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Recent Studies in the Field of Stroke

Prof. Wolfram Doehner, Prof. Hans Christoph Diener and Prof. Mikael Mazighi have selected and summarised recent and important studies within the field of Stroke.

Stroke


Effect of Conscious Sedation vs General Anesthesia on Early Neurological Improvement Among Patients With Ischemic Stroke Undergoing Endovascular Thrombectomy: A Randomized Clinical Trial.

SIESTA* study in acute stroke: general anaesthesia during endovascular thrombectomy in acute stroke was not inferior to conscious sedation in a single center randomized study. No difference between the two groups was observed for the early neurological improvement (primary endpoint based on the NIHSS) at 24 hours. These findings do not support any specific option for anaesthesia in acute ischemic stroke patients treated with thrombectomy. This result is surprising as previously published observational data showed better outcomes of patients treated with endovascular thrombectomy without general anaesthesia. The study was conducted at Heidelberg University Hospital, Germany.

*SIESTA: Sedation vs. Intubation for Endovascular Stroke TreAtment

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Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial.

The recent study which discusses the open-label, randomised, controlled phase 2 trial included 96 patients to test the safety and efficacy of minimally invasive catheter evacuation followed by thrombolysis for clot removal after intracerebral haemorrhage. The study concluded that minimally invasive surgery plus alteplase seems to be safe in patients with intracerebral haemorrhage, but increased asymptomatic bleeding is a major cautionary finding. These results, if replicable, could lead to the addition of surgical management as a therapeutic strategy for intracerebral haemorrhage.

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Stroke, Bleeding, and Mortality Risks in Elderly Medicare Beneficiaries Treated With Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation

A retrospective cohort study included 118 891 patients with nonvalvular AF who were 65 years or older, to compare risks of thromboembolic stroke, intracranial haemorrhage (ICH), major extracranial bleeding including major gastrointestinal bleeding, and mortality in patients with nonvalvular AF who were treated with dabigatran or rivaroxaban treatment for stroke prevention. Treatment with rivaroxaban 20mg once daily was associated with significant increases in ICH and major extracranial bleeding, compared with dabigatran 150mg twice daily.

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Validation and comparison of imaging-based scores for prediction of early stroke risk after transient ischaemic attack: a pooled analysis of individual-patient data from cohort studies.

The validity and prognostic utility of imaging-based stroke risk scores (ABCD2, ABCD2-I, and ABCD3-I scores) in patients after transient ischaemic attack was studied in pooled analyses of 16 cohort studies of transient ischaemic attack from Asia, Europe, and the USA.  It was shown that ABCD2-I and ABCD3-I showed validity, however, the ABCD3-I score reliably identified patients at highest risk of a stroke after transient ischaemic attack with improved risk prediction compared with ABCD2-I.

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