Base de dados : MEDLINE
Pesquisa : C10.228.140.300.510.200 [Categoria DeCS]
Referências encontradas : 2299 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 230 ir para página                         

  1 / 2299 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28457621
[Au] Autor:Demeestere J; Garcia-Esperon C; Lin L; Bivard A; Ang T; Smoll NR; Garnett A; Loudfoot A; Miteff F; Spratt N; Parsons M; Levi C
[Ad] Endereço:Acute Stroke Service, John Hunter Hospital, Newcastle, New South Wales, Australia.
[Ti] Título:Validation of the National Institutes of Health Stroke Scale-8 to Detect Large Vessel Occlusion in Ischemic Stroke.
[So] Source:J Stroke Cerebrovasc Dis;26(7):1419-1426, 2017 Jul.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy. AIMS: We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO. METHODS: We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS). LVO was identified on admission computed tomography angiography. Accuracy to identify LVO was calculated using receiver operating characteristics analysis. We used weighted Cohen's kappa statistics to assess inter-rater reliability for the NIHSS-8 score between the EMS and the hospital stroke team on a prospectively evaluated subgroup. RESULTS: Of the 551 included patients, 381 had a confirmed ischemic stroke and 136 patients had an LVO. NIHSS scores were significantly higher in patients with LVO (median 18; interquartile range 14-22). The NIHSS-8 score reliably predicted the presence of LVO (area under the receiver operating characteristic curve .82). The optimum NIHSS-8 cutoff of 8 or more had a sensitivity of .81, specificity of .75, and Youden index of .56 for prediction of LVO. The EMS and the stroke team reached substantial agreement (κ = .69). CONCLUSIONS: Accuracy of the NIHSS-8 to identify LVO in a population of patients with suspected acute stroke is comparable to existing prehospital stroke scales. The scale can be performed by EMS with reasonable reliability. Further validation in the field is needed to assess accuracy of the scale to identify patients with LVO eligible for endovascular treatment in a prehospital setting.
[Mh] Termos MeSH primário: Isquemia Encefálica/diagnóstico
Doenças Arteriais Cerebrais/diagnóstico
Lista de Checagem
Técnicas de Apoio para a Decisão
Avaliação da Deficiência
Acidente Vascular Cerebral/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Área Sob a Curva
Isquemia Encefálica/fisiopatologia
Isquemia Encefálica/psicologia
Isquemia Encefálica/terapia
Doenças Arteriais Cerebrais/fisiopatologia
Doenças Arteriais Cerebrais/psicologia
Doenças Arteriais Cerebrais/terapia
Angiografia por Tomografia Computadorizada
Serviços Médicos de Emergência
Feminino
Seres Humanos
Masculino
Meia-Idade
Variações Dependentes do Observador
Valor Preditivo dos Testes
Estudos Prospectivos
Curva ROC
Reprodutibilidade dos Testes
Acidente Vascular Cerebral/fisiopatologia
Acidente Vascular Cerebral/psicologia
Acidente Vascular Cerebral/terapia
Transporte de Pacientes
Triagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180109
[Lr] Data última revisão:
180109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


  2 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28867358
[Au] Autor:Kralik SF; Watson GA; Shih CS; Ho CY; Finke W; Buchsbaum J
[Ad] Endereço:Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: steve.kralik@gmail.com.
[Ti] Título:Radiation-Induced Large Vessel Cerebral Vasculopathy in Pediatric Patients With Brain Tumors Treated With Proton Radiation Therapy.
[So] Source:Int J Radiat Oncol Biol Phys;99(4):817-824, 2017 Nov 15.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The purpose of this research was to evaluate the incidence, time to development, imaging patterns, risk factors, and clinical significance of large vessel cerebral vasculopathy in pediatric patients with brain tumors treated with proton radiation therapy. METHODS AND MATERIALS: A retrospective study was performed on 75 consecutive pediatric patients with primary brain tumors treated with proton radiation therapy. Radiation-induced large vessel cerebral vasculopathy (RLVCV) was defined as intracranial large vessel arterial stenosis or occlusion confirmed on magnetic resonance angiography, computed tomographic angiography, catheter angiography, or a combination of these within an anatomic region with previous exposure to proton beam therapy and not present before radiation therapy. Clinical records were used to determine the incidence, timing, radiation dose to the large vessels, and clinical significance associated with the development of large vessel vasculopathy in these patients. RESULTS: RLVCV was present in 5 of 75 (6.7%) patients and included tumor pathologic features of craniopharyngioma (n=2), ATRT (n=1), medulloblastoma (n=1), and anaplastic astrocytoma (n=1). The median time from completion of radiation therapy to development was 1.5 years (mean, 3.0 years; range, 1.0-7.5 years). Neither mean age at the time of radiation therapy (5.1 years) nor mean radiation therapy dose to the large vessels (54.5 Gy) was a statistically significant risk factor. Four of the 5 patients with RLVCV presented with acute stroke and demonstrated magnetic resonance imaging evidence of acute infarcts in the expected vascular distributions. Angiography studies demonstrated collateral vessel formation in only 2 of the patients with RLVCV. No patients demonstrated acute hemorrhage or aneurysm. Two patients were treated with pial synangiomatosis surgery. CONCLUSIONS: RLVCV can occur in pediatric patients with brain tumors treated with proton radiation therapy. Further studies are necessary to determine potential risk factors for large vessel vasculopathy with proton radiation therapy in comparison with conventional photon radiation therapy.
[Mh] Termos MeSH primário: Neoplasias Encefálicas/radioterapia
Doenças Arteriais Cerebrais/etiologia
Artérias Cerebrais/efeitos da radiação
Terapia com Prótons/efeitos adversos
Lesões por Radiação/complicações
[Mh] Termos MeSH secundário: Adolescente
Astrocitoma/irrigação sanguínea
Astrocitoma/tratamento farmacológico
Neoplasias Encefálicas/irrigação sanguínea
Doenças Arteriais Cerebrais/diagnóstico por imagem
Artérias Cerebrais/diagnóstico por imagem
Criança
Pré-Escolar
Constrição Patológica/diagnóstico por imagem
Constrição Patológica/etiologia
Craniofaringioma/irrigação sanguínea
Craniofaringioma/radioterapia
Feminino
Seres Humanos
Lactente
Masculino
Meduloblastoma/irrigação sanguínea
Meduloblastoma/tratamento farmacológico
Lesões por Radiação/diagnóstico por imagem
Dosagem Radioterapêutica
Estudos Retrospectivos
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


  3 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28733481
[Au] Autor:Steinlin M; Bigi S; Stojanovski B; Gajera J; Regényi M; El-Koussy M; Mackay MT; Swiss NeuroPediatric Stroke Registry
[Ad] Endereço:From the Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (M.S., S.B., M.R.); Department of Neurology, Royal Children's Hospital Melbourne, Murdoch Children's Research Institute Melbourne, Parkville, Victoria, Australia (B.S.
[Ti] Título:Focal Cerebral Arteriopathy: Do Steroids Improve Outcome?
[So] Source:Stroke;48(9):2375-2382, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Focal cerebral arteriopathy accounts for up to 35% of arterial ischemic stroke (AIS) in children and is the most important predictor of stroke recurrence. The study objective was to compare outcomes for children with focal cerebral arteriopathy treated with combined corticosteroid antithrombotic treatment (CAT) to those receiving antithrombotic treatment (AT) alone. METHODS: This multicenter retrospective Swiss/Australian cohort study analyzed consecutive children, aged 1 month to 18 years, presenting with first AIS because of a focal cerebral arteriopathy from 2000 to 2014. Children with CAT were compared with those treated with AT. Primary outcome was the presence of neurological deficits at 6 months post-AIS as measured by the Pediatric Stroke Outcome Measure. Secondary outcomes included resolution of stenosis and stroke recurrence. Analysis of covariance was used to adjust for potential confounders (baseline pediatric National Institute of Health Stroke Scale and concomitant acyclovir use). RESULTS: A total of 73 children (51% males) were identified, 21 (29%) of whom received CAT. Mean (SD) age at stroke for the entire group was 7.9 years (4.7). Median (interquartile range) pediatric National Institute of Health Stroke Scale was 3 (2.0-8.0) in the CAT group and 5 (3.0-9.0) in the AT group ( =0.098). Median (interquartile range) Pediatric Stroke Outcome Measure 6 months post-AIS was 0.5 (0-1.5) in the CAT group compared with 1.0 (0.5-2.0) in the AT group ( =0.035), the finding was sustained after adjusting for potential confounders. Complete resolution of stenosis at last MRI was noted in 17 (81%) in the CAT group compared with 24 (59%) in the AT group ( =0.197). Stroke recurrence occurred in 1 patient in each group. CONCLUSIONS: Corticosteroid treatment may provide additional benefit over AT for improved neurological outcome in childhood AIS because of focal cerebral arteriopathy. Larger prospective studies are warranted to further investigate these differences and understand mechanisms by which steroids modify outcome.
[Mh] Termos MeSH primário: Isquemia Encefálica/tratamento farmacológico
Doenças Arteriais Cerebrais/tratamento farmacológico
Fibrinolíticos/uso terapêutico
Glucocorticoides/uso terapêutico
Metilprednisolona/uso terapêutico
Acidente Vascular Cerebral/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Isquemia Encefálica/diagnóstico por imagem
Criança
Pré-Escolar
Quimioterapia Combinada
Feminino
Seres Humanos
Lactente
Imagem por Ressonância Magnética
Masculino
Estudos Retrospectivos
Acidente Vascular Cerebral/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents); 0 (Glucocorticoids); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016818


  4 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28576782
[Au] Autor:Bivard A; Huang X; Levi CR; Spratt N; Campbell BCV; Cheripelli BK; Kalladka D; Moreton FC; Ford I; Bladin CF; Davis SM; Donnan GA; Muir KW; Parsons MW
[Ad] Endereço:From the Department of Neurology (A.B., C.R.L., N.S., M.W.P.), John Hunter Hospital, University of Newcastle, Australia; Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital (X.H., B.K.C., D.K., F.C.M., I.F., K.W.M.), and Robertson Centre for Biostatistics (I.F.), University
[Ti] Título:Tenecteplase in ischemic stroke offers improved recanalization: Analysis of 2 trials.
[So] Source:Neurology;89(1):62-67, 2017 Jul 04.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To test whether patients with complete vessel occlusion show greater recanalization at 24 hours and have improved clinical outcomes at 24 hours and 90 days when treated with tenecteplase compared to alteplase. METHODS: Pooled clinical and imaging data from 2 phase 2 randomized trials comparing tenecteplase with alteplase allowed CT angiography (CTA) scans to be assessed centrally for occlusion status at baseline and at 24 hours post thrombolysis using the modified thrombolysis in cerebral infarction (TICI) scale. Twenty-four-hour poststroke NIH Stroke Scale (NIHSS) and 90-day modified Rankin Scale (mRS) scores were also compared between treatment groups using linear regression to generate odds ratios (ORs). RESULTS: From 146 pooled patients, 69 had a TICI 0/1 occlusion overall at baseline. Tenecteplase-treated patients with a complete vessel occlusion had greater complete recanalization rates at 24 hours (71% for tenecteplase vs 43% for alteplase, < 0.001). Patients with a TICI 0/1 occlusion who were treated with tenecteplase also showed greater early clinical improvement (median NIHSS change with tenecteplase was 9, interquartile range [IQR] 6, alteplase 1, IQR 1, = 0.001) and higher rates of favorable 90-day outcomes (mRS 0-1 of tenecteplase compared with alteplase, OR 4.82, 95% confidence interval 1.02-7.84, = 0.05). CONCLUSIONS: Tenecteplase may offer greater recanalization efficacy compared to alteplase, possibly exaggerated in patients with complete vessel occlusions on baseline CTA.
[Mh] Termos MeSH primário: Isquemia Encefálica/diagnóstico por imagem
Isquemia Encefálica/tratamento farmacológico
Fibrinolíticos/farmacologia
Avaliação de Resultados (Cuidados de Saúde)
Índice de Gravidade de Doença
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/tratamento farmacológico
Ativador de Plasminogênio Tecidual/farmacologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/diagnóstico por imagem
Angiografia Cerebral
Doenças Arteriais Cerebrais/diagnóstico por imagem
Feminino
Fibrinolíticos/administração & dosagem
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Método Simples-Cego
Ativador de Plasminogênio Tecidual/administração & dosagem
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator); WGD229O42W (tenecteplase)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170604
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004062


  5 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28492918
[Au] Autor:McTaggart RA; Yaghi S; Cutting SM; Hemendinger M; Baird GL; Haas RA; Furie KL; Jayaraman MV
[Ad] Endereço:Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island2Department of Neurology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island3Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Provide
[Ti] Título:Association of a Primary Stroke Center Protocol for Suspected Stroke by Large-Vessel Occlusion With Efficiency of Care and Patient Outcomes.
[So] Source:JAMA Neurol;74(7):793-800, 2017 Jul 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: While prehospital triage to the closest comprehensive stroke center (CSC) may improve the delivery of care for patients with suspected emergent large-vessel occlusion (ELVO), efficient systems of care must also exist for patients with ELVO who first present to a primary stroke center (PSC). Objective: To describe the association of a PSC protocol focused on 3 key steps (early CSC notification based on clinical severity, vessel imaging at the PSC, and cloud-based image sharing) with the efficiency of care and the outcomes of patients with suspected ELVO who first present to a PSC. Design, Setting, and Participants: In this retrospective cohort study, 14 regional PSCs unfamiliar with the management of patients with ELVO were instructed on the use of the following protocol for patients presenting with a Los Angeles Motor Scale score 4 or higher: (1) notify the CSC on arrival, (2) perform computed tomographic angiography concurrently with noncontract computed tomography of the brain and within 30 minutes of arrival, and (3) share imaging data with the CSC using a cloud-based platform. A total of 101 patients were transferred from regional PSCs to the CSC between July 1, 2015, and May 31, 2016, and received mechanical thrombectomy for acute ischemic stroke. The CSC serves approximately 1.7 million people and partners with 14 PSCs located between 6.4 and 73.6 km away. All consecutive patients with internal carotid artery or middle cerebral artery occlusions transferred over an 11-month period were reviewed, and they were divided into 2 groups based on whether the PSC protocol was partially or fully executed. Main Outcomes and Measures: The primary outcomes were efficiency measures including time from PSC door in to PSC door out, time from PSC door to CSC groin puncture, and 90-day modified Rankin Scale score (range, 0-6; scores of 0-2 indicate a good outcome). Results: Although 101 patients were transferred, only 70 patients met the inclusion criteria during the study period. The protocol was partially executed for 48 patients (68.6%) (mean age, 77 years [interquartile range, 65-84 years]; 22 of the 48 patients [45.0%] were women) and fully executed for 22 patients (31.4%) (mean age, 76 years [interquartile range, 59-86 years]; 13 of the 22 patients [59.1%] were women). When fully executed, the protocol was associated with a reduction in the median time for PSC arrival to CSC groin puncture (from 151 minutes [95% CI, 141-166 minutes] to 111 minutes [95% CI, 88-130 minutes]; P < .001). This was primarily related to an improvement in the time from PSC door in to door out that reduced from a median time of 104 minutes (95% CI, 82-112 minutes) to a median time of 64 minutes (95% CI, 51-71.0 minutes) (P < .001). When the protocol was fully executed, patients were twice as likely to have a favorable outcome (50% vs 25%, P < .04). Conclusions and Relevance: When fully implemented, a standardized protocol at PSCs for patients with suspected ELVO consisting of early CSC notification, computed tomographic angiography on arrival to the PSC, and cloud-based image sharing is associated with a reduction in time to groin puncture and improved outcomes.
[Mh] Termos MeSH primário: Arteriopatias Oclusivas/terapia
Doenças Arteriais Cerebrais/terapia
Protocolos Clínicos/normas
Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Hospitais Especializados/estatística & dados numéricos
Trombólise Mecânica/estatística & dados numéricos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/diagnóstico por imagem
Doenças Arteriais Cerebrais/diagnóstico por imagem
Serviço Hospitalar de Emergência/normas
Feminino
Hospitais Especializados/normas
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Índice de Gravidade de Doença
Acidente Vascular Cerebral/diagnóstico por imagem
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2017.0477


  6 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28389614
[Au] Autor:Bouslama M; Haussen DC; Grossberg JA; Dehkharghani S; Bowen MT; Rebello LC; Bianchi NA; Frankel MR; Nogueira RG
[Ad] Endereço:From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
[Ti] Título:Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke.
[So] Source:Stroke;48(5):1271-1277, 2017 May.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with noncontrast computed tomography alone. METHODS: Review of a prospectively collected registry of anterior circulation stroke patients undergoing stent-retriever thrombectomy at a tertiary care center between September 2010 and March 2016. Patients undergoing CTP were compared with those with noncontrast computed tomography alone. The primary outcome was the shift in the 90-day modified Rankin scale (mRS). RESULTS: A total of 602 patients were included. CTP-selected patients (n=365, 61%) were younger ( =0.02) and had fewer comorbidities. CTP selection (n=365, 61%) was associated with a favorable 90-day mRS shift (adjusted odds ratio [aOR]=1.49; 95% confidence interval [CI], 1.06-2.09; =0.02), higher rates of good outcomes (90-day mRS score 0-2: 52.9% versus 40.4%; =0.005), modified Thrombolysis in Cerebral Infarction-3 reperfusion (54.8% versus 40.1%; <0.001), smaller final infarct volumes (24.7 mL [9.8-63.1 mL] versus 34.6 mL [13.1-88 mL]; =0.017), and lower mortality (16.6% versus 26.8%; =0.005). When matched on age, National Institutes of Health Stroke Scale (NIHSS) score, and glucose (n=424), CTP remained associated with a favorable 90-day mRS shift ( =0.016), lower mortality ( =0.02), and higher rates of reperfusion ( <0.001). CTP better predicted functional outcomes in patients presenting after 6 hours (as assessed by comparison of logistic regression models: Akaike information criterion: 199.35 versus 287.49 and Bayesian information criterion: 196.71 versus 283.27) and those with an Alberta Stroke Program Early Computed Tomography Score ≤7 (Akaike information criterion: 216.69 versus 334.96 and Bayesian information criterion: 213.6 versus 329.94). CONCLUSIONS: CTP selection is associated with a favorable mRS shift in patients undergoing stent-retriever thrombectomy. Future prospective studies are warranted.
[Mh] Termos MeSH primário: Arteriopatias Oclusivas/diagnóstico por imagem
Doenças Arteriais Cerebrais/diagnóstico por imagem
Circulação Cerebrovascular
Avaliação de Resultados (Cuidados de Saúde)
Sistema de Registros
Índice de Gravidade de Doença
Acidente Vascular Cerebral/diagnóstico por imagem
Trombectomia/métodos
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/complicações
Doenças Arteriais Cerebrais/complicações
Feminino
Seres Humanos
Masculino
Meia-Idade
Seleção de Pacientes
Estudos Retrospectivos
Stents
Acidente Vascular Cerebral/etiologia
Trombectomia/instrumentação
Tomografia Computadorizada por Raios X/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170409
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.015636


  7 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28373302
[Au] Autor:Hao Y; Yang D; Wang H; Zi W; Zhang M; Geng Y; Zhou Z; Wang W; Xu H; Tian X; Lv P; Liu Y; Xiong Y; Liu X; Xu G; ACTUAL Investigators (Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry)
[Ad] Endereço:From the Department of Neurology, Jinling Hospital, Southern Medical University (Guangzhou), Nanjing, China (Y.H., X.L., G.X.); Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China (Y.H.); Department of Neurology, Jinling Hospital, Se
[Ti] Título:Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke.
[So] Source:Stroke;48(5):1203-1209, 2017 May.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice. METHODS: Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH. RESULTS: Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; <0.001). On multivariate analysis, baseline neutrophil ratio >0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.24-3.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of <6 (OR, 2.27; 95% CI, 1.24-4.14), stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture >270 minutes (OR, 1.70; 95% CI, 1.03-2.80), >3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment. CONCLUSIONS: Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH.
[Mh] Termos MeSH primário: Isquemia Encefálica/terapia
Hemorragias Intracranianas/etiologia
Sistema de Registros
Stents
Acidente Vascular Cerebral/terapia
Trombectomia/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/complicações
Arteriopatias Oclusivas/epidemiologia
Isquemia Encefálica/epidemiologia
Isquemia Encefálica/etiologia
Doenças Arteriais Cerebrais/complicações
Doenças Arteriais Cerebrais/epidemiologia
China/epidemiologia
Feminino
Seres Humanos
Hemorragias Intracranianas/diagnóstico
Hemorragias Intracranianas/epidemiologia
Masculino
Meia-Idade
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/etiologia
Trombectomia/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016368


  8 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28319240
[Au] Autor:Gerschenfeld G; Muresan IP; Blanc R; Obadia M; Abrivard M; Piotin M; Alamowitch S
[Ad] Endereço:Service de Neurologie et d'Urgences Neurovasculaires, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.
[Ti] Título:Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic Stroke.
[So] Source:JAMA Neurol;74(5):549-556, 2017 May 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) is recommended to treat acute ischemic stroke (AIS) with a large vessel occlusion (LVO). Most hospitals do not have on-site MT facilities, and most patients need to be transferred secondarily after IVT (drip and ship), which may have an effect on the neurologic outcome. Objective: To compare the functional independence at 3 months between patients treated under the drip-and-ship paradigm and those treated on site (mothership). Design, Setting, and Participants: This study used a prospectively gathered registry of patients with AIS to select patients admitted through the Saint-Antoine and Tenon (drip and ship) or the Fondation Rothschild (mothership) hospitals from January 1, 2013, through April 30, 2016. The study included patients older than 18 years treated with bridging therapy for AIS with LVO of the anterior circulation. Among the 159 patients who received MT at the mothership, 100 had been transferred after IVT from the drip-and-ship hospitals and 59 had received IVT on site. Main Outcomes and Measures: The main outcome was 3-month functional independence (modified Rankin scale score ≤2). Both groups were compared using a multivariate linear model, including variables that were significantly different in the 2 groups. Results: During the study period, 497 patients were hospitalized at the drip-and-ship and mothership hospitals for an AIS eligible to reperfusion therapy; 11 patients had a basilar artery occlusion and were excluded, leaving 100 patients in the drip-and-ship group (mean age, 73 years; age range, 60-81 years; 57 men [57.0%]) and 59 in the mothership group (mean age, 70 years; age range, 58-82 years; 29 men [49.2%]). The proportion of patients with a favorable neurologic outcome at 3 months was similar in both groups (drip and ship, 61 [61.0%]; mothership, 30 [50.8%]; P = .26), even after adjusting the analysis for the baseline National Institutes of Health Stroke Scale score, diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, and general anesthesia (P = .82). Patients had less severe conditions in the drip-and-ship group (median baseline National Institutes of Health Stroke Scale score, 15 vs 17 [P = .03]; median diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, 7.5 vs 7 [P = .05]). Process times were longer in the drip-and-ship group (onset-to-needle time, 150 vs 135 minutes; onset-to-puncture time, 248 vs 189 minutes; and onset-to-recanalization time, 297 vs 240 minutes; P < .001). Both groups were similar in terms of substantial recanalization (Thrombolysis in Cerebral Ischemia scores 2B to 3; drip and ship, 84 [84.0%]; mothership, 47 [79.7%]; P = .49) and symptomatic hemorrhagic transformation (drip and ship, 2 [2.0%]; mothership, 2 [3.4%]; P = .63). Conclusions and Relevance: This study found that patients treated under the drip-and-ship paradigm also benefit from bridging therapy, with no statistically significant difference compared with those treated directly in a comprehensive stroke center.
[Mh] Termos MeSH primário: Isquemia Encefálica/terapia
Trombólise Mecânica/estatística & dados numéricos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Sistema de Registros/estatística & dados numéricos
Acidente Vascular Cerebral/terapia
Terapia Trombolítica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/terapia
Doenças Arteriais Cerebrais/terapia
Feminino
Seguimentos
Seres Humanos
Masculino
Trombólise Mecânica/métodos
Meia-Idade
Paris
Transferência de Pacientes/estatística & dados numéricos
Terapia Trombolítica/métodos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170321
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2016.5823


  9 / 2299 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28292867
[Au] Autor:Millán M; Remollo S; Quesada H; Renú A; Tomasello A; Minhas P; Pérez de la Ossa N; Rubiera M; Llull L; Cardona P; Al-Ajlan F; Hernández M; Assis Z; Demchuk AM; Jovin T; Dávalos A; REVASCAT Trial Investigators
[Ad] Endereço:From the Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Spain (M.M., S.R., N.P.d.l.O., M.H., A.D.); Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain (
[Ti] Título:Vessel Patency at 24 Hours and Its Relationship With Clinical Outcomes and Infarct Volume in REVASCAT Trial (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset).
[So] Source:Stroke;48(4):983-989, 2017 Apr.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Higher rates of target vessel patency at 24 hours were noted in the thrombectomy group compared with control group in recent randomized trials. As a prespecified secondary end point, we aimed to assess 24-hour revascularization rates by treatment groups and occlusion site as they related to clinical outcome and 24-hour infarct volume in REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset). METHODS: Independent core laboratory adjudicated vessel status according to modified arterial occlusive lesion classification at 24 hours on computed tomographic/magnetic resonance (94.2%/5.8%) angiography and 24-hour infarct volume on computed tomography were studied (95/103 patients in the thrombectomy group versus 94/103 in the control group, respectively). Complete revascularization was defined as modified arterial occlusive lesion grade 3. Its effect on clinical outcome was analyzed by ordinal logistic regression. RESULTS: Complete revascularization was achieved in 70.5% of the solitaire group and in 22.3% of the control group ( <0.001). Significant differences in complete revascularization rates were found for terminus internal carotid artery, M1, and tandem occlusions (all <0.001) but not for M2 occlusions. In the thrombectomy group, 2 out of 63 patients (3.1%) with modified Thrombolysis in Cerebral Infarction 2b/3 after thrombectomy showed arterial reocclusion (modified arterial occlusive lesion grade 0/1) at 24 hours. Complete revascularization was associated with improved outcome in both thrombectomy (adjusted odds ratio, 4.5; 95% confidence interval, 1.9-10.9) and control groups (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-6.7). Revascularization (modified arterial occlusive lesion grade 2/3) was associated with smaller infarct volumes in either treatment arm. CONCLUSIONS: Complete revascularization at 24 hours is a powerful predictor of favorable clinical outcome, whereas revascularization of any type results in reduced infarct volume in both thrombectomy and control groups. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
[Mh] Termos MeSH primário: Arteriopatias Oclusivas/diagnóstico por imagem
Arteriopatias Oclusivas/terapia
Infarto Encefálico/diagnóstico por imagem
Doenças Arteriais Cerebrais/diagnóstico por imagem
Doenças Arteriais Cerebrais/terapia
Circulação Cerebrovascular
Avaliação de Resultados (Cuidados de Saúde)
Trombectomia/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/complicações
Infarto Encefálico/etiologia
Angiografia Cerebral
Doenças Arteriais Cerebrais/complicações
Angiografia por Tomografia Computadorizada
Feminino
Seres Humanos
Angiografia por Ressonância Magnética
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170605
[Lr] Data última revisão:
170605
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170316
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.015455


  10 / 2299 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28248870
[Au] Autor:Jin ES; Jeong JH; Lee B; Im SB
[Ad] Endereço:aDepartment of Internal Medicine, College of Medicine, Kyung Hee University bDepartment of Neurosurgery, Soonchunhyang University Bucheon Hospital cDepartment of Biostatistic Consulting, Soon Chun Hyang Medical Center, Bucheon, Republic of Korea.
[Ti] Título:Association factor analysis between osteoporosis with cerebral artery disease: The STROBE study.
[So] Source:Medicine (Baltimore);96(9):e6164, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified cerebral artery disease. Some clinical factors such as age, hypertension, and osteoporotic hip fracture, smoking history and anti-osteoporosis drug use were associated with cerebral artery disease.
[Mh] Termos MeSH primário: Doenças Arteriais Cerebrais/epidemiologia
Osteoporose/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
República da Coreia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170324
[Lr] Data última revisão:
170324
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006164



página 1 de 230 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde