Risultati per: Stroke

Yang X, He X, Pan D, et al. Intra-arterial alteplase for acute ischaemic stroke after mechanical thrombectomy (PEARL): rationale and design of a multicentre, prospective, open-label, blinded-endpoint, randomised controlled trial. BMJ Open 2024;14:e091059. doi: 10.1136/bmjopen-2024091059 This article was previously published with an error. The follow-up visit at ‘48±12 hours’ was inadvertently omitted from ‘Follow-up Procedures’ under the Methods section. To accurately reflect all key assessment points, the text has been updated to: Study visits will occur at 24±12 hours, 48±12 hours, day 7±1 or at discharge (whichever occurs first), and day 90±7. The follow-up schedule is displayed in table 1. Accordingly, table 1 has been updated to include the missing ‘48±12 hours after randomisation’ visit, during which NIHSS scores, adverse event monitoring, and concomitant medication use are documented. The missing ‘48±12 hours’ follow-up visit has also been added to the timeline in figure 2, to align with…

Stroke, Ahead of Print. BACKGROUND:Acute intermittent hypoxia (AIH) is a novel therapeutic intervention that facilitates recovery of function, but the tolerability and effectiveness have not been tested in people living with chronic stroke. The purpose here was to examine whether AIH is tolerable and effective in this population.METHODS:Ten participants with a unilateral, hemispheric stroke were assessed before and after 4 sessions of AIH separated by ≥48 hours in a case series at Shirley Ryan AbilityLab (Chicago). Physician-assessed signs and symptoms (assessed via: repeated symptom reviews, National Institutes of Health Stroke Scale, cranial nerve assessment, a muscle strength test, the Brunnstrom scale, sensory changes, reflexes, assessment of heart and lung status, Fugl-Meyer test, Chedoke-McMaster Stroke Assessment, Modified Ashworth Scale for Spasticity, and Delis Kaplan Executive Function System Color-Word Interference Test) and bilateral upper limb strength (grip and elbow flexion) were assessed before, ≈15 to 30 minutes, and ≈60 minutes after the intervention.RESULTS:AIH was well-tolerated and there were no adverse events observed. After AIH, grip strength (12.91% and 16.53% improvement at 30 and 60 minutes post-AIH, respectively) and elbow flexion force (5.87% and 7.01% improvement at 30 and 60 minutes post-AIH, respectively) improved in the more-affected limb.CONCLUSIONS:AIH is potentially safe and effective for improving strength in the more-affected limb in people living with hemiparetic stroke. Future work should explore the use of AIH to enhance task-specific training-induced plasticity.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT04019522.

Stroke, Volume 56, Issue 3, Page 640-648, March 1, 2025. BACKGROUND:Stroke incidence is decreasing in older ages but increasing in young adults. These divergent trends are at least partially attributable not only to diverging trends in stroke risk factors but may also be due to differences in the impact of stroke risk factors at different ages. To address this latter possibility, we used Mendelian randomization to assess differences in the association of stroke risk factors between early-onset ischemic stroke ([EOS]; onset 18–59 years) and late-onset ischemic stroke ([LOS]; onset ≥60 years).METHODS:We identified genetic variants from the GWAS Catalog for use as instrumental variables to proxy conventional stroke risk factors and then estimated the effects of these variants on risk factors in younger and older individuals in the UK Biobank. We then used these estimates to estimate the causal effects of stroke risk factors on EOS (n=6728 cases) and LOS (n=9272) cases from SiGN (Stroke Genetic Network) and the EOSC (Early-Onset Stroke Consortium). Lastly, we compared odds ratios between EOS and LOS, stratified by TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtypes, to determine if differences between estimates could be attributed to differences in stroke subtype distributions.RESULTS:EOS was associated with higher levels of body mass index, blood pressure, type 2 diabetes, and lower levels of HDL (high-density lipoprotein) cholesterol (allP≤0.002), whereas LOS was associated with higher levels of systolic blood pressure (P=0.0001). The causal effect of body mass index on stroke was significantly stronger for EOS than for LOS (odds ratio, 1.26 versus 1.03;P=0.008). After the subtype-stratified analysis, the difference in causal effect sizes between EOS and LOS for body mass index diminished and was no longer significant.CONCLUSIONS:These results support a causal relationship between body mass index, blood pressure, type 2 diabetes, and HDL cholesterol levels with EOS and blood pressure levels in LOS. Interventions that target these traits may reduce stroke risk.

Stroke, Volume 56, Issue 3, Page 579-579, March 1, 2025.

Circulation, Volume 151, Issue 8, Page 566-567, February 25, 2025.

Circulation, Volume 151, Issue 8, Page e681-e681, February 25, 2025.

Introduction
Across different populations, listening difficulties have been shown to adversely impact social interactions and work performance, and substantively contribute to poorer quality of life. Following a stroke, people also report listening difficulties in noisy, everyday environments such as cafes and workplaces. Despite the prevalence of these challenges, there is limited understanding of this issue, which means the listening needs of stroke survivors remain under-recognised and unmet. The aim of this scoping review is to map the breadth and depth of the existing literature on stroke survivors’ experiences of listening in noisy environments, encompassing qualitative descriptions and quantitative assessments of listening-in-noise abilities, to identify contributing factors, knowledge gaps and potential intervention strategies.

Methods and analysis
This protocol has been registered with the Open Science Framework (protocol number: 39TCA) and follows the Joanna Briggs Institute guidelines for scoping reviews. The protocol was developed by a multidisciplinary and multiprofessional team, led by a survivor of stroke and informed by additional patient input. A mixed-methods approach will be used to generate independent narrative summaries of qualitative and quantitative studies, followed by an integrated narrative of findings across data types. We will first conduct a comprehensive search using Medline, Embase, PsycInfo, Scopus, Cumulated Index in Nursing and Allied Health Literature and Web of Science databases in February 2025. Eligible studies will include stroke survivors as participants and focus on listening-in-noise experiences or abilities. Qualitative studies must explore personal experiences or perceptions related to listening in noisy environments, and quantitative studies must assess listening-in-noise performance. Studies addressing mediating factors, such as cognition, comorbidities (eg, hearing loss, aphasia), environmental factors and intervention strategies (eg, auditory training, assistive devices) will also be included. Two independent reviewers will assess the studies for eligibility. In cases of disagreement, a third reviewer will independently compare and resolve any discrepancies, ensuring a consensus is reached. This approach aims to minimise bias and enhance the validity of the review findings. The data extraction and synthesis will adhere to established guidelines, ensuring a robust and transparent analysis.

Ethics and dissemination
Ethical approval is not required as this review will analyse the existing literature. The results will be published in an open-access peer-reviewed journal and presented at local and international conferences. This dissemination strategy aims to reach a wide audience, including clinicians, researchers, policymakers and people with lived experience of stroke.

Trial registration number
Open Science Framework (https://osf.io; protocol number: 39TCA).

Introduction
There is currently insufficient high-quality evidence to make general recommendations about high-dose high-intensity upper-limb rehabilitation programmes. Here we describe a randomised controlled trial that will determine the efficacy of two forms of high-dose, high-intensity upper-limb rehabilitation provided in a rehabilitation unit setting.

Methods and analysis
Patients with moderate upper-limb impairment (n=105, at least 6 months after stroke) will be randomised to either (1) high-dose high-intensity conventional upper-limb rehabilitation, (2) high-dose high-intensity virtual reality-based upper-limb rehabilitation and (3) usual care (a waiting list control group). Groups 1 and 2 will receive a minimum of 45 hours of active time on task over 3 weeks. Outcome measures will be collected at (T1) baseline; (T2) immediately post intervention and (T3) 3 months after the intervention has finished. The primary outcome measure will be the Fugl-Meyer Upper Extremity Assessment at 3 months after the intervention. Secondary outcome measures will be clinical, kinematic and neurophysiological using transcranial magnetic stimulation and electroencephalography. Explanatory measures will include MRI-based markers for integrity of the corticospinal tract, dorsal column-medial lemniscal pathway, grey and white matter and lesion load. The aim is to detect a difference of 7.25 points on the Fugl-Meyer Upper Extremity Assessment between each treatment group and the waitlist control group, with a power of 0.9 and significance of 0.025 (to account for two primary analyses). Analysis of change in the primary and secondary outcome measures will be performed using mulitple regression analysis.

Ethics and dissemination
The study protocol (V.1) has been approved by the Wales Research Ethics Committee 2 Cardiff (Rec reference: 22/WA/0065) on 15 March 2022. All recruited participants will provide informed consent. Trial results will be disseminated through peer-reviewed publications, presentations at major stroke/neurorehabilitation conferences and outreach to relevant stakeholder communities.

Trial registration number
NCT05527262.

An ever-increasing number of acute ischemic stroke patients are being treated with intra-arterial thrombectomy, which aims to remove an embolic occlusion from a major intracranial artery with a catheter-based device. However, despite its proven efficacy, more than half of all patients do not achieve a satisfactory outcome and remain functionally dependent despite successful reperfusion. Research groups around the world are studying the potential of adjunctive treatments to further improve patient outcomes after thrombectomy. These additions range from antiplatelet and antithrombotic agents during the procedure, which are likely harmful, to neuroprotective agents, which have not been proven effective in humans.

This randomized clinical trial assesses the effect of adjunctive intra-arterial tenecteplase on freedom from disability at 90 days in patients with large vessel occlusion stroke with near-complete to complete reperfusion.

This randomized clinical trial investigates whether intra-arterial urokinase following near-complete to complete reperfusion by endovascular thrombectomy increases the likelihood of survival without disability in patients with acute ischemic stroke due to large vessel occlusion.

Every year in the US, 800 000 people experience strokes, and although most survive, current treatment plans fail to adequately address their physical, emotional, psychosocial, and spiritual distress, according to a new scientific statement from the American Heart Association. Palliative care could aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. However, such care is often underused.

Our work suggested a potential association between brain ischemic lesion pattern on MR images and underlying AF. Furthermore, with additional validation, the AI model we developed may serve as a rapid screening tool for AF in clinical practice of stroke units.

Stroke, Ahead of Print. BACKGROUND:Stroke-induced aphasia significantly impacts communication and quality of life. Despite the standard treatment being speech and language therapy, outcomes vary, highlighting the need for additional therapies. Cerebrolysin, a neuroprotective and neurotrophic agent, has shown potential in stroke management. This study addresses the notable gap in research about the combined use of Cerebrolysin and speech therapy, evaluating their synergistic potential in the treatment of aphasia.METHODS:The ESCAS trial (The Efficacy and Safety of Cerebrolysin in the Treatment of Aphasia After Acute Ischemic Stroke), a prospective, randomized-controlled, double-blinded study was conducted in 2 Romanian stroke centers. Participants included those with left middle cerebral artery territory ischemic stroke and nonfluent aphasia, enrolled 3 to 5 days poststroke. Inclusion criteria were right-handedness and Romanian as the mother tongue. Participants received Cerebrolysin or a placebo combined with speech and language therapy in 10-day cycles over 3 intervals, and evaluations were done at baseline, 30, 60, and 90 days respectively. The main outcome measure was Western Aphasia Battery for language function. Changes at days 30, 60, and 90 compared with baseline were quantified, and the effect estimand used was the difference in means between groups. Secondary outcome measurements were the National Institutes of Health Stroke Scale for neurological deficit, the modified Rankin Scale for global disability, and the Barthel Index for activities of daily living.RESULTS:Out of 132 enrolled patients, 123 were included in the intention-to-treat analysis, and 120 in the per-protocol analysis. Overall, both groups showed improvement at subsequent visits compared with the baseline for Western Aphasia Battery and the National Institutes of Health Stroke Scale. The Cerebrolysin group showed greater improvements in Western Aphasia Battery (visit 4 mean increase of 35.579±16.316 [95% CI, 31.289–39.869] points;P

New England Journal of Medicine, Volume 392, Issue 7, Page 719-721, February 2025.

In a randomized trial, use of intra-arterial tenecteplase following thrombectomy was not associated with an improved outcome.