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Stroke; a journal of cerebral circulation (24 November 2010), doi:10.1161/STROKEAHA.110.597534

BACKGROUND AND PURPOSE: Treating ischemic stroke with thrombolytic therapy is effective and safe, but limited data exist on its efficacy and safety in different etiologic subtypes. METHODS: Patients with acute ischemic stroke treated with intravenous thrombolysis between 1995 and 2008 at our hospital were classified according to the Trial of ORG 10172 in Acute Stroke Treatment criteria based on diagnostic evaluation. Clinical outcome of the stroke subtypes by 3-month modified Rankin Scale was compared by multivariate logistic regression. A good outcome was defined as modified Rankin Scale ?2. Symptomatic intracranial hemorrhage was defined according to both National Institute of Neurological Disorders and Stroke and European Cooperative Acute Stroke Study criteria. RESULTS: Of the 957 eligible patients, 41% (389) had cardioembolisms, 23% (217) large-artery atherosclerosis, and 11% (101) small-vessel disease (SVD). A good outcome was more common in SVD than in the other subtypes. Patients with SVD were more often male (64% versus 54%), had a lower baseline National Institutes of Health Stroke Scale score, lower mortality rate, and experienced no symptomatic intracranial hemorrhage. Patients with SVD had a prior stroke more often (20% versus 11%), whereas hypertension, diabetes, hypercholesterolemia, and transient ischemic attacks were equally distributed in all subtypes. Patients with SVD had a better outcome even after adjusting for baseline National Institutes of Health Stroke Scale and glucose level, age, and hyperdense artery sign (OR, 1.81; 1.01 to 3.23). In the adjusted multivariate model, other etiologic groups showed no significant correlation to good outcome. CONCLUSIONS: Patients with SVD were spared from bleeding complications and had the best outcome even after adjustment for confounding factors.
Satu Mustanoja, Atte Meretoja, Jukka Putaala, Varpu Viitanen, Sami Curtze, Sari Atula, Ville Artto, Olli Häppölä, Markku Kaste,

The New England journal of medicine, Vol. 353, No. 26. (29 December 2005), pp. 2769-2778, doi:10.1056/NEJMoa050460

Discontinuation of transfusion for the prevention of stroke in children with sickle cell disease results in a high rate of reversion to abnormal blood-flow velocities on Doppler studies and stroke. (ClinicalTrials.gov number, NCT00006182.)
Robert Adams, Donald Brambilla,

Stroke; a journal of cerebral circulation, Vol. 42, No. 3. (March 2011), pp. 710-715., doi:10.1161/STROKEAHA.110.599274

Sulfonylurea use before stroke onset did not affect stroke severity or long-term functional outcome compared with other DM treatments. This finding casts doubt on the use of sulfonylureas for prophylactic neuroprotection. Furthermore, patients not using any medication for DM appear to have more severe strokes and worse outcomes.
Christopher Favilla, Michael Mullen, Myzoon Ali, Peter Higgins, Scott Kasner,

International journal of stroke, Vol. 5, No. 3. (June 2010), pp. 209-216, doi:10.1111/j.1747-4949.2010.00429.x

Stroke is a major cause of morbidity and mortality in Asia, and its pattern is changing. The incidence of haemorrhagic stroke is declining while the incidence of ischaemic stroke caused by large artery atherothromboembolism is increasing secondary to an increase in the prevalence of hypercholesterolaemia. The Working Group on Stroke and Lipids Management in Asia Consensus Panel assembled leading experts from the region to reach a consensus on how to address this challenge. The group discussed the observational epidemiology of the relationship between cholesterol and risk of stroke, the clinical trial evidence base for cholesterol-lowering for stroke prevention, and issues specific to stroke and lipid management for Asian doctors and patients. Stroke guidelines from many of the Asian countries have recently recommended consideration of statins for recurrent stroke prevention in patients with previous ischaemic stroke or transient ischaemic attack. However, because these recommendations have yet to be implemented widely, there is a need to educate Asian physicians and patients about the importance of adequate control of hypercholesterolaemia. Further trials of statins in Asian patients are also needed, particularly in those with intracranial stenosis.
Graeme Hankey, Ka Wong, Siwaporn Chankrachang, Christopher Chen, Denis Crimmins, Judith Frayne, Jong Kim, Yansheng Li, Chia-Wei Liou, Julia Merican, Jusuf Misbach, Jose Navarro, Yukito Shinohara, Yongjun Wang, Byung-Woo Yoon,

Stroke; a journal of cerebral circulation (18 February 2010), doi:10.1161/STROKEAHA.109.571976

BACKGROUND AND PURPOSE: Pooled analysis of major placebo-controlled trials suggests that the earlier thrombolysis is given after ischemic stroke, the better the outcome. We report a single-center assessment of the effect of ultraearly thrombolysis on the outcome of our patients. METHODS: Between January 2003, and December 2008, a total of 878 patients with ischemic stroke received thrombolysis within 4.5 hours from the symptom onset at the Helsinki University Central Hospital. Using univariate methods and multivariable logistic regression, we assessed the association between onset-to-treatment time (OTT) and favorable 3-month outcome (modified Rankin Scale 0 to 2). RESULTS: Median age was 70.5 years, median OTT 115 minutes, and median National Institutes of Health Stroke Scale (NIHSS) on admission 9. After adjustment for baseline stroke severity, more patients with OTT <70 minutes had a favorable outcome than those with OTT >/=70 minutes. Specifically, OR of 5.15 (1.50 to 27.5) was for the patients with NIHSS 7 to 12, and 2.74 (1.26 to 5.90) for those with NIHSS >/=13. Of the patients with OTT </=90 minutes, those with NIHSS 7 to 12 had an OR of 1.72 (1.00 to 2.96) for a favorable outcome, and those with NIHSS >/=13 had lower mortality than the ones with OTT >90 minutes (16.4% versus 29.5%; P=0.01). Multivariable model showed an association of better outcome with lower baseline glucose level, younger age, lower baseline NIHSS, and OTT <70 minutes. CONCLUSIONS: Ultraearly thrombolysis was associated with better outcome of our patients with stroke with moderate or severe symptoms. The earlier the treatment was given, the higher the likelihood of favorable outcome.
Daniel Strbian, Lauri Soinne, Tiina Sairanen, Olli Häppölä, Perttu Lindsberg, Turgut Tatlisumak, Markku Kaste,