Literature Watch

Claiborne Johnston, Pierre Amarenco, et al. for the THALES investigators.Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med   2020;383:207-17.
DOI: 10.1056/NEJMoa1916870
 Reviewed by Sanjeev Sivakumar,MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Backgound/Methods Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has been shown to prevent recurrent strokes. Clopidogrel requires hepatic conversion ...

Kwak HS, Park JS. Mechanical Thrombectomy in Basilar Artery Occlusion: Clinical Outcomes Related to Posterior Circulation Collateral Score.  Stroke . 2020;51(7):2045-2050. doi:10.1161/STROKEAHA.120.029861 Reviewed by Shannon Hextrum, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods Ischemic strokes due to basilar artery occlusion (BAO) are associated with high morbidity and mortality. The American Heart Association/American ...

Circulation (08/26/20) doi: 10.1161/CIR.0000000000000885 Gaudino, Mario; Benesch, Curtis; Bakaeen, Faisal; et al. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000885    A scientific statement from the American Heart Association (AHA) recommends specific preoperative, intraoperative, and postoperative steps to reduce the risk of perioperative stroke in adult patients undergoing cardiac and proximal thoracic aortic operations and improve the outcomes of patients who experience a perioperative stroke. The statement notes that perioperative ...

JAMA Neurology (09/08/20) doi: 10.1001/jamaneurol.2020.3263 Sheth, Kevin N.; Mazurek, Mercy H.; Yuen, Matthew M.; et al. https://jamanetwork.com/journals/jamaneurology/fullarticle/2769858   A recent study demonstrates the successful use of low-field, portable magnetic resonance imaging (MRI) for bedside neuroimaging in an intensive care setting. The cohort study involved a series of 50 patients imaged with the portable device, including individuals with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain ...

Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med . 2020 May 21;382(21):1981-93. Reviewed by Wazim Mohamed, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods As thrombectomy has become the mainstay of treatment for large vessel occlusion strokes, the additional benefit offered by thrombolytics has come into question. Thrombolysis with alteplase may ...

Divani A, Liu X, Petersen A, et al.  The magnitude of blood pressure reduction predicts poor in-hospital outcome in acute intracerebral hemorrhage.    Neurocrit Care   (2020).    Reviewed by Kyle Hobbs, MD Read the article . Summary While elevated systolic blood pressure (SBP) after ICH is associated with worse outcome, the optimal systolic blood pressure target in the acute phase is unknown.  This study was a retrospective analysis of 10 years of admission data on spontaneous ICH patients from two hospitals in Minnesota.  Patients ...

Hawryluk GWJ, Nielson JL, Huie JR, et al. Analysis of Normal High-Frequency Intracranial Pressure Values and Treatment Threshold in Neurocritical Care Patients: Insights into Normal Values and a Potential Treatment Threshold.  JAMA Neurol.  Published online June 15, 2020. doi:10.1001/jamaneurol.2020.1310 Reviewed by   Sanjeev Sivakumar, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods The magnitude and duration of intracranial ...

Stroke (08/20) Vol. 51, No. 8: 2587–2592 doi: 10.1161/STROKEAHA.120.030749 Wira, Charles R.; Goyal, Mayank; Southerland, Andrew M; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030749   The Stroke Nursing Science Subcommittee of the AHA/ASA Cardiovascular and Stroke Nursing Council has issued guidance for stroke centers providing assistance to healthcare systems strained by the COVID-19 pandemic. “Stroke centers have clinical and procedural expertise, as well as resources to help in the COVID pandemic,” write the authors. The guidance ...

Journal of the American Medical Association (08/03/20)  doi: 10.1001/jama.2020.11586 Greer, David M.; Shemie, Sam D.; Lewis, Ariane; et al. https://jamanetwork.com/journals/jama/fullarticle/2769149   A new report provides guidelines for determining brain death in children and adults. The World Brain Death Project consensus statement — based on a literature review from January 1992 through April 2020 and the expert opinion of a large multidisciplinary, international panel — includes recommendations for the minimum clinical criteria needed for the ...

JAMA Neurology (06/01/20) doi: 10.1001/jamaneurol.2020.0319 Mazya, Michael V.; Berglund, Annika; Ahmed, Niaz; et al https://jamanetwork.com/journals/jamaneurology/article-abstract/2763539 A new prehospital stroke triage system resulted in much shorter delivery times for endovascular thrombectomy (EVT) without delaying intravenous thrombolysis (IVT), a recent study shows. The population-based prospective cohort study assessed the predictive performance of the Stockholm Stroke Triage System (SSTS) for large-artery occlusion (LAO) stroke and EVT initiation. ...

JAMA Neurology (07/02/20) doi: 10.1001/jamaneurol.2020.2730 Merkler, Alexander E.; Parikh, Neal S.; Saad Mir; et al https://jamanetwork.com/journals/jamaneurology/fullarticle/2768098   Patients with COVID-19 may be at increased risk for risk for stroke compared with patients with influenza, according to a retrospective cohort study from New York–Presbyterian Hospital and Weill Cornell Medicine, both in New York City. “These findings suggest that clinicians should be vigilant for symptoms and signs of acute ischemic stroke in patients with COVID-19 ...

JAMA Neurology (06/15/20) doi: 10.1001/jamaneurol.2020.1310 Hawryluk, Gregory W. J.; Jessica L. Nielson; Huie, J. Russell; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2767085 To better understand the association between intracranial pressure (ICP) and outcome, researchers conducted a prospective observational study involving 523 ICP-monitored patients. The study was conducted over a 6-year period at a single level I trauma center. Participants included 383 patients with a traumatic brain injury, with or without craniectomy, ...

Circulation: Cardiovascular Quality and Outcomes (06/11/20) doi: 10.1161/CIRCOUTCOMES.120.006938 Khot, Umesh N.; Reimer, Andrew P.; Brown, Abigail; et al. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006938 New research shows a reduction in emergency transfers for serious cardiovascular and neurologic diseases coinciding with the COVID-19 pandemic. A team from the Cleveland Clinic, in Cleveland, OH, compared daily emergency transfers for patients experiencing ST-elevation myocardial infarction (STEMI), acute stroke, and aortic emergencies ...

New England Journal of Medicine (05/08/20) doi: 10.1056/NEJMc2014816 Kansagra, Akash P.; Goyal, Manu S.; Hamilton, Scott; et al. https://www.nejm.org/doi/full/10.1056/NEJMc2014816 The number of patients who underwent imaging for the evaluation of stroke decreased from a prepandemic epoch to an early pandemic epoch, according to new research. In a letter to the New England Journal of Medicine , Akash P. Kansagra, M.D., from the Washington University School of Medicine in St. Louis, and colleagues report they examined data for 231,753 patients ...

Stroke   (04/29/20) doi: 10.1161/STROKEAHA.120.03010 Nguyen, Thanh N.; Abdalkader, Mohamad; Jovin, Tudor G.; et al. https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.030100   The Society of Vascular and Interventional Neurology (SVIN) has released a guidance statement on acute ischemic large vessel occlusion strokes in an effort to reduce the transmission of COVID-19 and optimize healthcare resources. The document divides treatment for acute stroke into four phases: prehospital to the emergency department, prethrombectomy, thrombectomy ...

Olsen HT et al. Nonsedation or light sedation in critically ill, mechanically ventilated patients. NEJM. DOI: 10.1056/NEJMoa1906759 Reviewed by Sanjeev Sivakumar, MD Read the article .*   Background/Methods Sedating patients who require mechanical ventilation has been considered standard of care; however, clinical trials have suggested worse outcomes with use of sedatives.  This was a multi-center randomized clinical trial to investigate whether no sedation, compared with light sedation with daily interruption, would result in better ...

Circulation (04/09/20) doi: 10.1161/CIRCULATIONAHA.120.047463 Edelson, Dana P.; Sasson, Comilla; Chan, Paul S.; et al. https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047463 The American Heart Association (AHA) and seven other medical organizations have issued interim guidance regarding cardiopulmonary resuscitation (CPR) for victims of cardiac arrest with suspected or confirmed COVID-19 infection.  “The challenge is to ensure that patients with or without COVID-19 who experience cardiac arrest get the best possible chance of ...

International Journal of Stroke (04/07/20) doi: 10.1177/1747493020912602 Halstead, Michael R.; Mould, W. Andrew; Sheth, Kevin N.; et al. https://journals.sagepub.com/doi/abs/10.1177/1747493020912602 New research highlights the role of haptoglobin (Hp) phenotype in understanding the progression of perihematomal volume in spontaneous intracerebral hemorrhage. The study sought to determine whether rates of early perihematomal edema formation in people with Hp 1-1 phenotype differ from those with Hp 2-1 and Hp 2-2. Among 166 participants, taken ...

Johnson NJ, Danielson KR, Counts CR, et al. Targeted temperature management at 33 versus 36 degrees: A retrospective cohort study. Crit Care Med . 2020 Mar;48(3):362-369. Reviewed by Wazim Mohamed, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods Targeted temperature management (TTM) has become standard of care in post-cardiac arrest survivors after two landmark studies in 2002 demonstrated improved neurological outcomes ...

Sawyer KN, Humbert A, Leroux BG, et al. Relationship between duration of targeted temperature management, ischemic interval, and good functional outcome from out-of-hospital cardiac arrest. Crit Care Med 2020; 48(3):370-377. Reviewed by Alexis Steinberg, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Summary Targeted temperature management (TTM), or induced hypothermia, likely offers neuroprotection in patients after cardiac arrest. However, ...

European Journal of Neurology (02/17/20) doi: 10.1111/ene.14178 Fandler‐Höfler, Simon; Heschl, Stefan; Kneihsl, Markus; et al. For stroke patients receiving mechanical thrombectomy (MT), extubation should occur as early as safely possible, Austrian researchers report, citing as association between prolonged ventilation and unfavorable outcome at 3 months and increased rates of pneumonia. Their study involved 447 consecutive ischemic stroke patients who had been treated at their facility with MT for anterior circulation large vessel occlusion ...

Journal of the American Medical Association (02/20/20) doi: 10.1001/jama.2020.1511 Campbell, Bruce C. V.; Mitchell, Peter J.; Churilov, Leonid; et al. While I.V. thrombolysis with tenecteplase is superior to alteplase in improving cerebral reperfusion in ischemic stroke patients, it was unknown if tenecteplase's performance is influenced by dose. To explore, researchers in Australia and New Zealand assembled a trial population of 300 adults with ischemic stroke caused by large vessel occlusion. Participants in the EXTEND-IA TNK study Part II ...

Ferro JM, Coutinho JM, Dentali F, et al. JAMA neurology. 2019 Dec 1;76(12):1457-65.  Reviewed by Wazim Mohamed, MD   Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.      Summary Background/Methods: The prevalence of cerebral venous thrombosis (CVT) is low and the primary concern after the acute phase is that of recurrent CVT or venous thrombotic events (VTE). Current recommendations for prevention of such events is through anticoagulation ...

Amarenco P, Kim JS, Labreuche H, et al.  A comparison of two LDL cholesterol targets after ischemic stroke.  NEJM 2020; 382:9-19.   Reviewed by Kyle Hobbs, MD Read the article .   Summary :  Intensive lipid lowering therapy is recommended after ischemic stroke or TIA, but the exact LDL target is unclear. The Treat Stroke to Target trial is an international, multicenter, randomized, parallel-group, event driven trial comparing a target LDL of < 70 mg/dL to a target of 90-110 mg/dL after ischemic stroke or TIA in patients with atherosclerosis.  ...

Barletta JF, Abdul-Rahman D, Hall ST, Mangram AJ, Dzandu JK, Frontera JA, Zach V. The role of desmopressin on hematoma expansion in patients with mild traumatic brain injury prescribed pre-injury antiplatelet medications. Neurocritical Care. 2020 Jan 2. doi: 10.1007/s12028-019-00899-x Reviewed by Alexis Steinberg, MD   Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Methods: An increased risk for traumatic intracerebral hemorrhage (ICH) and ...

Annals of Neurology (01/10/20)  doi.org/10.1002/ana.25675 Sharma, Sripadh; Ifergan, Igal; Kurz, Jonathan E.; et al. Immunomodulatory nanoparticles (IMPs) – which ablate a particular subset of hematogenous monocytes – are a strong therapeutic candidate for traumatic brain injury (TBI), new research shows. Researchers from the Northwestern University Feinberg School of Medicine in Chicago administered an intravenous infusion of IMPs containing 500 nm carboxylated‐poly(lactic‐co‐glycolic) acid into wild‐type C57BL/6 mice following controlled cortical ...

Journal of Neurology (01/18/20)  doi: 10.1007/s00415-020-09701-x Fandler-Höfler, Simon; Heschl, Stefan; Argüelles-Delgado, Placido; et al. Declines in mean arterial pressure (MAP) below 60 mmHg during general anesthesia (GA) for stroke patients undergoing mechanical thrombectomy (MT) are independently associated with worse functional outcome three months after the stroke, according to new research. The retrospective cohort study, conducted at a single center in Austria, involved adults who had received MT because of anterior circulation large vessel ...