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Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke: The REM-AVC Randomized Trial
Olivier Rémy-Néris, Anaïs Le Jeannic, Angelina Dion, Béatrice Médée, Emmanuel Nowak, ?lodie Poiroux, Isabelle Durand-Zaleski,
doi : 10.1161/STROKEAHA.120.032545
Stroke. 2021;52:1938–1947
Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke.
What Is Next After This Well-Conducted, but Neutral, Multisite Trial Testing Self-Rehabilitation Approaches?
Julie Bernhardt, Kathryn S. Hayward
doi : 10.1161/STROKEAHA.121.034533
Stroke. 2021;52:1948–1950
Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial
Estelle Pruvost-Robieux, Joseph Benzakoun, Guillaume Turc, Angela Marchi, Rossella Letizia Mancusi, Catherine Lamy, Valérie Domigo, Catherine Oppenheim, David Calvet, Jean-Claude Baron, Jean-Louis Mas, Martine Gavaret
doi : 10.1161/STROKEAHA.120.032056
Stroke. 2021;52:1951–1960
In acute stroke, preventing infarct growth until complete recanalization occurs is a promising approach as an adjunct to reperfusion therapies to reduce infarct size and improve outcome. In rodent models, cathodal transcranial direct current stimulation (C-tDCS) decreases peri-infarct depolarizations and reduces infarct volume. We hypothesized that C-tDCS would nonpharmacologically reduce infarct growth in hyperacute middle cerebral artery territory stroke patients receiving reperfusion therapy.
Predictors of Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease
Shyam Prabhakaran, David S. Liebeskind, George Cotsonis, Azhar Nizam, Edward Feldmann, Rajbeer S. Sangha, Iszet Campo-Bustillo, Jose G. Romano, and on behalf of the MYRIAD Investigators
doi : 10.1161/STROKEAHA.120.032676
Stroke. 2021;52:1961–1966
While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence.
Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion: A Multicenter Experience
Ghada A. Mohamed, Hassan Aboul Nour, Raul G. Nogueira, Mahmoud H. Mohammaden, Diogo C. Haussen, Alhamza R. Al-Bayati, Thanh N. Nguyen, Mohamad Abdalkader, Artem Kaliaev, Alice Ma, Johanna Fifi, Jacob Morey, Dileep R. Yavagal, Vasu Saini, Santiago Ortega-Gutierrez, Mudassir Farooqui, Cynthia B. Zevallos, Darko Quispe-Orozco, Lonni Schultz, Maximilian Kole, Daniel Miller, Stephan A. Mayer, Horia Marin, Alex Bou Chebl
doi : 10.1161/STROKEAHA.120.033393
Stroke. 2021;52:1967–1973
Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO.
Antihypertensive Drugs for Secondary Prevention After Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis
Giorgio B. Boncoraglio, Cinzia Del Giovane, Irene Tramacere
doi : 10.1161/STROKEAHA.120.031945
Stroke. 2021;52:1974–1982
Approximately 30% of ischemic strokes occur after a previous stroke or transient ischemic attack. Arterial hypertension is one of the best established risk factors for first and recurrent stroke, both ischemic and hemorrhagic. Guidelines for the secondary prevention of ischemic stroke support the use of blood pressure (BP)–lowering drugs in most patients. However, the evidence for these recommendations comes from meta-analyses that included both ischemic and hemorrhagic stroke patients, whereas these 2 conditions differ quantitatively in several aspects. With this systematic review and meta-analysis, we aimed at summarizing the current evidence on BP-lowering drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack.
Prediction of Cognitive Recovery After Stroke: The Value of Diffusion-Weighted Imaging–Based Measures of Brain Connectivity
Hugo P. Aben, Leonie De Munter, Yael D. Reijmer, Jacoba M. Spikman, Johanna M.A. Visser-Meily, Geert Jan Biessels, Paul L.M. De Kort, and on behalf of the PROCRAS Study Group
doi : 10.1161/STROKEAHA.120.032033
Stroke. 2021;52:1983–1992
Prediction of long-term recovery of a poststroke cognitive disorder (PSCD) is currently inaccurate. We assessed whether diffusion-weighted imaging (DWI)–based measures of brain connectivity predict cognitive recovery 1 year after stroke in patients with PSCD in addition to conventional clinical, neuropsychological, and imaging variables.
Predicting Poststroke Cognitive Impairment: Sharpening the Diffuse?
Amy Brodtmann, Michele Veldsman
doi : 10.1161/STROKEAHA.121.035038
Stroke. 2021;52:1993–1994
Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS
Jose G. Romano, Hannah Gardener, Iszet Campo-Bustillo, Yosef Khan, Sofie Tai, Nikesha Riley, Eric E. Smith, Ralph L. Sacco, Pooja Khatri, Heather M. Alger, Brian Mac Grory, Deepak Gulati, Navdeep S. Sangha, Jeffrey M. Craig, Karin E. Olds, Curtis G. Benesch, Adam G. Kelly, Scott S. Brehaut, Amit C. Kansara, Lee H. Schwamm
doi : 10.1161/STROKEAHA.120.032809
Stroke. 2021;52:1995–2004
Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population.
Mild in Name but Not in Nature
Shuangyue Tan, Philip M.C. Choi
doi : 10.1161/STROKEAHA.121.035003
Stroke. 2021;52:2005–2006
Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD2 Score
Jing Jing, Yue Suo, Anxin Wang, Yingting Zuo, Yong Jiang, Liping Liu, Xingquan Zhao, Yilong Wang, Zixiao Li, Hao Li, Xia Meng, Yongjun Wang,
doi : 10.1161/STROKEAHA.120.032424
Stroke. 2021;52:2007–2015
Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD2 score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD2 score.
Computed Tomography Perfusion Deficit Volumes Predict Functional Outcome in Patients With Basilar Artery Occlusion
Matthias P. Fabritius, Steffen Tiedt, Daniel Puhr-Westerheide, Sergio Grosu, Stefan Maurus, Vincent Schwarze, Johannes Rübenthaler, Lena Stueckelschweiger, Jens Ricke, Thomas Liebig, Lars Kellert, Katharina Feil, Konstantinos Dimitriadis, Wolfgang G. Kunz, Paul Reidler
doi : 10.1161/STROKEAHA.120.032924
Stroke. 2021;52:2016–2023
Basilar artery occlusion is associated with high morbidity and mortality. Optimal imaging and treatment strategy are still controversial and prognosis estimation challenging. We, therefore, aimed to determine the predictive value of computed tomography perfusion (CTP) parameters for functional outcome in patients with basilar artery occlusion in the context of endovascular treatment.
Is It Time to Revisit Perfusion Imaging for Basilar Occlusion?
Jared B. Cooper, Haris Kamal, Katarina B. Dakay
doi : 10.1161/STROKEAHA.121.034638
Stroke. 2021;52:2024–2025
Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer
Joonsang Yoo, Young Dae Kim, Hyungjong Park, Byung Moon Kim, Oh Young Bang, Hyeon Chang Kim, Euna Han, Dong Joon Kim, Joonnyung Heo, Minyoung Kim, Jin Kyo Choi, Kyung-Yul Lee, Hye Sun Lee, Dong Hoon Shin, Hye-Yeon Choi, Sung-Il Sohn, Jeong-Ho Hong, Jong Yun Lee, Jang-Hyun Baek, Gyu Sik Kim, Woo-Keun Seo, Jong-Won Chung, Seo Hyun Kim, Tae-Jin Song, Sang Won Han, Joong Hyun Park, Jinkwon Kim, Yo Han Jung, Han-Jin Cho, Seong Hwan Ahn, Sung Ik Lee, Kwon-Duk Seo, Ji Hoe Heo, Hyo Suk Nam, and on behalf of the SECRET Study Investigators See fewer authors
doi : 10.1161/STROKEAHA.120.032380
Stroke. 2021;52:2026–2034
Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke.
Non–High-Density Lipoprotein Cholesterol Predicts Adverse Outcomes in Acute Ischemic Stroke
Guangyao Wang, Jing Jing, Anxin Wang, Xiaoli Zhang, Xingquan Zhao, Zixiao Li, Chunjuan Wang, Hao Li, Liping Liu, Yongjun Wang, Yilong Wang, and on behalf of the China National Stroke Registry II Investigators
doi : 10.1161/STROKEAHA.120.030783
Stroke. 2021;52:2035–2042
Non–high-density lipoprotein cholesterol (non–HDL-C) was significantly related to adverse outcomes in patients with cardiovascular disease. We aim to investigate the associations of non-HDL-C and adverse outcomes in acute ischemic stroke.
Body Mass Index in 1.9 Million Adolescents and Stroke in Young Adulthood
Aya Bardugo, Boris Fishman, Carmit Libruder, David Tanne, Amit Ram, Yael Hershkovitz, Inbar Zucker, Ariel Furer, Roy Gilon, Gabriel Chodick, Shmuel Tiosano, Estela Derazne, Dorit Tzur, Arnon Afek, Orit Pinhas-Hamiel, Cole Daniel Bendor, Gal Yaniv, Ran Shmuel Rotem, Gilad Twig
doi : 10.1161/STROKEAHA.120.033595
Stroke. 2021;52:2043–2052
There is a continuous rise in the prevalence of adolescent obesity and incidence of stroke among young adults in many Western countries, but the association between them is unclear.
Race Differences in High-Grade Carotid Artery Stenosis
Brajesh K. Lal, James F. Meschia, Thomas G. Brott, Michael Jones, Herbert D. Aronow, Angelica Lackey, George Howard
doi : 10.1161/STROKEAHA.120.032723
Stroke. 2021;52:2053–2059
Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (?70% diameter-reducing) carotid stenosis.
Late-Life Vascular Risk Score in Association With Postmortem Cerebrovascular Disease Brain Pathologies
Shahram Oveisgharan, Lei Yu, Ana Capuano, Zoe Arvanitakis, Lisa L. Barnes, Julie A. Schneider, David A. Bennett, Aron S. Buchman
doi : 10.1161/STROKEAHA.120.030226
Stroke. 2021;52:2060–2067
The general cardiovascular Framingham risk score (FRS) identifies adults at increased risk for stroke. We tested the hypothesis that baseline FRS is associated with the presence of postmortem cerebrovascular disease (CVD) pathologies.
Autonomic Imbalance and Risk of Dementia and Stroke: The Framingham Study
Galit Weinstein, Kendra Davis-Plourde, Alexa S. Beiser, Sudha Seshadri
doi : 10.1161/STROKEAHA.120.030601
Stroke. 2021;52:2068–2076
The autonomic nervous system has been implicated in stroke and dementia pathophysiology. High resting heart rate and low heart rate variability indicate the effect of autonomic imbalance on the heart. We examined the associations of resting heart rate and heart rate variability with incident stroke and dementia in a community-based cohort of middle- and old-aged adults.
Ischemic Stroke With Atrial Fibrillation: Characteristics and Time Trends 2006 to 2017 in the Dijon Stroke Registry
Amélie Gabet, Charles Guenancia, Gauthier Duloquin, Valérie Olié, Yannick Béjot
doi : 10.1161/STROKEAHA.120.030812
Stroke. 2021;52:2077–2085
Because of the aging population, an increase in the prevalence of atrial fibrillation (AF) is currently observed, thus leading to a rise in AF-related ischemic stroke (IS). We analyzed the current prevalence of AF among patients with IS, their characteristics, and temporal trends from 2006 to 2017 in the population-based Dijon Stroke Registry.
Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study
Mauro F. F. Mediano, Yejin Mok, Josef Coresh, Anna Kucharska-Newton, Priya Palta, Kamakshi Lakshminarayan, Wayne D. Rosamond, Kunihiro Matsushita, Silvia Koton
doi : 10.1161/STROKEAHA.120.032695
Stroke. 2021;52:2086–2095
The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities).
Hemostatic Efficacy and Anti-FXa (Factor Xa) Reversal With Andexanet Alfa in Intracranial Hemorrhage: ANNEXA-4 Substudy
Andrew M. Demchuk, Patrick Yue, Elena Zotova, Juliet Nakamya, Lizhen Xu, Truman J. Milling Jr, Tomoyuki Ohara, Joshua N. Goldstein, Saskia Middeldorp, Peter Verhamme, Jose Luis Lopez-Sendon, Pamela B. Conley, John T. Curnutte, John W. Eikelboom, Mark Crowther, Stuart J. Connolly, and on behalf of the ANNEXA-4 Investigators
doi : 10.1161/STROKEAHA.120.030565
Stroke. 2021;52:2096–2105
Andexanet alfa is a recombinant modified human FXa (factor Xa) developed to reverse FXa inhibition from anticoagulants. Hemostatic efficacy and reversal of anti-FXa activity with andexanet were assessed in patients from the ANNEXA-4 study (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXa Inhibitors) with intracranial hemorrhage (ICrH).
Evidence for Andexanet Alpha in Reversing Intracerebral Hemorrhage due to Factor Xa Inhibitors?
Michael J. Armahizer, Neeraj Badjatia
doi : 10.1161/STROKEAHA.120.031825
Stroke. 2021;52:2106–2108
Clinically Approximated Hypoperfused Tissue in Large Vessel Occlusion Stroke
Shashvat M. Desai, Santiago Ortega-Gutierrez, Sunil A. Sheth, Mudassir Farooqui, Victor Lopez-Rivera, Cynthia Zevallos, Sergio Salazar-Marioni, Darko Quispe-Orozco, Rania Abdelkhaliq, Daniel A. Tonetti, Tudor G. Jovin, Ashutosh P. Jadhav
doi : 10.1161/STROKEAHA.120.033294
Stroke. 2021;52:2109–2114
Patient selection for thrombectomy of acute ischemic stroke caused by large vessel occlusion in the delayed time window (>6 hours) is dependent on delineation of clinical-core mismatch or radiological target mismatch using perfusion imaging. Selection paradigms not involving advanced imaging and software processing may reduce time to treatment and broaden eligibility. We aim to develop a conversion factor to approximately determine the volume of hypoperfused tissue using the National Institutes of Health Stroke Scale (NIHSS) score (clinically approximated hypoperfused tissue [CAT] volume) and explore its ability to identify patients eligible for thrombectomy in the late-time window.
Disconnectomics of the Rich Club Impacts Motor Recovery After Stroke
Philip Egger, Giorgia G. Evangelista, Philipp J. Koch, Chang-Hyun Park, Laura Levin-Gleba, Gabriel Girard, Elena Beanato, Jungsoo Lee, Christine Choirat, Adrian G. Guggisberg, Yun-Hee Kim, Friedhelm C. Hummel
doi : 10.1161/STROKEAHA.120.031541
Stroke. 2021;52:2115–2124
Structural brain networks possess a few hubs, which are not only highly connected to the rest of the brain but are also highly connected to each other. These hubs, which form a rich-club, play a central role in global brain organization. To investigate whether the concept of rich-club sheds new light on poststroke recovery, we applied a novel network-theoretical quantification of lesions to patients with stroke and compared the outcomes with what lesion size alone would indicate.
Stroke Care in the United Kingdom During the COVID-19 Pandemic
Abdel Douiri, Walter Muruet, Ajay Bhalla, Martin James, Lizz Paley, Kaili Stanley, Anthony G. Rudd, Charles D.A. Wolfe, Benjamin D. Bray, and on behalf of the SSNAP Collaboration
doi : 10.1161/STROKEAHA.120.032253
Stroke. 2021;52:2125–2133
The coronavirus disease 2019 (COVID-19) pandemic has potentially caused indirect harm to patients with other conditions via reduced access to health care services. We aimed to describe the impact of the initial wave of the pandemic on admissions, care quality, and outcomes in patients with acute stroke in the United Kingdom.
Preexisting Mild Cognitive Impairment, Dementia, and Receipt of Treatments for Acute Ischemic Stroke
Deborah A. Levine, Andrzej T. Galecki, Lewis B. Morgenstern, Darin B. Zahuranec, Kenneth M. Langa, Mohammed U. Kabeto, Dolorence Okullo, Brahmajee K. Nallamothu, Bruno Giordani, Bailey K. Reale, Morgan Campbell, Lynda D. Lisabeth
doi : 10.1161/STROKEAHA.120.032258
Stroke. 2021;52:2134–2142
Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status.
Changes in Patient Volumes and Outcomes After Adding Thrombectomy Capability
Minerva H. Zhou, Akash P. Kansagra
doi : 10.1161/STROKEAHA.120.032389
Stroke. 2021;52:2143–2149
With the rising demand for endovascular thrombectomy (EVT) and introduction of thrombectomy-capable stroke centers (TSC), there is interest among existing stroke hospitals to add EVT capability to attract and retain stroke patient referrals. In this work, we quantify changes in patient volumes and outcomes when adding EVT capability to an existing stroke center.
IL33 (Interleukin 33)/ST2 (Interleukin 1 Receptor-Like 1) Axis Drives Protective Microglial Responses and Promotes White Matter Integrity After Stroke
Di Xie, Huan Liu, Fei Xu, Wei Su, Qing Ye, Fang Yu, Taylor J. Austin, Jun Chen, Xiaoming Hu
doi : 10.1161/STROKEAHA.120.032444
Stroke. 2021;52:2150–216
Emerging evidence highlights the importance of IL33 (interleukin 33) and its receptor (ST2 [interleukin 1 receptor-like 1]) in normal brains and neurological disorders. This study explores the function of the IL33/ST2 signaling axis and a transcription factor STAT6 (signal transducer and activator of transcription 6) in white matter integrity and long-term recovery after stroke.
TREM (Triggering Receptor Expressed on Myeloid Cells)-1 Inhibition Attenuates Neuroinflammation via PKC (Protein Kinase C) ?/CARD9 (Caspase Recruitment Domain Family Member 9) Signaling Pathway After Intracerebral Hemorrhage in Mice
Qin Lu, Rui Liu, Prativa Sherchan, Reng Ren, Wei He, Yuanjian Fang, Yi Huang, Hui Shi, Lihui Tang, Shuxu Yang, John H. Zhang, Jiping Tang
doi : 10.1161/STROKEAHA.120.032736
Stroke. 2021;52:2162–2173
Intracerebral hemorrhage (ICH) is a devastating subtype of stroke with high mortality and disability. Inflammatory response promotes secondary brain injury after ICH. TREM (triggering receptor expressed on myeloid cells)-1 is a key regulator of inflammation. The aim of this study was to evaluate the role of TREM-1 in neuroinflammatory response after ICH in mice.
Clinical Outcome After Endovascular Thrombectomy in 3 Triage Concepts: A Prospective, Observational Study (NEUROSQUAD)
Fatih Seker, Jens Fiehler, Markus A. M?hlenbruch, Christian Herweh, Fabian Flottmann, Peter A. Ringleb, G?tz Thomalla, Thorsten Steiner, Christoffer Kraemer, Caspar Brekenfeld, Martin Bendszus
doi : 10.1161/STROKEAHA.120.030520
Stroke. 2021;52:e213–e216
NEUROSQUAD (Stroke Treatment: Quality and Efficacy in Different Referral Systems) is a prospective, observational, bicenter study comparing 3 triage pathways in endovascular stroke treatment: mothership, drip and ship (DS), and transferring a neurointerventionalist to a remote hospital for thrombectomy (drive the doctor [DD]).
Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials
Kirtipal Bhatia, Vardhmaan Jain, Devika Aggarwal, Muthiah Vaduganathan, Sameer Arora, Zeeshan Hussain, Guneesh Uberoi, Alfonso Tafur, Cen Zhang, Mark Ricciardi, Arman Qamar
doi : 10.1161/STROKEAHA.120.033033
Stroke. 2021;52:e217–e223
Antiplatelet therapy is key for preventing thrombotic events after transient ischemic attack or ischemic stroke. Although the role of aspirin is well established, there is emerging evidence for the role of short-term dual antiplatelet therapy (DAPT) in preventing recurrent stroke.
Transient Vestibular Symptoms Preceding Posterior Circulation Stroke: A Prospective Multicenter Study
Hyun Ah Kim, Eun Hye Oh, Seo-Young Choi, Jae Hwan Choi, Ji-Yun Park, Hyung Lee, Kwang-Dong Choi
doi : 10.1161/STROKEAHA.120.032488
Stroke. 2021;52:e224–e228
The recognition of clinical features of transient vestibular symptoms (TVSs) preceding posterior circulation stroke (PCOS) would be informative to discriminate dizziness/vertigo due to vertebrobasilar transient ischemic attack from the acute transient vestibular syndrome. We sought to determine the prevalence and characteristics of TVSs preceding PCOS.
Unequal Local Progress Towards Healthy People 2020 Objectives for Stroke and Coronary Heart Disease Mortality
Rebecca C. Woodruff, Michele Casper, Fleetwood Loustalot, Adam S. Vaughan
doi : 10.1161/STROKEAHA.121.034100
Stroke. 2021;52:e229–e232
Healthy People establishes objectives to monitor the nation’s health. Healthy People 2020 included objectives to reduce national stroke and coronary heart disease (CHD) mortality by 20% (to 34.8 and 103.4 deaths per 100?000, respectively). Documenting the proportion and geographic distribution of counties meeting neither the Healthy People 2020 target nor an equivalent proportional reduction can help identify high-priority geographic areas for future intervention.
Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients
Lindsay S. McAlpine, Adeel S. Zubair, Ilavarasy Maran, Pola Chojecka, Paul Lleva, Adam S. Jasne, Dhasakumar Navaratnam, Charles Matouk, Joseph Schindler, Kevin N. Sheth, Hyung Chun, Alfred I. Lee, Serena Spudich, Richa Sharma, Lauren H. Sansing
doi : 10.1161/STROKEAHA.120.031971
Stroke. 2021;52:e233–e238
Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor.
Acute Coronary Syndrome and Ischemic Stroke Discharges in the United States During the COVID-19 Pandemic
Adam de Havenon, Shadi Yaghi, Jennifer J. Majersik, Samuel Hohmann, John P. Ney, Brian Callaghan, Mohammad Anadani
doi : 10.1161/STROKEAHA.120.033630
Stroke. 2021;52:e239–e241
Noncontrast Computed Tomography Markers in Brain Arteriovenous Malformation-Related Hematoma Are Not Predictive of Clinical Outcome
Jonathan Cortese, Idriss Haffaf, Lorenzo Garzelli, Grégoire Boulouis, Bertrand Mathon, Anne-Laure Boch, Stéphanie Lenck, Alice Jacquens, Caroline Amouyal, Kevin Premat, Nader-Antoine Sourour, Vincent Degos, Frédéric Clarençon, Eimad Shotar
doi : 10.1161/STROKEAHA.120.034086
Stroke. 2021;52:e242–e243
Vascular Surgery and Neurosurgery
Alison W. Halliday, Giuseppe Lanzino
doi : 10.1161/STROKEAHA.121.033293
Stroke. 2021;52:2174–2176
Health Policy and Health Services Delivery in the Era of COVID-19
Dominique A. Cadilhac, Janet Prvu Bettger
doi : 10.1161/STROKEAHA.121.033292
Stroke. 2021;52:2177–2179
Circadian Biology and Stroke
Eng H. Lo, Gregory W. Albers, Martin Dichgans, Geoffrey Donnan, Elga Esposito, Russell Foster, David W. Howells, Yi-Ge Huang, Xunming Ji, Elizabeth B. Klerman, Sarah Lee, Wenlu Li, David S. Liebeskind, Ignacio Lizasoain, Emiri T. Mandeville, Maria A. Moro, MingMing Ning, David Ray, Sava Sakad?i?, Jeffrey L. Saver, Frank A.J.L. Scheer, Magdy Selim, Steffen Tiedt, Fang Zhang, Alastair M. Buchan
doi : 10.1161/STROKEAHA.120.031742
Stroke. 2021;52:2180–2190
Circadian biology modulates almost all aspects of mammalian physiology, disease, and response to therapies. Emerging data suggest that circadian biology may significantly affect the mechanisms of susceptibility, injury, recovery, and the response to therapy in stroke. In this review/perspective, we survey the accumulating literature and attempt to connect molecular, cellular, and physiological pathways in circadian biology to clinical consequences in stroke. Accounting for the complex and multifactorial effects of circadian rhythm may improve translational opportunities for stroke diagnostics and therapeutics.
Optimal Medical Management of Asymptomatic Carotid Stenosis
Daniel G. Hackam
doi : 10.1161/STROKEAHA.120.033994
Stroke. 2021;52:2191–2198
Asymptomatic carotid stenosis (ACS) due to atherosclerosis is a risk factor for ipsilateral ischemic cerebrovascular events and cognitive impairment. The prognosis of ACS has improved over the past 4 decades due largely to improvements in medical management. Most patients with ACS can be managed without revascularization, but some patients with vulnerable plaque should be considered for revascularization. Regardless of the decision to refer for revascularization, all patients with ACS should receive intensive medical management. This includes lifestyle modification (Mediterranean diet, exercise, and smoking cessation) and pharmacological therapy (antiplatelets, lipid-lowering agents, blood pressure reduction, and glycemic control). Patients with ACS often have atherosclerosis in other critical locations, and thus optimal medical therapy is likely to reduce events outside the carotid arteries. The nature of optimal medical therapy is described.
Amylin Dyshomeostasis Hypothesis: Small Vessel–Type Ischemic Stroke in the Setting of Type-2 Diabetes
Florin Despa, Larry B. Goldstein
doi : 10.1161/STROKEAHA.121.034363
Stroke. 2021;52:e244–e249
Recent histological analyses of human brains show that small vessel–type injuries in the setting of type-2 diabetes colocalize with deposits of amylin, an amyloid-forming hormone secreted by the pancreas. Amylin inclusions are also identified in circulating red blood cells in people with type-2 diabetes and stroke or cardiovascular disease. In laboratory models of type-2 diabetes, accumulation of aggregated amylin in blood and the cerebral microvasculature induces brain microhemorrhages and reduces cerebral blood flow leading to white matter ischemia and neurological deficits. At the cellular level, aggregated amylin causes cell membrane lipid peroxidation injury, downregulation of tight junction proteins, and activation of proinflammatory signaling pathways which, in turn, induces macrophage activation and macrophage infiltration in vascular areas positive for amylin deposition. We review each step of this cascade based on experimental and clinical evidence and propose the hypothesis that systemic amylin dyshomeostasis may underlie the disparity between glycemic control and stroke risk and may be a therapeutic target to reduce the risk of small vessel ischemic stroke in patients with type-2 diabetes.
Does Src Kinase Mediated Vasoconstriction Impair Penumbral Reperfusion?
Halvor Osterby Guldbrandsen, Christian Staehr, Nina Kerting Iversen, Dmitry D. Postnov, Vladimir V. Matchkov
doi : 10.1161/STROKEAHA.120.032737
Stroke. 2021;52:e250–e258
Despite successful recanalization, a significant number of patients with ischemic stroke experience impaired local brain tissue reperfusion with adverse clinical outcome. The cause and mechanism of this multifactorial complication are yet to be understood. At the current moment, major attention is given to dysfunction in blood-brain barrier and capillary blood flow but contribution of exaggerated constriction of cerebral arterioles has also been suggested. In the brain, arterioles significantly contribute to vascular resistance and thus control of perfusion. Accordingly, pathological changes in arteriolar wall function can, therefore, limit sufficient reperfusion in ischemic stroke, but this has not yet received sufficient attention. Although an increased vascular tone after reperfusion has been demonstrated in several studies, the mechanism behind it remains to be characterized. Importantly, the majority of conventional mechanisms controlling vascular contraction failed to explain elevated cerebrovascular tone after reperfusion. We propose here that the Na,K-ATPase-dependent Src kinase activation are the key mechanisms responsible for elevation of cerebrovascular tone after reperfusion. The Na,K-ATPase, which is essential to control intracellular ion homeostasis, also executes numerous signaling functions. Under hypoxic conditions, the Na,K-ATPase is endocytosed from the membrane of vascular smooth muscle cells. This initiates the Src kinase signaling pathway that sensitizes the contractile machinery to intracellular Ca2+ resulting in hypercontractility of vascular smooth muscle cells and, thus, elevated cerebrovascular tone that can contribute to impaired reperfusion after stroke. This mechanism integrates with cerebral edema that was suggested to underlie impaired reperfusion and is further supported by several studies, which are discussed in this article. However, final demonstration of the molecular mechanism behind Src kinase-associated arteriolar hypercontractility in stroke remains to be done.
The Ambibaric Brain: Pathophysiological and Clinical Implications
Vladimir Hachinski, Leif ?stergaard
doi : 10.1161/STROKEAHA.120.033492
Stroke. 2021;52:e259–e262
We propose a new evolutionary interpretation of the brain’s circulation that has physiological, pathophysiological, and clinical implications. We review the evidence for the concept, discuss clinical implications, and suggest techniques to address outstanding questions. We conclude that the brain circulation contains complementary low-pressure and high-pressure system that must be kept in balance for optimal brain health.
Blood Pressure Management After Endovascular Therapy: An Ongoing Debate
Mohammad Anadani, Adam de Havenon, Eva Mistry, Craig S. Anderson
doi : 10.1161/STROKEAHA.121.034995
Stroke. 2021;52:e263–e265
Rudolf Virchow and the Discovery of Cerebral Embolism
Jonathan Leicester
doi : 10.1161/STROKEAHA.121.034443
Stroke. 2021;52:e266–e268
This article describes the project that led Virchow to his discovery of cerebral embolism as a cause of stroke, made during the 1840s, at the beginning of his remarkable career. It includes comment on Virchow’s statements on cerebral thrombosis and stroke.
An Update From the American Stroke Association and the Stroke Council
Lee H. Schwamm, Peter D. Panagos, Stephanie M. Mohl
doi : 10.1161/STROKEAHA.121.034827
Stroke. 2021;52:e269–e271
Motor Imagery for Gait Rehabilitation After Stroke
Stephano Tomaz da Silva, Lorenna Raquel Dantas de Macedo Borges, Lorenna Marques de Melo Santiago, Larissa Coutinho de Lucena, Ana Raquel Rodrigues Lindquist, Tatiana Souza Ribeiro
doi : 10.1161/STROKEAHA.120.033098
Stroke. 2021;52:e272–e273
How to Address Physical Activity Participation After Stroke in Research and Clinical Practice
Natalie A. Fini, Julie Bernhardt, Catherine M. Said, Sandra A. Billinger
doi : 10.1161/STROKEAHA.121.034557
Stroke. 2021;52:e274–e277
Progressive Myelopathy From a Craniocervical Junction Dural Arteriovenous Fistula
Ryan M. Naylor, Britney Topinka, Lorenzo Rinaldo, Jaclyn Jacobi, Bryan Neth, Kelly D. Flemming, Luis E. Savastano
doi : 10.1161/STROKEAHA.120.032552
Stroke. 2021;52:e278–e281
Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association
Brian Mac Grory, Matthew Schrag, Valérie Biousse, Karen L. Furie, Marie Gerhard-Herman, Patrick J. Lavin, Lucia Sobrin, Stavropoula I. Tjoumakaris, Cornelia M. Weyand, Shadi Yaghi, and on behalf of the American Heart Association Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Council on Peripheral Vascular Disease
doi : 10.1161/STR.0000000000000366
Stroke. 2021;52:e282–e294
Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention.
A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association
Ronald M. Lazar, Virginia J. Howard, Walter N. Kernan, Hugo J. Aparicio, Deborah A. Levine, Anthony J. Viera, Lori C. Jordan, David L. Nyenhuis, Katherine L. Possin, Farzaneh A. Sorond, Carole L. White, and on behalf of the American Heart Association Stroke Council
doi : 10.1161/STR.0000000000000367
Stroke. 2021;52:e295–e308
A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included “Life’s Simple 7,” we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.
Correction to: Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association
doi : 10.1161/STR.0000000000000374
Stroke. 2021;52:e309
Correction to: A New Class of Radially Adjustable Stentrievers for Acute Ischemic Stroke: Primary Results of the Multicenter Tiger Trial
doi : 10.1161/STR.0000000000000376
Stroke. 2021;52:e310
