnerhagen, Craig S. Anderson, Huy Thang-Nguyen, John Gommans, Qilong Yi, and on behalf of AFFINITY Trial Collaboration
doi : 10.1161/STROKEAHA.120.033070
Stroke. 2021;52:2502–2509
The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization.
Mechanical Characterization of Thrombi Retrieved With Endovascular Thrombectomy in Patients With Acute Ischemic Stroke
Nikki Boodt, Philip R.W. Snouckaert van Schauburg, Hajo M. Hund, Behrooz Fereidoonnezhad, J. Patrick McGarry, Ali C. Akyildiz, Adriaan C.G.M. van Es, Simon F. De Meyer, Diederik W.J. Dippel, Hester F. Lingsma, Heleen M.M. van Beusekom, Aad van der Lugt, Frank J.H. Gijsen
doi : 10.1161/STROKEAHA.120.033527
Stroke. 2021;52:2510–2517
Mechanical properties of thromboemboli play an important role in the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke. However, very limited data on mechanical properties of human stroke thrombi are available. We aimed to mechanically characterize thrombi retrieved with EVT, and to assess the relationship between thrombus composition and thrombus stiffness.
Platelets and Clot Stiffness: A Challenge but Also an Opportunity Toward Achieving Consistent Complete Reperfusion
Jean Darcourt, Andrew M. Demchuk, Jean-Marc Olivot
doi : 10.1161/STROKEAHA.121.035105
Stroke. 2021;52:2518–2520
Deintensification or No Statin Treatment Is Associated With Higher Mortality in Patients With Ischemic Stroke or Transient Ischemic Attack
Jennifer L. Dearborn-Tomazos, Xin Hu, Dawn M. Bravata, Manali A. Phadke, Fitsum M. Baye, Laura J. Myers, John Concato, Alan J. Zillich, Mathew J. Reeves, Jason J. Sico
doi : 10.1161/STROKEAHA.120.030089
Stroke. 2021;52:2521–2529
Practice guidelines recommend that most patients receive moderate- or high-potency statins after ischemic stroke or transient ischemic attack (TIA) of atherosclerotic origin. We tested the association of different patterns of potency for prescribed statin therapy—assessed before admission and at hospital discharge for ischemic stroke or TIA—on mortality in a large, nationwide sample of US Veterans.
Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience
Nirav R. Bhatt, Michael R. Frankel, Raul G. Nogueira, Carol Fleming, Nicolas A. Bianchi, Olivia Morgan, Katleen Chester, Stephen W. English, Nicholas Janocko, Digvijaya Navalkele, Diogo C. Haussen
doi : 10.1161/STROKEAHA.120.033775
Stroke. 2021;52:2530–2536
Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area.
Expression of Resistin, Chemerin, and Chemerin’s Receptor in the Unstable Carotid Atherosclerotic Plaque
Russell Yanofsky, Carina Sancho, Karina Gasbarrino, Huaien Zheng, Robert J. Doonan, Fanny Jaunet, Samantha Steinmetz-Wood, John P. Veinot, Chi Lai, Stella S. Daskalopoulou
doi : 10.1161/STROKEAHA.120.030228
Stroke. 2021;52:2537–2546
Unstable carotid plaques are a common cause of ischemic strokes. Identifying markers that reflect/contribute to plaque instability has become a prominent focus in cardiovascular research. The adipokines, resistin and chemerin, and ChemR23 (chemerin receptor), may play a role in carotid atherosclerosis, making them potential candidates to assess plaque instability. However, the expression and interrelationship of resistin and chemerin (and ChemR23) protein and mRNA within the carotid atherosclerotic plaque remains elusive. Thus, we investigated herein, the association between plaque mRNA and protein expression of resistin and chemerin (and ChemR23) and carotid plaque instability in humans, and whether sex differences exist in the relationship between these adipokines and plaque instability.
Predicting 90-Day Outcome After Thrombectomy: Baseline-Adjusted 24-Hour NIHSS Is More Powerful Than NIHSS Score Change
Eva A. Mistry, Sharon Yeatts, Adam de Havenon, Tapan Mehta, Niraj Arora, Felipe De Los Rios La Rosa, Amy K. Starosciak, James E. Siegler III, Akshitkumar M. Mistry, Shadi Yaghi, Pooja Khatri
doi : 10.1161/STROKEAHA.120.032487
Stroke. 2021;52:2547–2553
The National Institutes of Health Stroke Scale (NIHSS) measured at an early time point is an appealing surrogate marker for long-term functional outcome of stroke patients treated with endovascular therapy. However, definitions and analytical methods for an early NIHSS-based outcome measure that optimize power and precision in clinical studies are not well-established.
Access to Mechanical Thrombectomy for Ischemic Stroke in the United States
Hooman Kamel, Neal S. Parikh, Abhinaba Chatterjee, Luke K. Kim, Jeffrey L. Saver, Lee H. Schwamm, Kori S. Zachrison, Raul G. Nogueira, Opeolu Adeoye, Iv?n D?az, Andrew M. Ryan, Ankur Pandya, Babak B. Navi
doi : 10.1161/STROKEAHA.120.033485
Stroke. 2021;52:2554–2561
Mechanical thrombectomy helps prevent disability in patients with acute ischemic stroke involving occlusion of a large cerebral vessel. Thrombectomy requires procedural expertise and not all hospitals have the staff to perform this intervention. Few population-wide data exist regarding access to mechanical thrombectomy.
Ten-Year Trend in Age, Sex, and Racial Disparity in tPA (Alteplase) and Thrombectomy Use Following Stroke in the United States
Fadar Oliver Otite, Vasu Saini, Nicole Beaton Sur, Smit Patel, Richa Sharma, Emmanuel O. Akano, Nnabuchi Anikpezie, Karen Albright, Elena Schmidt, Haydn Hoffman, Grahame Gould, Priyank Khandelwal, Julius Gene Latorre, Amer M. Malik, Ralph L. Sacco, Seemant Chaturvedi
doi : 10.1161/STROKEAHA.120.032132
Stroke. 2021;52:2562–2570
IV tPA (intravenous thrombolysis with alteplase) and mechanical thrombectomy (MT) utilization increased in acute ischemic stroke hospitalizations in the United States over the last decade. It is uncertain whether this increase occurred equally across all age, sex, and racial groups.
Demographic Disparities in Proximity to Certified Stroke Care in the United States
Cathy Y. Yu, Timothy Blaine, Peter D. Panagos, Akash P. Kansagra
doi : 10.1161/STROKEAHA.121.034493
Stroke. 2021;52:2571–2579
Demographic disparities in proximity to stroke care influence time to treatment and clinical outcome but remain understudied at the national level. This study quantifies the relationship between distance to the nearest certified stroke hospital and census-derived demographics.
Going the Extra Mile: Disparities in Access to Specialized Stroke Care
Michael T. Mullen, Olajide A. Williams
doi : 10.1161/STROKEAHA.121.035128
Stroke. 2021;52:2580–2582
Age at Menopause and Risk of Ischemic and Hemorrhagic Stroke
Sabrina J.G.C. Welten, N. Charlotte Onland-Moret, Jolanda M.A. Boer, W.M. Monique Verschuren, Yvonne T. van der Schouw
doi : 10.1161/STROKEAHA.120.030558
Stroke. 2021;52:2583–2591
The few epidemiological studies that addressed the association between age at menopause and ischemic and hemorrhagic stroke risk in women had conflicting findings. We aimed to investigate whether age at (natural and surgical) menopause is a risk factor for total, ischemic, and hemorrhagic stroke in women.
Age At Menopause: A Female Risk Factor of Stroke?
Hanne Christensen, Charlotte Cordonnier
doi : 10.1161/STROKEAHA.121.034828
Stroke. 2021;52:2592–2593
Association of Coronary Artery Atherosclerosis With Brain White Matter Hyperintensity
Michelle C. Johansen, Rebecca F. Gottesman, Brian G. Kral, Dhananjay Vaidya, Lisa R. Yanek, Lewis C. Becker, Diane M. Becker, Paul Nyquist
doi : 10.1161/STROKEAHA.120.032674
Stroke. 2021;52:2594–2600
We aim to determine, in healthy high-risk adults, the association between subclinical coronary artery disease and white matter hyperintensity (WMH) volume and location, independent of atherosclerotic risk factors.
Increased Risk of Stroke in Patients With Obsessive-Compulsive Disorder: A Nationwide Longitudinal Study
Mu-Hong Chen, Shih-Jen Tsai, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Tzeng-Ji Chen, Tai-Long Pan, Ya-Mei Bai
doi : 10.1161/STROKEAHA.120.032995
Stroke. 2021;52:2601–2608
Patients with obsessive-compulsive disorder (OCD) tend to be comorbid with stroke-related risk factors, including obesity, hypertension, and diabetes. However, the temporal association between OCD and subsequent stroke risk is unclear.
Stroke Risks in Adult Survivors of Preterm Birth: National Cohort and Cosibling Study
Casey Crump, Jan Sundquist, Kristina Sundquist
doi : 10.1161/STROKEAHA.120.033797
Stroke. 2021;52:2609–2617
Clinicians will increasingly encounter adult patients who were born preterm and will need to understand their long-term sequelae. Adult survivors of preterm birth have been reported to have increased risks of hypertension and other stroke risk factors. However, their stroke risks have seldom been examined and the findings are discrepant, possibly due to small sample sizes, insufficient follow-up, or survivor bias. We examined whether preterm birth is associated with stroke in a large population-based cohort.
Young Adult Survivors of Preterm Birth Are at Increased Risk of Stroke: The Missing Link
Nomazulu Dlamini, Lori C. Jordan
doi : 10.1161/STROKEAHA.121.035283
Stroke. 2021;52:2618–2620
?-Cell Function and Clinical Outcome in Nondiabetic Patients With Acute Ischemic Stroke
Takuya Kiyohara, Ryu Matsuo, Jun Hata, Kuniyuki Nakamura, Yoshinobu Wakisaka, Masahiro Kamouchi, Takanari Kitazono, Tetsuro Ago,
doi : 10.1161/STROKEAHA.120.031392
Stroke. 2021;52:2621–2628
Little is known about how ?-cell dysfunction affects clinical outcome after ischemic stroke. We examined whether ?-cell function is associated with clinical outcome after acute ischemic stroke and if so, whether insulin resistance influences this association in a prospective study of patients with acute stroke.
Tranexamic Acid for Prevention of Hematoma Expansion in Intracerebral Hemorrhage Patients With or Without Spot Sign
Christian Ovesen, Janus Christian Jakobsen, Christian Gluud, Thorsten Steiner, Zhe Law, Katie Flaherty, Rob A. Dineen, Louisa M. Christensen, Karsten Overgaard, Rune S. Rasmussen, Philip M. Bath, Nikola Sprigg, Hanne Christensen, the TICH-2 Investigators
doi : 10.1161/STROKEAHA.120.032426
Stroke. 2021;52:2629–2636
The computed tomography angiography or contrast-enhanced computed tomography based spot sign has been proposed as a biomarker for identifying on-going hematoma expansion in patients with acute intracerebral hemorrhage. We investigated, if spot-sign positive participants benefit more from tranexamic acid versus placebo as compared to spot-sign negative participants.
Aflibercept, a VEGF (Vascular Endothelial Growth Factor)-Trap, Reduces Vascular Permeability and Stroke-Induced Brain Swelling in Obese Mice
Il-doo Kim, John W. Cave, Sunghee Cho
doi : 10.1161/STROKEAHA.121.034362
Stroke. 2021;52:2637–2648
Brain edema is an important underlying pathology in acute stroke, especially when comorbidities are present. VEGF (Vascular endothelial growth factor) signaling is implicated in edema. This study investigated whether obesity impacts VEGF signaling and brain edema, as well as whether VEGF inhibition alters stroke outcome in obese subjects.
Role of Complement Component 3 in Early Erythrolysis in the Hematoma After Experimental Intracerebral Hemorrhage
Ming Wang, Fan Xia, Shu Wan, Ya Hua, Richard F. Keep, Guohua Xi
doi : 10.1161/STROKEAHA.121.034372
Stroke. 2021;52:2649–2660
Early erythrolysis occurs within the hematoma following intracerebral hemorrhage (ICH), and the release of erythrocyte cytoplasmic proteins such as hemoglobin and Prx2 (peroxiredoxin 2) can cause brain injury. Complement activation can induce erythrolysis. This study determined the function of complement component 3 (C3) in erythrolysis in hematoma and brain injury after ICH in mice.
Roles of Phytoestrogen in the Pathophysiology of Intracranial Aneurysm
Kimihiko Yokosuka, Caleb Rutledge, Yoshinobu Kamio, Atsushi Kuwabara, Hiroki Sato, Redi Rahmani, James Purcell, Satoru Eguchi, Jacob F. Baranoski, Tigran Margaryan, Artak Tovmasyan, Jinglu Ai, Michael T. Lawton, Tomoki Hashimoto
doi : 10.1161/STROKEAHA.120.032042
Stroke. 2021;52:2661–2670
The incidences of intracranial aneurysm and aneurysmal subarachnoid hemorrhage are high in postmenopausal women. Although population-based studies suggest that hormone replacement therapy is beneficial for postmenopausal women with intracranial aneurysms, estrogen replacement may no longer be recommended for the prevention of chronic diseases given its association with adverse outcomes, such as cancer and ischemic stroke. The isoflavone daidzein and its intestinal metabolite equol are bioactive phytoestrogens and potent agonists of estrogen receptors. Given their estrogenic properties, we investigated whether the isoflavones daidzein and equol are protective against the formation and rupture of intracranial aneurysms in a mouse model of the postmenopausal state.
Central Triage of Acute Stroke Patients Across a Distributive Stroke Network Is Safe and Reduces Transfer Denials
Derek Holder, Kevin Leeseberg, James A. Giles, Jin-Moo Lee, Sheyda Namazie, Andria L. Ford
doi : 10.1161/STROKEAHA.120.033018
Stroke. 2021;52:2671–2675
Mechanical thrombectomy has dramatically increased patient volumes transferred to comprehensive stroke centers (CSCs), resulting in transfer denials for patients who need higher level of care only available at a CSC. We hypothesized that a distributive stroke network (DSN), triaging low severity acute stroke patients to a primary stroke center (PSC) upon initial telestroke consultation, would safely reduce transfer denials, thereby providing additional volume to treat severe strokes at a CSC.
Improving Prehospital Stroke Diagnosis Using Natural Language Processing of Paramedic Reports
Anoop Mayampurath, Zahra Parnianpour, Christopher T. Richards, William J. Meurer, Jungwha Lee, Bruce Ankenman, Ohad Perry, Scott J. Mendelson, Jane L. Holl, Shyam Prabhakaran
doi : 10.1161/STROKEAHA.120.033580
Stroke. 2021;52:2676–2679
Accurate prehospital diagnosis of stroke by emergency medical services (EMS) can increase treatments rates, mitigate disability, and reduce stroke deaths. We aimed to develop a model that utilizes natural language processing of EMS reports and machine learning to improve prehospital stroke identification.
Metabolic Traits and Stroke Risk in Individuals of African Ancestry: Mendelian Randomization Analysis
Segun Fatumo, Ville Karhunen, Tinashe Chikowore, Toure Sounkou, Brenda Udosen, Chisom Ezenwa, Mariam Nakabuye, Opeyemi Soremekun, Iyas Daghlas, David K. Ryan, Amybel Taylor, Amy M. Mason, Scott M. Damrauer, Marijana Vujkovic, Keith L. Keene, Myriam Fornage, Marjo-Riitta J?rvelin, Stephen Burgess, Dipender Gill
doi : 10.1161/STROKEAHA.121.034747
Stroke. 2021;52:2680–2684
Metabolic traits affect ischemic stroke (IS) risk, but the degree to which this varies across different ethnic ancestries is not known. Our aim was to apply Mendelian randomization to investigate the causal effects of type 2 diabetes (T2D) liability and lipid traits on IS risk in African ancestry individuals, and to compare them to estimates obtained in European ancestry individuals.
Cerebral Small Vessel Disease Associated With Atrial Fibrillation Among Older Adults: A Population-Based Study
Mozhu Ding, Rui Wang, Grégoria Kalpouzos, Erika J. Laukka, Yuanjing Li, Kristina Johnell, Laura Fratiglioni, Chengxuan Qiu
doi : 10.1161/STROKEAHA.120.031573
Stroke. 2021;52:2685–2689
Cerebral small vessel disease, as a potential mechanism underlying the association between atrial fibrillation (AF) and dementia, remains poorly investigated. In this cohort study, we sought to examine the association between AF and cerebral small vessel disease markers among older adults.
Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial
Shadi Yaghi, Eytan Raz, Seena Dehkharghani, Howard Riina, Ryan McTaggart, Mahesh Jayaraman, Shyam Prabhakaran, David S. Liebeskind, Pooja Khatri, Brian Mac Grory, Fawwaz Al-Mufti, Maarten Lansberg, Gregory Albers, Adam de Havenon
doi : 10.1161/STROKEAHA.120.033806
Stroke. 2021;52:2690–2693
In patients with acute large vessel occlusion, the natural history of penumbral tissue based on perfusion time-to-maximum (Tmax) delay is not well established in relation to late-window endovascular thrombectomy. In this study, we sought to evaluate penumbra consumption rates for Tmax delays in patients with large vessel occlusion evaluated between 6 and 16 hours from last known normal.
Decompressive Craniectomy in Malignant Stroke After Hemorrhagic Transformation
Silvia Hern?ndez-Dur?n, Dorothee Mielke, Veit Rohde, Christian von der Brelie
doi : 10.1161/STROKEAHA.121.035072
Stroke. 2021;52:e486–e487
Stroke Disparities Among Nonracial Minorities in the All of Us Research Program
Audrey C. Leasure, Julian N. Acosta, Cameron Both, Natalia Szejko, Stacy C. Brown, Kevin N. Sheth, Guido J. Falcone
doi : 10.1161/STROKEAHA.121.034903
Stroke. 2021;52:e488–e490
Differences Between Subarachnoid Hemorrhage Seen in Daily Practice and Aneurysms That Rupture During Follow-Up
Nakao Ota, Akio Morita, Shinjiro Tominari, Takeo Nakayama, Kazuhiko Nozaki, Teiji Tominaga, Kosumo Noda, Hiroyasu Kamiyama, Rokuya Tanikawa, on behalf of the Japan Neurosurgical Society for UCAS Japan Investigators
doi : 10.1161/STROKEAHA.121.035278
Stroke. 2021;52:e491–e493
Early Brain Injury and Soluble ST2 After Nontraumatic Subarachnoid Hemorrhage
Riana L. Schleicher, Matthew B. Bevers, Daniel B. Rubin, Matthew J. Koch, S?ren Bache, India A. Lissak, Aman B. Patel, Eric S. Rosenthal, Kirsten M?ller, W. Taylor Kimberly
doi : 10.1161/STROKEAHA.121.035372
Stroke. 2021;52:e494–e496
Safety of the Mobile Stroke Unit: A Descriptive Review and Results of Radiation Monitoring
Stephen Susa, Redi Rahmani, David Conover, Samuel Carr, Nathaniel Ellens, Diana Proper, Peter Le Roux, Joshua Catapano, Visish Srinivasan, Tarun Bhalla
doi : 10.1161/STROKEAHA.120.033545
Stroke. 2021;52:e497–e498
Telerehabilitation: Has Its Time Come?
Pamela W. Duncan, Julie Bernhardt
doi : 10.1161/STROKEAHA.121.033289
Stroke. 2021;52:2694–2696
Cognitive Impairment and Dementia After Stroke: Design and Rationale for the DISCOVERY Study
Natalia S. Rost, James F. Meschia, Rebecca Gottesman, Lisa Wruck, Karl Helmer, Steven M. Greenberg, on behalf of the DISCOVERY Investigators*
doi : 10.1161/STROKEAHA.120.031611
Stroke. 2021;52:e499–e516
Stroke is a leading cause of the adult disability epidemic in the United States, with a major contribution from poststroke cognitive impairment and dementia (PSCID), the rates of which are disproportionally high among the health disparity populations. Despite the PSCID’s overwhelming impact on public health, a knowledge gap exists with regard to the complex interaction between the acute stroke event and highly prevalent preexisting brain pathology related to cerebrovascular and Alzheimer disease or related dementia. Understanding the factors that modulate PSCID risk in relation to index stroke event is critically important for developing personalized prognostication of PSCID, targeted interventions to prevent it, and for informing future clinical trial design. The DISCOVERY study (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery), a collaborative network of thirty clinical performance clinical sites with access to acute stroke populations and the expertise and capacity for systematic assessment of PSCID will address this critical challenge. DISCOVERY is a prospective, multicenter, observational, nested-cohort study of 8000 nondemented ischemic and hemorrhagic stroke patients enrolled at the time of index stroke and followed for a minimum of 2 years, with serial cognitive evaluations and assessments of functional outcome, with subsets undergoing research magnetic resonance imaging and positron emission tomography and comprehensive genetic/genomic and fluid biomarker testing. The overall scientific objective of this study is to elucidate mechanisms of brain resilience and susceptibility to PSCID in diverse US populations based on complex interplay between life-course exposure to multiple vascular risk factors, preexisting burden of microvascular and neurodegenerative pathology, the effect of strategic acute stroke lesions, and the mediating effect of genomic and epigenomic variation.
Inflammation and Stroke Risk: A New Target for Prevention
Peter J. Kelly, Robin Lemmens, Georgios Tsivgoulis
doi : 10.1161/STROKEAHA.121.034388
Stroke. 2021;52:2697–2706
New therapeutic approaches are required for secondary prevention of residual vascular risk after stroke. Diverse sources of evidence support a causal role for inflammation in the pathogenesis of stroke. Randomized controlled trials of anti-inflammatory agents have reported benefit for secondary prevention in patients with coronary disease. We review the data from observational studies supporting a role for inflammation in pathogenesis of stroke, overview randomized controlled trials of anti-inflammatory therapy in cardiac disease and discuss the potential implications for stroke prevention therapy.
Cerebral Amyloid Angiopathy and the Fibrinolytic System: Is Plasmin a Therapeutic Target?
Chloe A. Mutimer, Charithani B. Keragala, Hugh S. Markus, David J. Werring, Geoffrey C. Cloud, Robert L. Medcalf
doi : 10.1161/STROKEAHA.120.033107
Stroke. 2021;52:2707–2714
Cerebral amyloid angiopathy is a devastating cause of intracerebral hemorrhage for which there is no specific secondary stroke prevention treatment. Here we review the current literature regarding cerebral amyloid angiopathy pathophysiology and treatment, as well as what is known of the fibrinolytic pathway and its interaction with amyloid. We postulate that tranexamic acid is a potential secondary stroke prevention treatment agent in sporadic cerebral amyloid angiopathy, although further research is required.
Reexamination of the Embolic Stroke of Undetermined Source Concept
Gregory W. Albers, Richard Bernstein, Johannes Brachmann, A. John Camm, Peter Fromm, Shinya Goto, Christopher B. Granger, Stefan H. Hohnloser, Elaine Hylek, Derk Krieger, Rod Passman, Jesse M. Pines, Peter Kowey
doi : 10.1161/STROKEAHA.121.035208
Stroke. 2021;52:2715–2722
Occult atrial fibrillation (AF) is a leading cause of stroke of unclear cause. The optimal approach to secondary stroke prevention for these patients remains elusive. The term embolic stroke of undetermined source (ESUS) was coined to describe ischemic strokes in which the radiographic features demonstrate territorial infarcts resembling those seen in patients with confirmed sources of embolism but without a clear source of embolism detected. It was assumed that patients with ESUS had a high rate of occult AF and would benefit from treatment with direct oral anticoagulants, which are at least as effective as vitamin K antagonists for secondary stroke prevention in patients with AF, but with a much lower risk of intracerebral hemorrhage. Two recent large randomized trials failed to show superiority of direct oral anticoagulants over aspirin in ESUS patients. These findings prompt a reexamination of the ESUS concept, with the goal of improving specificity for detecting patients with a cardioembolic cause. Based on the negative trial results, there is renewed interest in the role of long-term cardiac monitoring for AF in patients who fit the current ESUS definition, as well as the clinical implication of detecting AF. Ongoing trials are exploring these questions. Current ESUS definitions do not accurately detect the patients who should be prescribed direct oral anticoagulants, potentially because occult AF is less common than expected in these patients and/or anticoagulants may be less beneficial in patients with ESUS but no AF than they are for patients with stroke with established AF. More specific criteria to identify patients who may be at higher risk for occult AF and reduce their risk of subsequent stroke have been developed and are being tested in ongoing clinical trials.
Acute Stroke Imaging Research Roadmap IV: Imaging Selection and Outcomes in Acute Stroke Clinical Trials and Practice
Bruce C.V. Campbell, Maarten G. Lansberg, Joseph P. Broderick, Colin P. Derdeyn, Pooja Khatri, Amrou Sarraj, Jeffrey L. Saver, Achala Vagal, Gregory W. Albers, on behalf of the STAIR XI Consortium†
doi : 10.1161/STROKEAHA.121.035132
Stroke. 2021;52:2723–2733
The Stroke Treatment Academic Industry Roundtable (STAIR) sponsored an imaging session and workshop during the Stroke Treatment Academic Industry Roundtable XI via webinar on October 1 to 2, 2020, to develop consensus recommendations, particularly regarding optimal imaging at primary stroke centers.
Organizational Update From the European Stroke Organisation
Martin Dichgans, Else Charlotte Sandset, Peter Kelly
doi : 10.1161/STROKEAHA.121.035358
Stroke. 2021;52:e517–e519
Starting Your Independent Research Laboratory
Adrian Liston, Sylvie Lesage
doi : 10.1161/STROKEAHA.121.035333
Stroke. 2021;52:e520–e522
Correction to: Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation
doi : 10.1161/STR.0000000000000381
Stroke. 2021;52:e523
Correction to: Outcomes of Large Vessel Occlusion Stroke in Patients Aged ?90 Years
doi : 10.1161/STR.0000000000000384
Stroke. 2021;52:e524
Correction to: Hemostatic Efficacy and Anti-FXa (Factor Xa) Reversal With Andexanet Alfa in Intracranial Hemorrhage: ANNEXA-4 Substudy
doi : 10.1161/STR.0000000000000386
Stroke. 2021;52:e525
Correction to: Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial
doi : 10.1161/STR.0000000000000387
Stroke. 2021;52:e526
