Time to Blood Pressure Control Before Thrombolytic Therapy in Patients With Acute Ischemic Stroke

2015 ◽  
Vol 47 (6) ◽  
pp. 327-332 ◽  
Author(s):  
Courtney McKay ◽  
A. Brad Hall ◽  
Jennifer Cortes
2011 ◽  
Vol 4 (4) ◽  
pp. 399-407 ◽  
Author(s):  
Christianne L. Roumie ◽  
Susan Ofner ◽  
Joseph S. Ross ◽  
Greg Arling ◽  
Linda S. Williams ◽  
...  

2015 ◽  
Vol 16 (7) ◽  
pp. 1002-1006 ◽  
Author(s):  
Bryan Darger ◽  
Nicole Gonzales ◽  
Rosa Banuelos ◽  
Hui Peng ◽  
Ryan Radecki ◽  
...  

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Eric Goldstein ◽  
Stephanie Lyden ◽  
Jennifer Majersik

Background: The Systolic Blood Pressure Intervention Trial enrolled patients aged 50 or older with at least one cardiovascular disease risk factor, but free of prior symptomatic stroke. Patients were assigned to two blood pressure reduction goals (<140 versus 120 mm Hg). There was not a significant difference in the rate of stroke, making this an ideal cohort to refine risk prediction of primary stroke, which is understudied in patients with adequate blood pressure control and a rigorously adjudicated outcome of stroke. Methods: The primary outcome is ischemic stroke. We fit Cox models to the primary outcome and evaluated all baseline demographic variables to determine which would be most predictive of stroke, which we then used to create a prediction score. Results: We included 9,361 patients with a mean (SD) age of 67.9 (9.4) years and 171 (1.8%) patients met the primary outcome of stroke. For our prediction model, we gave one point each for history of TIA, atrial fibrillation, congestive heart failure, or diabetes. Patients with 2 or more points were collapsed, making three possible scores of 0, 1, and 2, which had rates of stroke of 1.5% (117/8042), 3.2% (30/933), and 6.2% (24/386) (p<0.001). Compared to a score of 0, the hazard ratios for stroke of score 1 and 2 were 2.3 (95% CI, 1.6-3.5) and 4.6 (95% CI, 2.9-7.1) (both p<0.001) (Figure 1). Conclusion: A simple scoring system can improve prediction of ischemic stroke from 1.8% to 6.2% in patients with no prior history of stroke and excellent blood pressure control. This information could be used to improve patient selection for clinical trials or for identifying patients for more aggressive primary prevention strategies.


2018 ◽  
Vol 36 (9) ◽  
pp. 1936-1941 ◽  
Author(s):  
Jong-Moo Park ◽  
Bum Joon Kim ◽  
Sun U. Kwon ◽  
Yang-Ha Hwang ◽  
Sung Hyuk Heo ◽  
...  

2008 ◽  
Vol 30 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Yilong Wang ◽  
Di Wu ◽  
Yong Zhou ◽  
Xingquan Zhao ◽  
Chunxue Wang ◽  
...  

Author(s):  
Maryam Esmaeili

Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms.Methods: This is a review paper that report up to date finding with review some research papers and databases.Results: Sudden loss of focal brain function is the core feature of the onset of ischemic stroke. However, patients with conditions other than brain ischemia may present in a similar fashion. The goals in the initial phase include: ensuring medical stability, with particular attention to airway, breathing, and circulation, quickly reversing any conditions that are contributing to the patient's problem, determining if patients with acute ischemic stroke are candidates for thrombolytic therapy, moving toward uncovering the pathophysiologic basis of the patient's neurologic symptoms. Time is of the essence in the hyperacute evaluation of stroke patients. In addition to stabilization of airway, breathing, and circulation, and rapid neurologic evaluation, early key management issues that often arise in acute stroke include blood pressure control, fluid management, treatment of abnormal blood glucose levels, swallowing assessment and treatment of fever and infection. Care in a dedicated stroke unit is associated with better outcomes.Conclusion: The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for thrombolytic therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms. 


Hypertension ◽  
2021 ◽  
Vol 77 (4) ◽  
pp. 1391-1398
Author(s):  
Clinton B. Wright ◽  
Alexander P. Auchus ◽  
Alan Lerner ◽  
Walter T. Ambrosius ◽  
Hakan Ay ◽  
...  

In the SPRINT (Systolic Blood Pressure Intervention Trial), the number of strokes did not differ significantly by treatment group. However, stroke subtypes have heterogeneous causes that could respond differently to intensive blood pressure control. SPRINT participants (N=9361) were randomized to target systolic blood pressures of <120 mm Hg (intensive treatment) compared with <140 mm Hg (standard treatment). We compared incident hemorrhage, cardiac embolism, large- and small-vessel infarctions across treatment arms. Participants randomized to the intensive arm had mean systolic blood pressures of 121.4 mm Hg in the intensive arm (N=4678) and 136.2 mm Hg in the standard arm (N=4683) at one year. Sixty-nine strokes occurred in the intensive arm and 78 in the standard arm when SPRINT was stopped. The breakdown of stroke subtypes across treatment arms included hemorrhagic (intensive treatment, n=6, standard treatment, n=7) and ischemic stroke subtypes (large artery atherosclerosis: intensive treatment n=11, standard treatment, n=13; cardiac embolism: intensive treatment n=11, standard treatment n=15; small artery occlusion: intensive treatment n=8, standard treatment n=8; other ischemic stroke: intensive treatment n=3, standard treatment n=1). Fewer strokes occurred among participants without prior cardiovascular disease in the intensive (n=43) than the standard arm (n=61), but the difference did not reach predefined statistical significance level of 0.05 ( P =0.09). The interaction between baseline cardiovascular risk factor status and treatment arm on stroke risk did not reach significance ( P =0.05). Similar numbers of stroke subtypes occurred in the intensive BP control and standard control arms of SPRINT.


2021 ◽  
pp. 197140092110177
Author(s):  
Alfonso E Martinez-Nunez ◽  
Julie E Fynke ◽  
Daniel J Miller

Basilar artery dolichoectasia can lead to ischemic stroke through thrombosis of small perforating vessels of the brainstem. Here we report the case of a patient with transient paramedian pontine syndrome in the setting of a hypertensive crisis, finding a dolichoectasia basilar artery compressing on the ventral surface of the pons. The outcome was near-complete resolution of deficits after blood pressure control. We propose increased basilar artery pulse pressure as a novel mechanism of transient compression of the brainstem by a dolichoectasia artery.


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