Guidelines for the Early Management of Patients With Ischemic Stroke

Adams, Harold P.; Adams, Robert J.; Zoppo, Gregory del; Goldstein, Larry B.

doi:10.1161/01.str.0000163257.66207.2d

Cited by 405 publications

(175 citation statements)

References 74 publications

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“…12,13,15,16 All patients were diagnosed with nonlacunar ischemic stroke by a board certified neurologist and underwent initial brain CT (computed tomography) scan followed by brain MRI (magnetic resonance imaging) studies, or repeat brain CT (if MRI was contraindicated) within 12 to 24 hours to confirm the presence of cerebral ischemia. 17 The diagnosis of nonlacunar ischemic stroke was based on clinical and imaging data and published criteria. 14 Additional investigations included carotid ultrasound studies and echocardiogram/ECG, along with routine laboratory studies including coagulation studies and complete blood count, serum chemistry, troponin, and creatine kinase levels.…”

Section: Materials and Methods Subjectsmentioning

confidence: 99%

Higher Coated-Platelet Levels are Associated with Stroke Recurrence following Nonlacunar Brain Infarction

Prodan

Stoner

Cowan

et al. 2012

J Cereb Blood Flow Metab

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Coated-platelets are procoagulant platelets observed upon dual-agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with nonlacunar (large-vessel) ischemic stroke and decreased in patients with spontaneous intracerebral hemorrhage as compared with controls. The purpose of this study was to investigate a possible relationship between coated-platelet levels and stroke recurrence in patients with nonlacunar ischemic stroke. We assayed coated-platelet levels in 190 consecutive patients with nonlacunar stroke who were followed for up to 12 months; 20 subjects experienced recurrent stroke. Subjects were categorized into tertiles of coated-platelet levels. The distributions of time-to-recurrent stroke were estimated for each tertile using cumulative incidence curves and compared statistically using a log-rank test. The cumulative incidence of recurrent stroke at 12 months differed among the coated-platelet tertiles: 2% for the first tertile (lowest coated-platelet levels), 18% for the second tertile, and 17% for the third tertile (overall log-rank test, P ¼ 0.019). These data suggest that higher levels of coated-platelets, measured shortly after a nonlacunar stroke, are associated with an increased incidence of stroke recurrence. This observation offers an additional tool for identifying patients at highest risk for stroke recurrence following a nonlacunar (large-vessel) infarct.

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Section: Materials and Methods Subjectsmentioning

confidence: 99%

Higher Coated-Platelet Levels are Associated with Stroke Recurrence following Nonlacunar Brain Infarction

Prodan

Stoner

Cowan

et al. 2012

J Cereb Blood Flow Metab

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“…As it has been shown that severe dysfunctions in cerebral activity and neurobehavior can persist despite normal appearing brain on DWI, perfusion-weighted imaging (PWI), and T2WI , further research is warranted to understand the mechanisms underlying SSD. However, most experimental data regarding transient MCAO were derived with suture MCAO models (Li et al, 2000;Neumann-Haefelin et al, 2000;Sicard et al, 2006), which do not reliably reproduce the inhomogeneous vascular findings in patients suffering from acute territorial stroke (Adams et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Spectacular Shrinking Deficit: Insights from Multimodal Magnetic Resonance Imaging after Embolic Middle Cerebral Artery Occlusion in Sprague—Dawley Rats

Henninger

Sicard

Fisher

2007

J Cereb Blood Flow Metab

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Almost no data is available on the serial changes in the brain after spectacular shrinking deficit (SSD) that may help understand this relatively rare clinical phenomenon. Quantitative diffusion-(DWI), perfusion-(PWI), T 1 -(T1WI), T 2 -weighted (T2WI), and functional magnetic resonance imaging (fMRI) were performed before, during, and up to 7 days after embolic middle cerebral artery occlusion (eMCAO) in male Sprague-Dawley rats (n = 9). Region of interest (ROI) analysis was used to evaluate structural and functional MR signal changes within three ROIs defined by the apparent diffusion coefficient (ADC), cerebral blood flow (CBF) signatures, and final tissue viability. DWI, PWI, and T2WI lesion volumes were calculated using previously established viability thresholds and final infarct volumes ascertained with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Serial MRI demonstrated spontaneous reperfusion of initially hypoperfused MCA regions accompanied by substantial reduction of initial ADC and CBF lesions and gradual recovery of neurological outcome. Recovery rates of CBF/ADC abnormalities differed among ROIs. Functional magnetic resonance imaging showed persistent tissue dysfunction after the recovery of the CBF/ADC lesions. This study may facilitate our understanding of the pathophysiological mechanisms by which early, spontaneous reperfusion affects tissue fate and neurological function.

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“…[8] The following diagnosis of cerebral infarction was made in accordance with the standards for diagnosis of cerebral infarction formulated at the Fourth National Congress on Cerebrovascular Disease in 1995 and with the National Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2010. [9] The standards or guidelines included: (1) age, 18 – 80 years old; (2) time point, within 6 hours after ACI; (3) physical signs of brain function damage persisted for 1 hour, and paralysis <degree 3; (4) intracranial hemorrhage excluded by cerebral CT, and no images indicating massive cerebral infarction; (5) informed consent form signed by the patient or his/her family.…”

Section: Methodsmentioning

confidence: 99%

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

Liu

Wang

Liu

et al. 2013

World Journal of Emergency Medicine

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BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator (rt-PA) on the onset of acute cerebral infarction (ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5–6 hours after ACI.RESULTS:National Institute of Health Stroke Scale (NIHSS) scores were statistically decreased in both groups (P>0.05) at 24 hours and 7 days after ACI. There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups (P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5–6 hours after the onset of the disease were similar to those in patients who received rt-PA within 4.5 hours after the onset of this disease. Therefore, intravenous thrombolytic therapy for ACI within 4.5–6 hours after ACI was effective and safe.

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Guidelines for the Early Management of Patients With Ischemic Stroke

Cited by 405 publications

References 74 publications

Higher Coated-Platelet Levels are Associated with Stroke Recurrence following Nonlacunar Brain Infarction

Higher Coated-Platelet Levels are Associated with Stroke Recurrence following Nonlacunar Brain Infarction

Spectacular Shrinking Deficit: Insights from Multimodal Magnetic Resonance Imaging after Embolic Middle Cerebral Artery Occlusion in Sprague—Dawley Rats

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

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