ischemic stroke
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Introduction
A stroke caused by an insufficient supply of blood & oxygen to a part of the brain, generally result of cerebrovascular disease.
Etiology
- thrombus related to atherosclerosis of large arteries (30%)
- internal carotids
- aortic arch {uncommon}[24]
- large intracranial arteries
- cervicocephalic arterial dissection
- embolus from cardiac source (20%)
- secondary hemorrhage may occur
- patent foramen ovale[24][31],
- cryptogenic stroke, all ages, epecially < 55-60
- atrial septal aneurysm in 28-40% of ischemic strokes in patients < 55 years of age
- patent foramen ovale & atrial septal aneurysm frequently occur together
- multiple cardiac emboli are suggested by 2 or more areas of ischemic infarction
- myocardial infarction[11] resulting in LV systolic dysfunction
- atrial fibrillation[11]
- 25% of patients with cryptogenic embolic stroke have paroxysmal atrial fibrillation[3][60][77]; 12-16%[66]
- cardiac surgery increases risk of atrial fibrillation[3]
- lacunar (small vessel) (20%)
- other (30%)
- pharmacologic:
- hypercoagulable state
- arteritis
- cervical artery dissection due to trauma
- fibromuscular dysplasia
- migraine
- Moya Moya disease
- children's medical visits for respiratory tract infection (within 3 days) confer 12-fold increase in risk for ischemic stroke[68]*
- idiopathic in 50% of patients < 55 years of age[41]
- embolic stroke of undetermined source[3]
- suspect embolus from cardiac source (see above)
- paroxysmal atrial fibrillation in 25% of patients with idiopathic stroke[54][77]
- embolic stroke of undetermined source[3]
- also see risk factors for ischemic stroke
* Editorialist not impressed. Absolute risk is very low, No evidence that attempt to treat would mitigate risk.[58]
Epidemiology
- 3rd most common cause of death
- most common cause of adult disability
- most preventable of catastrophic conditions
- 75% of all strokes are ischemic
- persons with type A blood have 16% higher risk for early-onset stroke than persons with other blood types[118]
- persons with type O blood have 12% lower risk[118]
- states with high stroke mortality[93]
- Alabama, Alaska, Arkansas, Louisiana, Mississippi, Oklahoma, Tennessee, South Carolina, or West Virginia
Pathology
- infarction of a vascular territory of the brain due to ischemia
- an ischemic zone surrounds an infarct & secondary phenomena increase the severity of the irreversible injury
- these secondary phenomena include excitotoxin-induced neuronal injury, cerebral edema & altered local blood flow
- morbidity & mortality associated with massive hemispheric ischemic strokes is due to brain tissue edema resulting in brainstem & diencephalic compression[23]
Genetics
- susceptibility to ischemic stroke associated with
- defects in protein kinase C-eta (PRKCH)
- defects in P-selectin (SELP)
- genetic variations in ALOX5AP
- defects in factor V
- defects in prothrombin
- polymorphisms in IL4
- defects in CECR1 (lacunar infarcts)
Clinical manifestations
- focal or multifocal neurologic deficit evolving over second to minutes, persisting > 24 hours
- sensory involvement of affected areas may result in sensory deficits
- motor involvement of affected areas may result
- paresis, paralysis, generally unilateral
- dysarthria, dysphagia
- transient improvement in renal function may occur in patients with renal insufficiency (central regulation hypothesized)[85]
- suspect vertebrobasilar stroke in older patients with acute onset vertigo[3]
Laboratory
- telomere length in peripheral blood mononuclear cells allegedly predicts cognitive decline, dementia & death after stroke[27]
- difficult to envision mechanism
Diagnostic procedures
- prestroke trailmaking B test may predict risk of first stroke & mortality after first stroke
- cardiac rhythm monitoring (in hospital telemetry) for atrial fibrillation
- at least 24 hours of Holter monitoring[88]
- prolonged outpatient cardiac rhythm monitoring indicated for patients with embolic stroke[3]
- 30-day event-triggered recorder more sensitive than 24 hour HOLTER*
- 6 months of monitoring with an insertable cardiac monitor[6]
- 10 day HOLTER monitoring 3 times within 6 months[90]
- atrial fibrillation identified in 25% if patients with idiopathic stroke
- swallowing evaluation for dysphagia after stroke[3]
* it is not clear how or why the events were triggered
Radiology
- head CT to rule out intracranial hemorrhage[3]
- magnetic resonance imaging (MRI)
- may be useful to identify patients who might benefit from endovascular thrombolysis up to 12 hours after an ischemic stroke[49]
- CT or MRI within 8 hours after onset of stroke symptoms to predict which patients might benefit from endovascular thrombolysis does not improve outcomes[53]
- diffusion-weighted imaging may be more sensitive
- magnetic resonance angiography or CT angiography useful for evaluating extracranial & large intracranial arteries[3]
- indicated for arterial thrombectomy
- angiography is the gold standard for delineating vascular anatomy, but rarely used (associated with small risk of stroke)[3]
- identify collateral circulation to determine likely benefit of thrombectomy (see Management)
- carotid ultrasound
- transcranial doppler ultrasound showing increased flow velocity can confirm magnetic resonance angiographic findings
- transthoracic echocardiogram
- identifies atrial septal defect in young adults with stroke
- transesophageal ultrasound not routinely indicated
- can also detect aortic arch thrombi: thrombi > 3 mm are suspect
Complications
- cerebral edema or cerebellar edema resulting in increased intracranial pressure may occur after major ischemic stroke
- conversion to hemorrhagic stroke, usually within 48 hours
- delirium occurs in 12% of patients admitted to stroke unit; associated with poor prognosis[40]
- seizures early after stroke
- less common with ischemic stroke than hemorrhagic stroke (4% vs 15%)[43]
- more common with cortical stroke than subcortical stroke (19% vs 10%)
- do not predict mortality or function at 6 months[43]
- risk of pneumonia is highest in the 1st week after stroke[120]
- poststroke dementia due to cerebrovascular disease[45]
- anxiety & depression common[3][46]
- major depression with psychosis is a further complication
- fatigue after stroke due to depression, sleep apnea, heart failure[3]
- recurrence of stroke
- risk highest with atherosclerotic stenosis of large artery of >70%[3]
- risk of recurrent stroke lower with atrial fibrillation diagnosed after stroke than before[98]
- death, recurrent stroke, MI, or admission to a care facility more common in stroke (without 90 day complications) than in controls 10% vs 5% at 1 year, 24% vs 14% at 3 years & 36% vs 21% at 5 years[92]
- reemergence or recrudescence of stroke symptoms in the setting of an intercurrent illness[103]
- atrial fibrillation diagnosed after stroke (10%)[98]
- neurogenic mechanism suggested[98]
Differential diagnosis
- see stroke
Management
- acute ischemic stroke (within 4 hours, 4.5 hours[37])
- see ACLS algorithm for suspected stroke
- see thrombolysis for ischemic stroke
- helpful when administered within 3-4.5 hours of stroke symptom[105]
- thrombolysis within 90 minutes provides best outcomes[57]
- mobile stroke units may reduce time to thrombolysis
- NCY-059, a free radical trapping agent, 72 hour infusion appears to improve outcomes in clinical trials[21]
- endovascular thrombectomy
- within 24 hours if suspected large vessel occlusion[3][96]
- within 6-16 hours of anterior-circulation large-vessel occlusion[105]
- following tPA
- tenecteplase may be reasonable alternative to alteplase if eligible for arterial thrombectomy[105]
- CT angiography determines large vessel occlusion & elgiblity for arterial thrombectomy
- endovascular thrombectomy with retrievable stent
- intracranial stenting associated with 2-fold increase in risk or stroke vs medical therapy[3]
- may be beneficial in patients with acute ischemic stroke due to proximal intracranial arterial occlusion[36][51][72][73][78][81]
- patients < 80 years
- thrombus in the internal carotid artery or proximal middle cerebral artery
- few comorbidities & no contraindications[82]
- 45% functional independence at 90 days vs 32% for tPA alone[82]
- benefit only if begun within 7 hours of symptom onset[89]
- patients with poor collateral circulation generally progress to rapid tissue infarction, & interventional treatment may be futile[94]
- hemicraniectomy may reduce intracranial pressure from malignant middle cerebral artery (MCA) infarcts involving > 50% of arterial territory[3][23][64]
- antiplatelet therapy for patients who arrive outside the window for thrombolysis for ischemic stroke[3]
- see pharmacologic therapy post stroke below
- general guidelines (see stroke)
- blood pressure control[62][71]
- do not attempt to acutely lower blood pressure unless
- systolic blood pressure > 220 mm Hg, or
- diastolic blood pressure > 120 mm Hg, or
- mean arterial blood pressure > 140 mm Hg
- patient has acute coronary syndrome
- aortic dissection suspected
- thrombolytic therapy planned[4]
- systolic BP > 230 mm Hg or diastolic BP 121-140 mm Hg
- labetolol 10 mg IV, over 1-2 min q 10 min up to 150 mg
- nicardipine IV is an alternative
- if response in inadequate, use sodium nitroprusside
- diastolic BP > 140 mm Hg
- nitroprusside 0.5-10 ug/kg/min
- monitor closely
- nitroprusside effective for malignant hypertension, but may increase intracranial pressure[8]
- avoid hypotension[3][58]
- see risk factors for & prevention of ischemic stroke for long-term post ischemic stroke blood pressure control
- do not attempt to acutely lower blood pressure unless
- glycemic control
- tight glycemic control (< 130 mg/dL) no better than standard control (< 180 mg/dL) during 1st 72 hours after stroke[102]
- MKSAP 16 recommends maintaining blood glucose < 140 mg/dL at least for 1st 24 hours[3]
- tight glycemic control (blood glucose 72-135 mg/dL) of no benefit immediately after ischemic stroke[74]
- supportive therapy directed towards:
- reducing risk factors (attenuating pathologic processes)
- removing underlying cause
- minimizing secondary brain damage by maintaining adequate perfusion & limiting edema
- monitor for cerebral edema for 3-5 days post stroke[3]
- avoid postural hypotension, a frequent cause of neurologic deterioration after completion of ischemic stroke
- return to supine position
- supine vs sitting up has no effect on disability or mortality after acute stroke[91]
- administer fluids to maintain euvolemia (normal saline)
- monitor blood pressure
- reassess pharmacologic therapy
- return to supine position
- avoid/treat hyperthermia or fever with acetaminophen
- routine acetaminophen of no benefit[38]
- inpatient telemetry to evaluate for atrial fibrillation[3]
- pharmacologic therapy post stroke
- thrombolytic therapy (within 1st 4.5 hours)
- tissue plasminogen activator (tPA, Alteplase)
- disability-free survival at 90 days 35% with tPA vs 30% with endovascular approach[51]
- endovascular therapy after tPA of no benefit[52]
- heparin* followed by warfarin - do NOT use
- for embolic stroke, use asprin for 4-14 days, then switch to anticoagulation[3]
- antiplatelet therapy
- all patients within 24 hours, unless contraindicated[3][59][105]
- avoid for 2-7 days if hemorrhagic transformation involving hematoma[3]
- clopidogrel (Plavix) 75 mg PO QD superior to aspirin[3][32]
- aspirin 325 mg QD
- 650 mg BID for intracranial arterial stenosis
- 160-300 mg QD, started within 48 hours of onset improves long-term outcome[75]
- aspirin reduces risk of recurrent stroke by 93% at 2 weeks & 74% at 12 weeks relative to placebo[86]
- aspirin + dipyridamole superior to aspirin alone in preventing recurrent stroke[3]
- dual antiplatelet therapy
- American Heart Association endorses dual antiplatelet therapy for 21 days[3]
- dual antiplatelet therapy increases risk of systemic bleeding ~5-6 events per 100 patient-years relative to monotherapy[97]
- dual antiplatelet therapy decreases risk of stroke at the cost of increased risk for major hemorrhage (09% vs 0.2%)[99][106]
- dual antiplatelet therapy may not increase risk of intracerebral hemorrhage[97]; it does[106]
- short-term (up to 3 weeks) dual antiplatelet therapy with aspirin plus clopidogrel or ticagrelor for minor ischemic stroke,then aspirin alone[101][106]
- 30 day outcomes for dual antiplatelet therapy with ticagrelor + aspirin 75-100 mg for moderate ischemic stroke better than aspirin alone[110]
- dual antiplatelet therapy should not be used in patients with major stroke due to increased risk for intracranial bleeding[101]
- long-term dual antiplatelet therapy does not decrease risk of stroke but increases risk of hemorrhage & death vs single antiplatelet agent[3]
- presence of an acute infarct on index imaging is associated with an increased risk of recurrent stroke & a more pronounced benefit from dual antiplatelet therapy[112]
- all patients within 24 hours, unless contraindicated[3][59][105]
- patients should receive high-intensity statin with aspirin in the acute post-stroke period[3][44]
- minocycline 200 mg PO QD for 5 days (window 6-24 hours after onset of stroke)[29]
- SSRI to improve outcomes in patients with stroke controversial[61]
- fluoxetine 20 mg PO QD for 90 days starting 5-10 days after stroke may diminish motor disability[39]
- fluoxetine of no benefit at 6 months[108]
- ginkgo biloba extract (450 mg QD) + aspirin associated with less cognitive decline following stroke than aspirin alone[95]
- thrombolytic therapy (within 1st 4.5 hours)
- blood pressure reduction predicts poor prognosis:[14]
- reduction in blood pressure (both systolic or diastolic) during the 1st 24 hours associated with negative outcomes
- antihypertensive therapy does not seem to affect either blood pressure or outcome during the 1st 24 hours[14]
- lowering systolic blood pressure by 10-20% within 24-48 hours does not affect morbidity or mortality[121]
- initial blood pressure < 150/70 mm Hg associated with increased mortality
- do not initiate antihypertensive treatment in the 1st 48 hours unless
- systolic BP > 220 mm Hg, diastolic BP > 120 mm Hg (MKSAP19)[3]
- acute coronary syndrome, aortic dissection, end-organ damage[3]
- if patient eligible for thrombolysis for ischemic stroke
- systolic BP < 180 mm Hg, diastolic BP < 105 mm Hg with pressures maintained for 24 hours after therapy[3]
- intensive control of systolic blood pressure to <120 mm Hg after endovascular thrombectomy may compromise functional recovery[117]
- swallowing evaluation for dysphagia prior to administraion of oral meds[3]
- stroke units (neurorehabilitation) improve outcomes[44][83] (see neurorehabilitation)
- telestroke systems of benefit for rural areas (see telehealth)
- early mobilization
- mobilization in 1st 24 hours of no benefit, possibly harmful[79]
- if not, DVT prophylaxis within 48 hours[3]
- LMW heparin, do not use warfarin, DOAC not FDA approved use[44]
- graduated compression stockings of no benefit []
- remote ischemic conditioning may improve neurologic function[116]
- of no benefit[119]
- secondary prevention[3][4][12][15][16][26][28][32][42][44][47][55][56][65]
- see prevention of ischemic stroke
- target LDL cholesterol < 70 mg/dL[104]
- see embolic stroke
- routine evaluation for thrombophilia not indicated[3]
- anticonvulsant not indicated unless patient has had a seizure[3]
- carotid endarterectomy not indicated for 100% carotid artery stenosis[3]
- see prevention of ischemic stroke
- prognosis
- most stroke survivors have neurologic impairment after 1 years
- severity of initial neurologic deficit is the strongest predictor of long-term disability[3]
- magnitude of chronic cognitive impairment after stroke cannot be determined for at least 3 months[44]
- childhood & young adult ischemic stroke associated with similar prognosis, 55% considered favorable by Rankin scale scores[80]
- depression is prevalent & treatment of depression is one of the long-term modifiable disability factors[3]
- advance directives documented with a minority of patients[87]
* unfractionated heparin & low-molecular-weight heparin not as effective as aspirin for acute ischemic stroke[12]
* LMW heparin for DVT prophylaxis, do not use warfarin, DOAC not FDA-approved
Follow-up:
- neurorehabilitation (see above)
- workup for coronary artery disease
- wait at least 6-9 months[3][67][114] after ischemic stroke prior to elective non-cardiac surgery
- risk of perioperative stroke & death remains elevated to 2 years[115]
Notes
- 'Get with the Guidelines - Stroke' an internet-based tool improved outcomes in hospitalized stroke patients[34]
- frequency of gastrostomy tube placement varies substantially among U.S. hospitals[69]
More general terms
More specific terms
- anterior cerebral artery syndrome
- embolic stroke
- lacunar infarct
- middle cerebral artery syndrome (M1 stenosis)
- posterior cerebral artery syndrome
- vertebrobasilar stroke
Additional terms
- ACLS algorithm for suspected stroke
- carotid artery disease
- endovascular thrombectomy for acute ischemic stroke
- intracranial arterial stenosis
- ischemic stroke prevention trial
- mobile stroke unit; STroke Emergency MObile (STEMO)
- neurorehabilitation
- prevention of ischemic stroke
- reversible ischemic neurologic deficit (RIND)
- risk factors for & prevention of ischemic stroke
- secondary prevention in patients with cardiovascular disease
- thrombolysis for ischemic stroke
- transient ischemic attack (TIA)
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1019-20
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 3.37 3.38 3.39 3.40 3.41 3.42 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 4.2 Prescriber's Letter 8(7):38 2001 (subscription needed) http://www.prescribersletter.com
- ↑ Moncayo J et al Coexisting causes of ischemic stroke. Arch Neurol 57:1139, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10927793
- ↑ 6.0 6.1 Yamamoto H & Bogousslavsky J Mechanisms of second and further strokes. J Neurol Neurosurg Psychiatry 64:771, 1998 PMID: https://www.ncbi.nlm.nih.gov/pubmed/9647308
- ↑ Izitari D et al The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 342:1693, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10841871
- ↑ 8.0 8.1 Barnett et al, North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group Causes and severity of ischemic stroke in patients with internal carotid artery stenosis. JAMA 283:1429, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10732932
- ↑ Wikipedia: Stroke http://en.wikipedia.org/wiki/Ischemic_stroke#Ischemic_stroke
- ↑ Alamowitch et al, North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid- artery stenosis. Lancet 357:1154, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11323042
- ↑ 11.0 11.1 11.2 Journal Watch 22(10):77, 2002 Lichtman et al Risk and predictors of stroke after myocardial infarction among the elderly: results from the Cooperative Cardiovascular Project. Circulation 105:1082, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11877359
- ↑ 12.0 12.1 12.2 Prescriber's Letter 9(9):52 2002 (subscription needed) http://www.prescribersletter.com
- ↑ Journal Watch 23(23):183, 2003 He K et al Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. BMJ 327:777, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14525873 <Internet> http://bmj.com/cgi/content/full/327/7418/777
- ↑ 14.0 14.1 14.2 Journal Watch 23(24):192-93, 2003 Oliveira-Filho J et al Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology 61:1047 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14581662
Vlcek M et al Association between course of blood pressure within the first 24 hours and functional recovery after acute ischemic stroke. Ann Emerg Med 42:619, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14581913
Adams HP et al Guidelines for Early Management of Patients ith Ischemic Stroke http://stroke.ahajournals.org/cgi/reprint/34/4/1056.pdf - ↑ 15.0 15.1 Journal Watch 24(7):55, 2004 Collins R et al, Heart Protection Study Collaborative Group Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet 363:757, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15016485
- ↑ 16.0 16.1 Journal Watch 24(17):133, 2004 Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo- controlled trial. Lancet. 2004 Jul 24;364(9431):331-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15276392
- ↑ Ovbiagele B, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Alberts MJ et al, Antiplatelet Effect of Aspirin in Patients with Cerebrovascular Disease Stroke 25:175, 2004
- ↑ Brown DL, Barsan WG, Lisabeth LD, Gallery ME, Morgenstern LB. Survey of emergency physicians about recombinant tissue plasminogen activator for acute ischemic stroke. Ann Emerg Med. 2005 Jul;46(1):56-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15988427
- ↑ Stead LG, Gilmore RM, Decker WW, Weaver AL, Brown RD Jr. Initial emergency department blood pressure as predictor of survival after acute ischemic stroke. Neurology. 2005 Oct 25;65(8):1179-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16247043
- ↑ 21.0 21.1 Lees KR et al, NXY-059 for acute ischemic stroke. N Engl J Med 2006, 354:588 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16467546
- ↑ Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T; American Heart Association; American Stroke Association Council on Stroke; Council on Cardiovascular Radiology and Intervention; American Academy of Neurology. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Feb;37(2):577-617. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16432246 <Internet> http://stroke.ahajournals.org/cgi/content/full/37/2/577
- ↑ 23.0 23.1 23.2 Els T, Oehm E, Voigt S, Klisch J, Hetzel A, Kassubek J. Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis. 2006;21(1-2):79-85. Epub 2005 Nov 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16330868
Huttner HB, Schwab S. Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol. 2009 Oct;8(10):949-58 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19747656 - ↑ 24.0 24.1 24.2 Petty GW, Khandheria BK, Meissner I, Whisnant JP, Rocca WA, Christianson TJ, Sicks JD, O'Fallon WM, McClelland RL, Wiebers DO. Population-based study of the relationship between patent foramen ovale and cerebrovascular ischemic events. Mayo Clin Proc. 2006 May;81(5):602-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16706256
Petty GW, Khandheria BK, Meissner I, Whisnant JP, Rocca WA, Sicks JD, Christianson TJ, O'Fallon WM, McClelland RL, Wiebers DO. Population-based study of the relationship between atherosclerotic aortic debris and cerebrovascular ischemic events. Mayo Clin Proc. 2006 May;81(5):609-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16706257 - ↑ Stefanick ML et al Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy JAMA 2006; 295:1647 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16609086
Chen WY et al, Unopposed estrogen therapy and the risk of invasive breast cancer Arch Intern Med 2006; 166:1027 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16682578 - ↑ 26.0 26.1 Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA; Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 Aug 10;355(6):549-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16899775
- ↑ 27.0 27.1 Martin-Ruiz C et al, Telomer length predicts poststroke mortality, dementia, and cognitive decline. Ann Neurol 2006, 60:174 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16685698
- ↑ 28.0 28.1 Bianco M et al, Statin treatment withdrawal in ischaemic stroke: a controlled randomized study. Neurology 2007, 69:904 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17724294
- ↑ 29.0 29.1 Lampl Y et al, Minocycline treatment in acute stroke. An open-label, evaluator-blinded study. Neurology 2007, 69:1404 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17909152
- ↑ Rothwell PM et al, Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): A prospective population-based sequential comparison Lancet 2007, 370:1432 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17928046
- ↑ 31.0 31.1 Handke M et al, Patient foramen ovale and cryptogenic stroke in older patients. N Engl J Med 2007, 357:2262 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18046029
- ↑ 32.0 32.1 32.2 Prescriber's Letter 15(10): 2008 Antiplatelet Agents for Stroke Prevention Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=241010&pb=PRL (subscription needed) http://www.prescribersletter.com
Verro P, Gorelick PB, Nguyen D. Aspirin plus dipyridamole versus aspirin for prevention of vascular events after stroke or TIA: a meta-analysis. Stroke. 2008 Apr;39(4):1358-63. Epub 2008 Mar 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18323511
Sacco RL et al; PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008 Sep 18;359(12):1238-51. Epub 2008 Aug 27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18753638 - ↑ Goldstein LB et al Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke. 2011 42(2):517-584 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21127304 <Internet> http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181fcb238v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=guidelines+for+the+primary+prevention+of+stroke&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Guidelines on primary prevention of ischemic stroke American Heart Association (AHA) and the American Stroke Association (ASA) http://circ.ahajournals.org/cgi/content/full/113/24/e873 Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF; American Heart Association/American Stroke Association Stroke Council; American Heart Association/ American Stroke Association Clinical Cardiology Council; American Heart Association/American Stroke Association Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease Working Group; Quality of Care Outcomes in Research Interdisciplinary Working Group. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007 May 22;115(20):e478-534. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17515473 [PubMed]
Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF; American Heart Association; American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007 May;38(5):1655-711. Epub 2007 Apr 12. Erratum in: Stroke. 2007 Jun;38(6):e38. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/17431204 <Internet> http://stroke.ahajournals.org/cgi/reprint/STROKEAHA.107.181486 - ↑ 34.0 34.1 LaBresh KA et al, Hospital treatment of patients with ischemic stroke or transient ischemic attack using the 'Get With The Guidelines' program. Arch Intern Med 2008, 168:411 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18299497
- ↑ Luengo-Fernandez R et al. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): A prospective population-based sequential comparison. Lancet Neurol 2009 Mar; 8:235. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19200786
- ↑ 36.0 36.1 Brekenfeld C et al. Stent placement in acute cerebral artery occlusion: Use of a self-expandable intracranial stent for acute stroke treatment. Stroke 2009 Mar; 40:847. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19182080
- ↑ 37.0 37.1 Hacke W et al Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke N Engl J Med. 2008 Sep 25;359(13):1317-29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18815396
del Zoppo GJ et al Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator A Science Advisory From the American Heart Association/American Stroke Association (from stroke.ahajo1urnals.org by on June 1, 2009) http://stroke.ahajournals.org/cgi/reprint/STROKEAHA.109.192535
Prescriber's Letter 16(7): 2009 COMMENTARY: Expanding the Window for Administration of tPA in Ischemic Stroke GUIDELINES: Expansion of the Time Window for Treatment of Acute Ischemic Stroke with Intravenous Tissue Plasminogen Activator (AHA/ASA, 2009) GUIDELINES: Early Management of Adults with Ischemic Stroke (AHA/ASA, 2007) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250717&pb=PRL (subscription needed) http://www.prescribersletter.com
Saver JL et al Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3 to 4.5 hour window. Joint outcome table analysis of the ECASS 3 trial. Stroke. 2009 Jun 4. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/19498197 DOI:10.1161/STROKEAHA.108.543561.
Lansberg MG et al Treatment time-specific number needed to treat estimates for tissue plasminogen activator therapy in acute stroke based on shifts over the entire range of the modified Rankin Scale Stroke. 2009 Jun;40(6):2079-84. Epub 2009 Apr 16. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19372447
Lansberg MG et al Efficacy and Safety of Tissue Plasminogen Activator 3- to 4.5-Hours After Acute Ischemic Stroke. A Metaanalysis. Stroke. 2009 May 28. [Epub ahead of print] PMID: https://www.ncbi.nlm.nih.gov/pubmed/19478213 - ↑ 38.0 38.1 den Hertog HM et al The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: A multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol 2009 May; 8:434. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19297248
- ↑ 39.0 39.1 Chollet F et al Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial Lancet Neurol. 2011 Jan 7. [Epub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21216670 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(10)70314-8/fulltext
Robinson RG and Adams HP Selective serotonin-reuptake inhibitors and recovery after stroke. Lancet Neurol. 2011 Jan 7. [Epub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21216671 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(10)70326-4/fulltext - ↑ 40.0 40.1 Oldenbeuving AW et al. Delirium in the acute phase after stroke: Incidence, risk factors, and outcome. Neurology 2011 Mar 15; 76:993. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21307355
- ↑ 41.0 41.1 Larrue V et al. Etiologic investigation of ischemic stroke in young adults. Neurology 2011 Jun 7; 76:1983. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21646623
- ↑ 42.0 42.1 Callahan A et al. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: Secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Arch Neurol 2011 Oct; 68:1245. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21670382
- ↑ 43.0 43.1 43.2 Beghi E et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology 2011 Nov 15; 77:1785 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21975208
De Herdt V et al. Early seizures in intracerebral hemorrhage: Incidence, associated factors, and outcome. Neurology 2011 Nov 15; 77:1794. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21975203 - ↑ 44.0 44.1 44.2 44.3 44.4 44.5 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 45.0 45.1 Allan LM et al. Long term incidence of dementia, predictors of mortality and pathological diagnosis in older stroke survivors. Brain 2011 Dec; 134:3716. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22171356
- ↑ 46.0 46.1 El Husseini NE et al Depression and Antidepressant Use After Stroke and Transient Ischemic Attack Stroke March 29, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22461330 <Internet> http://stroke.ahajournals.org/content/early/2012/03/29/STROKEAHA.111.643130.abstract
- ↑ 47.0 47.1 Flint AC et al Inpatient statin use predicts improved ischemic stroke discharge disposition Neurology May 22, 2012 vol. 78 no. 21 1678-1683 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22614435 <Internet> http://www.neurology.org/content/78/21/1678
Flint AC et al Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival. Stroke. 2012 Jan;43(1):147-54 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22020026 - ↑ Furie KL, Kasner SE, Adams RJ et al Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Jan;42(1):227-76 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20966421
- ↑ 49.0 49.1 Lansberg MG et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): A prospective cohort study. Lancet Neurol 2012 Oct; 11:860. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22954705
- ↑ Jauch EC et al AHA/ASA Guideline Guidelines for the Early Management of Patients With Acute Ischemic Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. Jan 31, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23370205 <Internet> http://stroke.ahajournals.org/content/early/2013/01/31/STR.0b013e318284056a.full
- ↑ 51.0 51.1 51.2 Physician's First Watch, Feb 7, 2013 Massachusetts Medical Society
Ciccone A et al Endovascular Treatment for Acute Ischemic Stroke. New Engl J Med. February 6, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23387822 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1213701 - ↑ 52.0 52.1 Broderick JP et al Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke. N Engl J Med. February 7, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23390923 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1214300
- ↑ 53.0 53.1 Kidwell CS et al A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke. N Engl J Med. February 8, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23394476 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1212793
Chimowitz MI Endovascular Treatment for Acute Ischemic Stroke - Still Unproven N Engl J Med. February 8, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23394477 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1215730 - ↑ 54.0 54.1 Cotter PE et al. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology 2013 Apr 23; 80:1546. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23535493 <Internet> http://www.neurology.org/content/80/17/1546
- ↑ 55.0 55.1 Armstrong MJ et al Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology May 28, 2013 vol. 80 no. 22 2065-2069 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23713086 <Internet> http://www.neurology.org/content/80/22/2065.full
- ↑ 56.0 56.1 Wang Y et al Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack. N Engl J Med. June 26, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23803136 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1215340
Hankey GJ Dual Antiplatelet Therapy in Acute Transient Ischemic Attack and Minor Stroke N Engl J Med. June 26, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23803138 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1305127 - ↑ 57.0 57.1 Strbian D et al Ultra-Early Intravenous Stroke Thrombolysis. Do All Patients Benefit Similarly? Stroke. August 22, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23970791 <Internet> http://stroke.ahajournals.org/content/early/2013/08/22/STROKEAHA.111.000819.abstract
- ↑ 58.0 58.1 58.2 Cumbler E, Glasheen J. Management of blood pressure after acute ischemic stroke: An evidence-based guide for the hospitalist. J Hosp Med. 2007 Jul;2(4):261-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17705177
- ↑ 59.0 59.1 Sandercock PA, Counsell C, Gubitz GJ, Tseng MC. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD000029 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18646056
- ↑ 60.0 60.1 Tayal AH, Tian M, Kelly KM Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology. 2008 Nov 18;71(21):1696-701 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18815386
- ↑ 61.0 61.1 Mead GE et al. Selective serotonin reuptake inhibitors for stroke recovery. JAMA 2013 Sep 11; 310:1066 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24026602
- ↑ 62.0 62.1 He J et al Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Patients With Acute Ischemic Stroke. The CATIS Randomized Clinical Trial. JAMA. Published online November 17, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24240777 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1778674
- ↑ Sandercock PA, Gibson LM, Liu M. Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD000248. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19370555
- ↑ 64.0 64.1 64.2 Juttler E et al. Hemicraniectomy in older patients with extensive middle- cerebral-artery stroke. N Engl J Med. 2014 Mar 20;370(12):1091-100 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24645942 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1311367
- ↑ 65.0 65.1 Jamerson K et al, Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients N Engl J Med 2008, 359:2417-2428 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19052124
- ↑ 66.0 66.1 Gladstone DJ et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014 Jun 26; 370:2467 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24963566 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1311376
Sanna T et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014 Jun 26; 370:2478. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24963567 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1313600
Kamel H. Heart-rhythm monitoring for evaluation of cryptogenic stroke. N Engl J Med. 2014; 370:2532-2533 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24963573 - ↑ 67.0 67.1 Jorgensen ME et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014 Jul 16; 312:269. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25027142
- ↑ 68.0 68.1 Hills NK et al Timing and number of minor infections as risk factors for childhood arterial ischemic stroke. Neurology. August 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25142897 <Internet> http://www.neurology.org/content/early/2014/08/20/WNL.0000000000000752
Marquardt L A common cold is no stroke of luck. Risk for cerebral ischemia in Children. Neurology. August 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25142898 <Internet> http://www.neurology.org/content/suppl/2014/08/20/WNL.0000000000000752.DC1/WNL.0000000000000760.pdf - ↑ 69.0 69.1 George BP et al. Current practices in feeding tube placement for US acute ischemic stroke inpatients. Neurology 2014 Sep 2; 83:874. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25098538 <Internet> http://www.neurology.org/content/83/10/874
- ↑ Athauda D, Tan GS Evolving Infarction in the Anterior Circulation. N Engl J Med 2014; 371:e20. October 2, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25271620 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1313055
- ↑ 71.0 71.1 The ENOS Trial Investigators Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial. The Lancet, Early Online Publication, 22 October 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25465108 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961121-1/fulltext
Rothwell PM Blood pressure in acute stroke: which questions remain? The Lancet, Early Online Publication, 22 October 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25465109 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961898-5/fulltext - ↑ 72.0 72.1 Berkhemer OA et al A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med. 2015 Jan 1;372(1):11-20 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25517348 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1411587
Hacke W Interventional Thrombectomy for Major Stroke - A Step in the Right Direction. N Engl J Med. December 17, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25517349 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1413346 - ↑ 73.0 73.1 Goyal M et al Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med. 2015 Mar 12;372(11):1019-30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25671798 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1414905
Campbell BCV et al Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med. 2015 Mar 12;372(11):1009-18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25671797 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1414792
Saver JL, Goyal M, Bonafe A et al Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015 Jun 11;372(24):2285-95 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25882376
Saver J, Goyal M, Bonafe A et al Primary Results. Soltaire <TM> FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke Nashville, TN. February 11, 2015 http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_471815.pdf - ↑ 74.0 74.1 74.2 The NNT: Insulin for Glycemic Control in Acute Ischemic Stroke. http://www.thennt.com/nnt/insulin-for-glucose-control-in-ischemic-stroke/
Bellolio MF, Gilmore RM, Stead LG. Insulin for glycaemic control in acute ischaemic stroke. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005346 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21901697 - ↑ 75.0 75.1 The NNT: Antiplatelet Agents for Acute Ischemic Stroke. http://www.thennt.com/nnt/antiplatelet-agents-for-acute-stroke/
Sandercock PA, Counsell C, Gubitz GJ, Tseng MC. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD000029 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18646056 - ↑ The NNT: Graduated Compression Stockings for Prevention of Deep Vein Thrombosis in Stroke Patients
Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA. Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. 2010 Aug 4;(8):CD001922 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20687069 - ↑ 77.0 77.1 77.2 Sposato LA et al. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: A systematic review and meta-analysis. Lancet Neurol 2015 Apr; 14:377 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25748102
- ↑ 78.0 78.1 Saver JL et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015 Apr 17; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25882376 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1415061
Jovin TG et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015 Apr 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25882510 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1503780
Furlan AJ. Endovascular therapy for stroke - it's about time. N Engl J Med 2015 Apr 17; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25882509 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1503217 - ↑ 79.0 79.1 The AVERT Trial Collaboration Group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): A randomised controlled trial. Lancet 2015 Apr 16; [e-pub] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25892679 <Internet> http://www.jwatch.org/na37670/2015/05/14/early-mobilization-after-stroke-helpful-or-harmful
- ↑ 80.0 80.1 Goeggel Simonetti B et al. Long-term outcome after arterial ischemic stroke in children and young adults. Neurology 2015 May 12; 84:1941 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25862797 <Internet> http://www.neurology.org/content/84/19/1941
- ↑ 81.0 81.1 Powers WJ et al 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment. Stroke. June 29, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26123479 <Internet> http://stroke.ahajournals.org/content/early/2015/06/26/STR.0000000000000074
- ↑ 82.0 82.1 82.2 Badhiwala JH, Nassiri F, Alhazzani W et al Endovascular Thrombectomy for Acute Ischemic Stroke. A Meta-analysis. JAMA. 2015;314(17):1832-1843. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26529161 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2467553
Wardlaw JM, Dennis MS Thrombectomy for Acute Ischemic Stroke. JAMA. 2015;314(17):1803-1805 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26529158 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2467530 - ↑ 83.0 83.1 Stroke Unit Trialists' Collaboration Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013 Sep 11;9:CD000197 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24026639
- ↑ Merwick A, Werring D. Posterior circulation ischaemic stroke. BMJ. 2014;348:g3175 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24842277
- ↑ 85.0 85.1 Haider DG, Ferrari J, Mittermayer F et al A transient improvement in renal function occurs after ischemic stroke. Ren Fail. 2012;34(1):7-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22023107
- ↑ 86.0 86.1 Rothwell PM et al Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. May 18, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27209146 Free Article <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930468-8/abstract
- ↑ 87.0 87.1 Robinson MT, Vickrey BG, Holloway RG et al The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. Neurology. 2016 May 31;86(22):2056-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27060165
- ↑ 88.0 88.1 Edwards JD et al. Underutilization of ambulatory ECG monitoring after stroke and transient ischemic attack: Missed opportunities for atrial fibrillation detection. Stroke 2016 Aug; 47:1982 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27406109
- ↑ 89.0 89.1 Saver JL, Goyal M, van der Lugt A et al Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016;316(12):1279-1288 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27673305 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2556124
- ↑ 90.0 90.1 Wachter R, Groschel K, Gelbrich G et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): An open-label randomised controlled trial. Lancet Neurol 2017 Apr; 16:282. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28187920 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(17)30002-9/abstract
- ↑ 91.0 91.1 Anderson CS, Arima H, Lavados P et al Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke. N Engl J Med 2017; 376:2437-2447. June 22, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28636854 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1615715
- ↑ 92.0 92.1 Edwards JD, Kapral MK, Fang J et al Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack. CMAJ July 24, 2017 vol. 189 no. 29 E954-E961 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28739847 <Internet> http://www.cmaj.ca/content/189/29/E954
Hill MD Long-term stroke prevention: We can do better . CMAJ July 24, 2017 vol. 189 no. 29 E952-E953 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28739846 <Internet> http://www.cmaj.ca/content/189/29/E952 - ↑ 93.0 93.1 Gilsanz P, Mayeda ER, Glymour M et al Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia. JAMA Neurol. Published online July 31, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28759663 <Internet> http://jamanetwork.com/journals/jamaneurology/fullarticle/2645931
Lackland DT Impact of Birth Place and Geographic Location on Risk Disparities in Cerebrovascular Disease. Implications for Future Research. JAMA Neurol. Published online July 31, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28759684 <Internet> http://jamanetwork.com/journals/jamaneurology/fullarticle/2645929 - ↑ 94.0 94.1 Boulouis G, Lauer A, Siddiqui AK et al. Clinical imaging factors associated with infarct progression in patients with ischemic stroke during transfer for mechanical thrombectomy. JAMA Neurol 2017 Sep 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973081
Campbell BCV. Stroke imaging: Do it right the first time. JAMA Neurol 2017 Sep 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973521 - ↑ 95.0 95.1 Li S, Zhang X, Fang Q et al Ginkgo biloba extract improved cognitive and neurological functions of acute ischaemic stroke: a randomised controlled trial. Stroke Vasc Neurol. 2017 Dec 18;2(4):189-197 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29507779 Free PMC Article <Internet> http://svn.bmj.com/content/early/2017/11/08/svn-2017-000104
- ↑ 96.0 96.1 Powers WJ, Rabinstein AA, Ackerson T et al 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; Jan 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29367334 <Internet> http://stroke.ahajournals.org/content/early/2018/01/23/STR.0000000000000158
Furie KL, Jayaraman MV 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29367335 <Internet> http://stroke.ahajournals.org/content/early/2018/01/24/STROKEAHA.118.020176 - ↑ 97.0 97.1 97.2 Hilkens NA, Algra A, Kappelle LJ et al. Early time course of major bleeding on antiplatelet therapy after TIA or ischemic stroke. Neurology 2018 Feb 20; 90:e683 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29374102 Free PMC Article <Internet> http://n.neurology.org/content/90/8/e683
- ↑ 98.0 98.1 98.2 98.3 Sposato LA, Cerasuolo JO, Cipriano LE et al. Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence. Neurology 2018 Mar 13; 90:e924 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29444969 <Internet> http://n.neurology.org/content/90/11/e924
- ↑ 99.0 99.1 Johnston SC, Easton JD, Farrant M et al Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018; 379:215-225. Online May 16, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29766750 https://www.nejm.org/doi/full/10.1056/NEJMoa1800410
Grotta JC Antiplatelet Therapy after Ischemic Stroke or TIA. N Engl J Med. May 16, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29766754 https://www.nejm.org/doi/full/10.1056/NEJMe1806043
Tillman H, Johnston SC, Farrant M et al Risk for Major Hemorrhages in Patients Receiving Clopidogrel and Aspirin Compared With Aspirin Alone After Transient Ischemic Attack or Minor Ischemic Stroke. A Secondary Analysis of the POINT Randomized Clinical Trial JAMA Neurol. Published online April 29, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31034032 https://jamanetwork.com/journals/jamaneurology/fullarticle/2731585 - ↑ Yaghi S, Willey JZ, Khatri P. Minor ischemic stroke: Triaging, disposition, and outcome. Neurol Clin Pract. 2016 Apr;6(2):157-163. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27104067 Free PMC Article
- ↑ 101.0 101.1 101.2 Prasad K, Siemieniuk R, Hao Q et al Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline BMJ 2018;363:k5130 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30563885 https://www.bmj.com/content/363/bmj.k5130
Hao Q, Tampi M, O'Donnell M et al Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. BMJ 2018;363:k5108 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30563866 Free full text https://www.bmj.com/content/363/bmj.k5108 - ↑ 102.0 102.1 Johnston KC, Bruno A, Pauls Q et al Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke. The SHINE Randomized Clinical Trial. JAMA. 2019;322(4):326-335. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31334795 https://jamanetwork.com/journals/jama/fullarticle/2738553
- ↑ 103.0 103.1 NEJM Knowledge+ Question of the Week. Aug 13, 2019 https://knowledgeplus.nejm.org/question-of-week/1860/
Topcuoglu MA, Saka E, Silverman SB, Schwamm LH, Singhal AB. Recrudescence of deficits after stroke: clinical and imaging phenotype, triggers, and risk factors. JAMA Neurol 2017 Sep 1; 74:1048. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28783808 Free PMC Article - ↑ 104.0 104.1 Amarenco P, Kim JS, Labreuche J et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med 2019 Nov 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31738483 https://www.nejm.org/doi/10.1056/NEJMoa1910355
- ↑ 105.0 105.1 105.2 105.3 105.4 Powers WJ, Rabinstein AA, Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2019 Dec; 50:e344. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31662037 https://www.ahajournals.org/doi/10.1161/STR.0000000000000211
- ↑ 106.0 106.1 106.2 106.3 Johnston SC, Amarenco P, Denison H, et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med 2020 Jul 16; 383:207-217 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32668111 https://www.nejm.org/doi/10.1056/NEJMoa1916870
- ↑ Rothaus C Acute Ischemic Stroke. NEJM Resident 360. July 15, 2020 https://resident360.nejm.org/clinical-pearls/acute-ischemic-stroke-2
- ↑ 108.0 108.1 Hankey GJ et al. Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): A randomised, double-blind, placebo-controlled trial. Lancet Neurol 2020 Aug; 19:651. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32702334 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30207-6/fulltext
Lundstrom E et al. Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): A randomised, double-blind, placebo-controlled trial. Lancet Neurol 2020 Aug; 19:661. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32702335 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30219-2/fulltext
Kwakkel G et al. Time for the next stage of stroke recovery trials. Lancet Neurol 2020 Aug; 19:636. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32702322 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30218-0/fulltext - ↑ Mendelson SJ, Prabhakaran S Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke. A Review. JAMA. 2021;325(11):1088-1098 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33724327 https://jamanetwork.com/journals/jama/fullarticle/2777474
- ↑ 110.0 110.1 Wang Y, Pan Y, Li H et al Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke. An Exploratory Analysis of the THALES Randomized Clinical Trial. JAMA Neurol. Published online July 9, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34244703 https://jamanetwork.com/journals/jamaneurology/fullarticle/2781887
- ↑ Diener HC Key Takeaways From the Latest Stroke Guidelines. Medscape. October 13, 2021 https://www.medscape.com/viewarticle/956496
- ↑ 112.0 112.1 Rostanski SK, Kvernland A,Liberman AL et al Infarct on Brain Imaging, Subsequent Ischemic Stroke, and Clopidogrel-Aspirin Efficacy. A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Neurol. Published online January 18, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35040913 https://jamanetwork.com/journals/jamaneurology/fullarticle/2787639
- ↑ 113.0 113.1 Cai M, Zhang S, Lin A et al Association of Ambient Particulate Matter Pollution of Different Sizes With In-Hospital Case Fatality Among Stroke Patients in China. Neurology. 2022. May 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35613931 https://n.neurology.org/content/early/2022/05/25/WNL.0000000000200546
- ↑ 114.0 114.1 Benesch C, Glance LG, Derdeyn CP et al Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association. Circulation. 2021. Oct 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33827230 Review. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000968
- ↑ 115.0 115.1 Glance LG et al. Association of time elapsed since ischemic stroke with risk of recurrent stroke in older patients undergoing elective nonneurologic, noncardiac surgery. JAMA Surg 2022 Jun 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35767247 https://jamanetwork.com/journals/jamasurgery/fullarticle/2793559
- ↑ 116.0 116.1 Chen HS, Cui Y, Li XQ et al Effect of Remote Ischemic Conditioning vs Usual Care on Neurologic Function in Patients With Acute Moderate Ischemic Stroke. The RICAMIS Randomized Clinical Trial. JAMA. 2022;328(7):627-636. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35972485 https://jamanetwork.com/journals/jama/fullarticle/2795267
- ↑ 117.0 117.1 Hughes S Intensive BP Lowering Harmful in Acute Ischemic Stroke: ENCHANTED2/MT. Medscape. Oct 28, 2022 https://www.medscape.com/viewarticle/983176
Yang P, Song L, Zhang Y et al Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial. Lancet. 2022. Oct 27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36341753 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01882-7/fulltext - ↑ 118.0 118.1 118.2 Whitlock Burton K Blood Type Linked to Higher Risk for Early-Onset Stroke. Medscape. August 31, 2022. https://www.medscape.com/viewarticle/980048
Jaworek T, Xu H, Gaynor BJ et al Contribution of Common Genetic Variants to Risk of Early-Onset Ischemic Stroke. Neurology. 2022 October 18; 99(16) PMID: https://www.ncbi.nlm.nih.gov/pubmed/36240095 PMCID: PMC9620803 Free PMC article https://n.neurology.org/content/99/16/e1738 - ↑ 119.0 119.1 Blauenfeldt RA, Hjort N, MD, Valentin JB et al Remote Ischemic Conditioning for Acute Stroke. The RESIST Randomized Clinical Trial. JAMA. 2023;330(13):1236-1246. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37787796 https://jamanetwork.com/journals/jama/fullarticle/2810034
- ↑ 120.0 120.1 Parr E, Ferdinand P, Roffe C. Management of Acute Stroke in the Older Person. Geriatrics (Basel). 2017 Aug 15;2(3):27. doi:http://dx.doi.org/ 10.3390/geriatrics2030027. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31011037 PMCID: PMC6371128 Free PMC article.
- ↑ 121.0 121.1 Liu L et al. Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke: Multicentre, open label, randomised, controlled trial. BMJ 2023 Oct 9; 383:e076448. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37813418 PMCID: PMC10561001 Free PMC article https://www.bmj.com/content/383/bmj-2023-076448
- ↑ NINDS Cerebral Arteriosclerosis Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Arteriosclerosis-Information-Page
Patient information
ischemic stroke patient information