Search Our Scientific Publications & Authors

J Neurophysiol 2019 Feb 20. Epub 2019 Feb 20.

Shantou University.

Two macroscopic parameters describe the interstitial diffusion of substances in the extracellular space (ECS) of the brain, the ECS volume fraction α and the diffusion tortuosity λ. Past methods based on sampling the extracellular concentration of a membrane-impermeable ion tracer, such as tetramethyl ammonium (TMA+), can characterize either the dynamic α(t) alone or the constant α and λ in resting state, but never the dynamic α(t) and λ(t) simultaneously in short-lived brain events. In this work, we propose to use a sinusoidal method of TMA+ to provide time-resolved quantification of α(t) and λ(t) in acute brain events. Read More

JACC Clin Electrophysiol 2019 Feb 1;5(2):231-241. Epub 2018 Nov 1.

Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Center for Digital Health, Stanford University School of Medicine, Stanford, California. Electronic address:

Objectives: In this study the authors investigated effectiveness and safety of an initial treatment strategy with class IC or class III antiarrhythmic drugs (AAD) for newly diagnosed atrial fibrillation (AF) or atrial flutter (AFL).

Background: There is limited evidence to guide optimal AAD selection for rhythm control in newly diagnosed AF/AFL.

Methods: Using data from TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF), the authors performed a retrospective cohort study of patients with AF/AFL from 2004 to 2014 and class IC or class III AAD prescription within 90 days following diagnosis. Read More

Lancet Neurol 2019 Mar 12;18(3):248-258. Epub 2019 Feb 12.

Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK.

Background: Risk of dementia after stroke is a major concern for patients and carers. Reliable data for risk of dementia, particularly after transient ischaemic attack or minor stroke, are scarce. We studied the risks of, and risk factors for, dementia before and after transient ischaemic attack and stroke. Read More

Lancet Neurol 2019 Mar 12;18(3):223-225. Epub 2019 Feb 12.

Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Feodor-Lynen-Straße 17, D-81377, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. Electronic address:

SAGE Open Med 2019 4;7:2050312119828261. Epub 2019 Feb 4.

Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA.

Background: We performed a meta-analysis to evaluate the benefit of patent foramen ovale closure in stroke prevention.

Methods: We searched Medline/PubMed, EMBASE, Web of Science and Cochrane central database for randomized control trials assessing the incidence of recurrent stroke after patent foramen ovale closure when compared to medical therapy. Pooled odds ratio and 95% confidence intervals were calculated using a random effects model. Read More

BMJ Open 2019 Feb 19;9(2):e025301. Epub 2019 Feb 19.

Department of Ageing and Stroke Medicine, University of East Anglia, Norwich, UK.

Introduction: Raised blood pressure (BP) is common after stroke and is associated with a poor prognosis, yet trials of BP lowering in the immediate poststroke period have not demonstrated a benefit. One possible explanation for this may be that BP variability (BPV) rather than absolute levels predicts outcome, as BPV is increased after stroke and is associated with poor outcomes. Furthermore, there is evidence of distinct antihypertensive class effects on BPV despite similar BP-lowering effects. Read More

BMJ Open 2019 Feb 19;9(2):e024695. Epub 2019 Feb 19.

Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.

Introduction: Hypertension is a major risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, many stroke survivors have poorly controlled BP after their initial stroke. The Stroke Transitions Education and Prevention (STEP) Clinic was established to provide a comprehensive approach to stroke risk factor reduction. Read More

Acta Neurochir (Wien) 2019 Feb 18. Epub 2019 Feb 18.

Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.

Background: This study aimed to investigate factors related to improvement of hemodynamics and evaluated the usefulness of intraoperative Doppler for predicting postoperative hemodynamics in patients with cerebrovascular atherosclerotic steno-occlusive disease (CASD) of the internal carotid artery (ICA) or middle cerebral artery (MCA) who were treated with extracranial-intracranial (EC-IC) bypass surgery.

Method: Forty-eight patients with CASD of the ICA or MCA who were treated by superficial temporal artery to middle cerebral artery bypass with a follow-up longer than 12 months were enrolled. Repeated transient ischemic attack or completed ischemic stroke was observed under optimal medical therapy in all patients. Read More

J Vasc Surg 2019 Feb 15. Epub 2019 Feb 15.

Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, Md. Electronic address:

Background: The timing of carotid revascularization in symptomatic patients is a matter of ongoing debate. Current evidence indicates that carotid endarterectomy (CEA) within 2 weeks of symptoms is superior to delayed treatment. However, there is little evidence on the outcomes of emergent CEA (eCEA). Read More

Stroke 2019 Feb 19:STROKEAHA118022675. Epub 2019 Feb 19.

Department of Medicine & Therapeutics, The Chinese University of Hong Kong (K.S.L.W.).

Background and Purpose- Recurrent ischemia risk is high in the acute period after cerebral ischemic events. Effects of antiplatelet agents may vary by time to loading dose (TLD). We explored the risk of recurrent events and safety and efficacy of ticagrelor versus aspirin in relation to TLD. Read More

Seizure 2019 Feb 8;66:31-35. Epub 2019 Feb 8.

Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain. Electronic address:

Purpose: Late-onset non-lesional focal epilepsy, defined as new-onset seizures in patients older than 60 years, is diagnosed increasingly more often in relation to aging of the population. It has been attributed mainly to occult cerebral small vessel disease (SVD), although high levels of evidence to support this notion are lacking. This study aimed to evaluate the burden of leukoaraiosis, a marker of cerebral SVD, and hippocampal atrophy in patients with late-onset epilepsy (LOE). Read More

Circulation 2019 Feb 18. Epub 2019 Feb 18.

Endocrinology, VU Medical Centre, Netherlands.

In hypogonadal/postmenopausal individuals, hormone therapy has been associated with an increased risk for cardiovascular events (CVEs). A steeply growing population that often receives exogenous hormones is transgender individuals. Although transgender individuals hypothetically have an increased risk of CVEs, there is little known about the occurrence of CVEs in this population. Read More

Mol Genet Metab Rep 2019 Jun 6;19:100454. Epub 2019 Feb 6.

Department of Paediatrics, University of Torino, Torino, Italy.

Background: Enzyme replacement therapy (ERT) with recombinant human α-galactosidase has been available for the treatment of Fabry disease since 2001 in Europe and 2003 in the USA. Treatment outcomes with ERT are dependent on baseline patient characteristics, and published data are derived from heterogeneous study populations.

Methods: We conducted a comprehensive systematic literature review of all original articles on ERT in the treatment of Fabry disease published up until January 2017. Read More

Zhonghua Yi Xue Za Zhi 2019 Jan;99(5):349-353

Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China.

To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke. We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Loss-of-function allele carriers of CYP2C19 were included and randomly divided into loading dose group (first dose of 300 mg clopidogrel) and standard dose group (first dose of 75 mg clopidogrel), 100 mg aspirin was gave at the same time, followed by aspirin 100 mg/d plus clopidogrel 75 mg/d maintaining for 20 days. Read More

JACC Cardiovasc Interv 2019 Feb 7. Epub 2019 Feb 7.

Lille University Hospital, Lille, France. Electronic address:

Objectives: This study sought to describe the procedural and clinical outcomes of patients undergoing transcarotid (TC) transcatheter aortic valve replacement (TAVR) with the Edwards Sapien 3 device.

Background: The TC approach for TAVR holds the potential to become the optimal alternative to the transfemoral gold standard. Limited data exist regarding safety and efficacy of TC-TAVR using the Edwards Sapien 3 device. Read More

J Cardiothorac Vasc Anesth 2019 Jan 17. Epub 2019 Jan 17.

Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Italy; Santa Maria Hospital, Department of Cardiac Surgery, GVM Care & Research, Bari, Italy. Electronic address:

Objectives: Cardiac surgery induces a systemic inflammatory reaction that has been associated with postoperative mortality and morbidity. Many studies have characterized this reaction through laboratory biomarkers while clinical studies generally are lacking. This study aimed to assess the incidence of postoperative systemic inflammation after cardiac surgery, and the association of postoperative systemic inflammation with preoperative patients' characteristics and postoperative outcomes. Read More

J Stroke Cerebrovasc Dis 2019 Feb 13. Epub 2019 Feb 13.

Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Department of Neurosciences and Mental Health, Service of Neurology, Hospital Santa Maria-CHLN, Universidade de Lisboa, Lisboa, Portugal.

Introduction: Identifying the cause of ischemic stroke in young adults is often difficult. Our objective was to compare the etiologic diagnostic strategy for ischemic stroke in young adults between 2 European centers and investigate the influence of workup variations in the diagnosed etiologies.

Patients And Methods: We included patients aged 18-55 years admitted for ischemic stroke or transient ischemic attack to the stroke units of Santa Maria Hospital in Lisbon, Portugal, and Innsbruck University Hospital in Innsbruck, Austria, between 2014 and 2016. Read More

Thromb Haemost 2019 Feb 15. Epub 2019 Feb 15.

Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.

Introduction:  Cerebral micro-embolic signals (MES) predict risk of stroke in carotid stenosis patients. However, MES-negative 'recently symptomatic patients' also have a higher stroke risk than 'asymptomatic patients'. Differences in platelet activation status may contribute to this disparity in risk. Read More

Ann R Coll Surg Engl 2019 Feb 15:1-9. Epub 2019 Feb 15.

Regional Vascular Centre, Royal Preston Hospital , Preston , UK.

Introduction: We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy.

Methods: Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Read More

J Am Coll Cardiol 2019 Feb;73(6):654-662

University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address:

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulatory support in patients with refractory cardiogenic shock. A common drawback of this modality is a resultant increase in left ventricular afterload.

Objectives: The purpose of this meta-analysis was to examine the efficacy and safety of left ventricular unloading strategies during VA-ECMO in adult patients with cardiogenic shock. Read More

Cerebrovasc Dis 2019 Feb 14;47(1-2):32-39. Epub 2019 Feb 14.

Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of

Background: To investigate whether there are differences in long-term all-cause and cardiovascular mortality according to the burden of liver fibrosis or steatosis in patients with ischaemic stroke or transient ischaemic attack (TIA). -Methods: Consecutive patients with acute ischaemic stroke or TIA who underwent transient elastography (TE) from January 2014 to December 2014 were considered eligible. The influence of liver fibrosis or steatosis, assessed via TE, on long-term outcomes was investigated using Cox proportional hazard models. Read More

Cerebrovasc Dis 2019 Feb 14;47(1-2):40-47. Epub 2019 Feb 14.

College of Medicine, China Medical University, Taichung, Taiwan.

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied.

Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0-49%; moderate to severe: 50-99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Read More

Cerebrovasc Dis 2019 Feb 14;47(1-2):15-23. Epub 2019 Feb 14.

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Background: Aortic complicated lesions (ACLs) are key parameters for evaluating aortic embolic sources in embolic stroke, and are usually diagnosed using transesophageal echocardiography (TEE). However, alternative methods for diagnosing ACLs have not been well established. We investigated associations between high-intensity areas on T1-weighted imaging (T1WI) with magnetization-prepared rapid acquisition with gradient echo (MPRAGE) and ACLs on TEE among ischemic stroke patients. Read More

Medicine (Baltimore) 2019 Feb;98(7):e14499

Department of Ultrasonic Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Background: It is well known that atrial fibrillation (AF) carried a high risk of cognitive decline, which is independent of stroke or transient ischemic attack (TIA). Whether anticoagulation is associated with reduced risk of cognitive decline in participants with AF still remains controversial. We conducted a systematic review and meta-analysis to explore the effect of anticoagulation on the risk of cognitive decline in patients with AF. Read More

Front Neurol 2018 29;9:1194. Epub 2019 Jan 29.

Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating The National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.

Alagille syndrome (AGS) is an autosomal-dominant, multisystem disorder caused by mutations in the JAG1 gene. A 34-year-old man was referred to our service 10 years ago with focal seizures with impaired awareness and transient slurred speech. He had a 5-year history of intermittent left monocular low-flow retinopathy. Read More

Front Neurol 2019 30;10:44. Epub 2019 Jan 30.

Department of Neurology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, South Korea.

Patients undergoing carotid artery stenting (CAS) who show low responsiveness to clopidogrel may have a higher risk of peri-procedural embolic events. This study aimed to compare the effectiveness and safety of clopidogrel and ticlopidine plus in clopidogrel-resistant patients undergoing CAS. In this multi-center, randomized, controlled trial, we used platelet reactivity test to select patients undergoing CAS who showed clopidogrel resistance, and compared treatments using clopidogrel and ticlopidine plus ginkgo. Read More

Front Neurol 2019 29;10:26. Epub 2019 Jan 29.

Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.

Stylocarotid artery syndrome (SAS) is a type of Eagle syndrome, which is caused by the compression of the internal or external carotid artery (along with their perivascular sympathetic fibers) by an elongated styloid process, resulting in neurological symptoms including transient ischemic attack (TIA) and cervicofacial pain along the distribution of the artery. The authors describe the case of a 56-year-old man with a history of TIA of unknown origin, who underwent color Doppler flow imaging (CDFI) that detected an elongated styloid process and transcranial Doppler (TCD) monitoring that revealed changes in intracranial blood flow when turning his head. To the best of our knowledge, this report is the first to describe the combination of CDFI and TCD to assess changes in extracranial and intracranial blood flow in patients with suspected SAS. Read More

PLoS One 2019 13;14(2):e0212354. Epub 2019 Feb 13.

International University of Health and Welfare Director, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo, Japan.

The efficacy of early anticoagulation in acute stroke with nonvalvular atrial fibrillation (NVAF) remains unclear. We performed a study to evaluate the risk of recurrent ischemic stroke (IS) and major bleeding in acute IS patients with NVAF who started rivaroxaban. This observational study evaluated patients with NVAF and acute IS/transient ischemic attack (TIA) in the middle cerebral arterial territory who started rivaroxaban within 30 days after the index IS/TIA. Read More

Int J Stroke 2019 Feb 13:1747493019830315. Epub 2019 Feb 13.

1 Neurology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest.

Aims: We sought to identify targets for improving dispatcher stroke identification. Read More

Eur J Health Econ 2019 Feb 12. Epub 2019 Feb 12.

UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.

Empirical evidence on the so-called 'weekend-effect' on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. Read More

BMC Neurol 2019 Feb 12;19(1):22. Epub 2019 Feb 12.

Department of Neurology, Second Peoples Hospital of Chengdu, Chengdu, 610000, Sichuan Province, China.

Background: Endothelial progenitor cells (EPCs) play an important role in ischemic stroke. However, there are few studies on the relationship between EPC and nondisabling ischemic cerebrovascular events. Our aim was to investigate the association of EPCs and SDF-1 (serum stromal cell-derived factor-1) with NICE (nondisabling ischemic cerebrovascular events). Read More

Int J Stroke 2019 Feb 12:1747493019830307. Epub 2019 Feb 12.

7 Department of Neurology, Beijing Tiantan Hospital, Beijing, China.

Rationale: In patients with acute cerebral ischemia, the rate of stroke, myocardial infarction, or death during 90 days was reported to be non-significantly lower with ticagrelor compared with aspirin, with no increase in major hemorrhage. Dual antiplatelet therapy may be more effective in this setting.

Aim: To investigate whether ticagrelor combined with aspirin are superior to aspirin alone in preventing stroke or death in patients with non-severe, non-cardioembolic ischemic stroke or high-risk transient ischemic attack. Read More

J Cardiovasc Echogr 2018 Oct-Dec;28(4):236-238

Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.

Papillary fibroelastoma is a rare benign cardiac tumor, second after cardiac myxoma as more frequent cardiac valvular tumor. The therapy is usually based on surgery according to size, mobility, symptoms, and risks of surgery. We report the case of a 67-year old female with transient ischemic attack. Read More

J Cardiovasc Echogr 2018 Oct-Dec;28(4):218-227

Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy.

The introduction of three-dimensional echography (3D echo) in vascular field is not recent, but it still remains a seldom-used technique because of the costs of ultrasound probe and the need of dedicated laboratories. Therefore, despite significant prognostic implications, the high diagnostic accuracy in plaque definition, and the relative ease of use, 3D echo in vascular field is a niche technique. The purpose of this review is mainly clinical and intends to demonstrate the potential strength of a 3D approach, including technical aspects, in order to present to clinicians and imagers the appealing aspects of a noninvasive and radiation-free methodology with relevant diagnostic and prognostic correlates in the assessment of carotid atherosclerosis. Read More

Trials 2019 Feb 11;20(1):114. Epub 2019 Feb 11.

Faculdade de Motricidade Humana, Universidade de Lisboa, CIPER - Centro Interdisciplinar de Estudo da Performance Humana, Lisbon, Portugal.

Background: Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Read More

Semin Neurol 2019 Feb 11;39(1):27-40. Epub 2019 Feb 11.

Deparment of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.

Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Read More

JAMA Neurol 2019 Feb 11. Epub 2019 Feb 11.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Importance: Genetic variants of ABCB1 may affect intestinal absorption of clopidogrel bisulfate. However, it is unclear whether ABCB1 polymorphisms are associated with clopidogrel efficacy for minor ischemic stroke or transient ischemic attack (TIA).

Objectives: To investigate the association between ABCB1 polymorphisms and clopidogrel efficacy for minor stroke or TIA. Read More

Cardiovasc Diagn Ther 2018 Dec;8(6):739-753

Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.

A patent foramen ovale (PFO) is a remnant interatrial communication, best diagnosed with transoesophageal echocardiography (TOE) and bubble study. Although quite common and often asymptomatic, PFO is associated with cryptogenic stroke and migraine. Approximately one-half of patients with a cryptogenic stroke have a PFO, and the dilemma regarding whether or not to proceed with percutaneous device closure, to reduce the risk of future recurrent events due to paradoxical embolism, has been subject to debate for nearly two decades. Read More

Med Princ Pract 2019 Feb 10. Epub 2019 Feb 10.

Objective: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf.

Methods: Data was analyzed from 4044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or ankle brachial index of < 0. Read More

Lancet 2019 Feb 5. Epub 2019 Feb 5.

Background: High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset.

Methods: We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Read More

J Neurosurg 2019 Feb 8:1-7. Epub 2019 Feb 8.

1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.

OBJECTIVEFollowing hemorrhagic stroke in moyamoya disease, de novo intracranial hemorrhage can occur in the previously unaffected nonhemorrhagic hemisphere. In the present analysis the authors intended to determine whether the presence in the nonhemorrhagic hemisphere of choroidal collateral vessels, which have been the focus of attention as a source of bleeding, affects the risk of de novo hemorrhage.METHODSThe subject of focus of the present cohort study was the nonhemorrhagic hemispheres of adult patients with hemorrhagic moyamoya disease enrolled in the Japan Adult Moyamoya Trial and allocated to the nonsurgical arm. Read More

J Neurosurg 2019 Feb 8:1-6. Epub 2019 Feb 8.

2Department of Clinical Medicine, Macquarie University; and.

OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. Read More

J Cardiol 2019 Feb 5. Epub 2019 Feb 5.

Medicine Division, Nippon Boehringer Ingelheim Co., Ltd., Tokyo, Japan.

Background: The effectiveness and safety of dabigatran etexilate (DE) have not been elucidated thoroughly in clinical practice for Japanese patients with non-valvular atrial fibrillation (NVAF). In particular, those of DE at a reduced dose due to dose reduction recommendations (DRR) remain unknown.

Methods: NVAF patients who had newly initiated DE treatment for prevention of thromboembolic events between December 2011 and November 2013 were enrolled. Read More

Neurologia 2019 Feb 5. Epub 2019 Feb 5.

Departamento de Psicología y Antropología, Universidad de Extremadura, Badajoz, España.

Objective: The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. Read More

Int J Stroke 2019 Feb 8:1747493019830322. Epub 2019 Feb 8.

1 Serviço de Neurologia, Hospital Santo António-Centro Hospitalar do Porto, Porto, Portugal.

Objective: A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal.

Methods: Data from two prospective community-based registers of first-ever TIA in 104,700 (1998-2000) and 118,232 (2009-2011) persons were collected using comprehensive case ascertainment methods. Read More

JAMA Neurol 2019 Feb 7. Epub 2019 Feb 7.

Department of Medicine, Yale School of Medicine, New Haven, Connecticut.

Importance: In the Insulin Resistance Intervention After Stroke (IRIS) randomized clinical trial, pioglitazone, an insulin-sensitizing agent, reduced the risk for recurrent stroke or myocardial infarction (MI) among patients with insulin resistance. However, insulin resistance is not commonly measured in clinical practice.

Objective: To analyze the effects of pioglitazone in patients with good adherence as well as intention-to-treat effects of pioglitazone in patients with prediabetes in the IRIS trial. Read More

Congenit Heart Dis 2019 Feb 6. Epub 2019 Feb 6.

Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania.

Objective: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone.

Design: Single-center retrospective study.

Setting: Tertiary care academic hospital. Read More

J Investig Med 2019 Feb 6. Epub 2019 Feb 6.

Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. Read More

Int J Stroke 2019 Feb 6:1747493019828554. Epub 2019 Feb 6.

1 Department of Clinical Neurological Sciences, Division of Neurology, University of Western Ontario, London, Canada.

Background: There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack.

Aims: This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in stroke patients, (3) estimate the proportion of carotid free-floating thrombi patients treated medically and surgically, and (4) evaluate 30-day outcomes.

Methods: We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. Read More