Cardiovascular Events After Intracerebral Hemorrhage

 You're describing a problem but offering no solution. What the fuck do you think stroke research is for? MAYBE 100% RECOVERY PROTOCOLS?

Cardiovascular Events After Intracerebral Hemorrhage

Linxin Li

and

Santosh B. Murthy

Originally published8 Jun 2022https://doi.org/10.1161/STROKEAHA.122.036884Stroke. 2022;53:2131–2141

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Abstract

Cardiovascular events after primary intracerebral hemorrhage (ICH) have emerged as a leading cause of poor functional outcomes and mortality during the long-term recovery after an ICH. These events encompass arterial ischemic events such as ischemic stroke and myocardial infarction, arterial hemorrhagic events that include recurrent ICH, and venous thrombotic events such as venous thromboembolism. The purpose of this review is to summarize the cardiovascular complications after ICH, epidemiology and associated risk factors, and their impact on ICH outcomes. Additionally, we will highlight possible pathophysiological mechanisms to explain the short- and long-term increased risks of ischemic and hemorrhagic events after ICH. Finally, we will highlight potential secondary stroke and venous thrombotic prevention strategies often not considered after ICH, balanced against the risk of ICH recurrence.

Footnotes

Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.036884.

For Sources of Funding and Disclosures, see page 2138.

Correspondence to: Santosh Murthy, MD, MPH, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, 525 East 68th St, Room F610, New York, NY 10065. Email sam9200@med.cornell

 

Bridging versus direct endovascular therapy in basilar artery occlusion

SO NO MEASUREMENT OF 100% RECOVERY?  What the fuck do you think stroke research is for?  It is not to get 'better', it is to completely recover. Talk to survivors sometime without using your tyranny of low expectations to justify failure.

 Bridging versus direct endovascular therapy in basilar artery occlusion

1. http://orcid.org/0000-0002-2607-5815Sergio Nappini1,
2. http://orcid.org/0000-0003-3941-7383Francesco Arba2,
3. Giovanni Pracucci3,
4. Valentina Saia4,
5. Danilo Caimano3,
6. Nicola Limbucci1,
7. Leonardo Renieri1,
8. Andrea Zini5,
9. Domenico Inzitari3,
10. Danilo Toni6,
11. Salvatore Mangiafico1
12. On behalf of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Study Group

1. Correspondence to Dr Sergio Nappini, Neurovascular Interventional Unit, University Hospital Careggi, Firenze, Italy; nappini@gmail.com

Abstract

Background We evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).

Methods From a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.

Results We included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).

Conclusions In ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All free text entered below will be published.

http://dx.doi.org/10.1136/jnnp-2020-325328