Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion.

Objective: Whether bridging therapy (intravenous thrombolysis [IVT] followed by endovascular treatment) is superior to IVT alone in minor stroke with large vessel occlusion (LVO) is unknown.

Methods: Multicentric retrospective observational study including, in intention-to-treat, consecutive IVT-treated minor strokes (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with LVO, with or without additional mechanical thrombectomy. Propensity-score (inverse probability of treatment weighting) was used to reduce baseline between-groups differences.

Better Collaterals Are Independently Associated With Post-Thrombolysis Recanalization Before Thrombectomy.

Background and Purpose- In acute stroke patients with large vessel occlusion, the goal of intravenous thrombolysis (IVT) is to achieve early recanalization (ER). Apart from occlusion site and thrombus length, predictors of early post-IVT recanalization are poorly known. Better collaterals might also facilitate ER, for instance, by improving delivery of the thrombolytic agent to both ends of the thrombus.

Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion.

In large vessel occlusion (LVO) stroke, it is unclear whether severity of ischemia is involved in early post-thrombolysis recanalization over and above thrombus site and length. Here we assessed the relationships between perfusion parameters and early recanalization following intravenous thrombolysis administration in LVO patients. From a multicenter registry, we identified 218 thrombolysed LVO patients referred for thrombectomy with both (i) pre-thrombolysis MRI, including diffusion-weighted imaging (DWI), T2*-imaging, MR-angiography and dynamic susceptibility-contrast perfusion-weighted imaging (PWI); and (ii) evaluation of recanalization on first angiographic run or non-invasive imaging ≤ 3 h from thrombolysis start.

Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion.

Background and Purpose- Whether bridging therapy, that is, intravenous thrombolysis [IVT] followed by mechanical thrombectomy, is beneficial as compared with IVT alone in minor stroke (National Institutes of Health Stroke Scale ≤5) with large vessel occlusion is unknown and should be tested in randomized trials. To help select the most appropriate candidates for such trials, we aimed to identify strong predictors of lack of post-IVT early recanalization (ER)-a surrogate marker of poor outcome. Methods- From a large multicenter French registry of patients with large vessel occlusion referred for thrombectomy immediately after IVT start between 2015 and 2017, we extracted 97 minor strokes with ER evaluated on first angiographic run or noninvasive imaging ≤3 hours from IVT start.

Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy: Incidence, Predictors, and Prediction Scores.

Background and Purpose—Whether all acute stroke patients with large vessel occlusion need to undergo intravenous thrombolysis before mechanical thrombectomy (MT) is debated as (1) the incidence of post-thrombolysis early recanalization (ER) is still unclear; (2) thrombolysis may be harmful in patients unlikely to recanalize; and, conversely, (3) transfer for MT may be unnecessary in patients highly likely to recanalize. Here, we determined the incidence and predictors of post-thrombolysis ER in patients referred for MT and derive ER prediction scores for trial design. Methods—Registries from 4 MT-capable centers gathering patients referred for MT and thrombolyzed either on site (mothership) or in a non MT-capable center (drip-and-ship) after magnetic resonance– or computed tomography–based imaging between 2015 and 2017.

Impact of a direct-admission stroke pathway on delays of admission, care, and rates of intravenous thrombolysis.

Introduction: This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA.

Methods: This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data.

Susceptibility-Diffusion Mismatch in Hyperacute Stroke: Correlation with Perfusion-Diffusion Mismatch and Clinical Outcome.

Background: A prominent vein (PV) on susceptibility-weighted imaging (SWI) was recently proposed to be a marker of the penumbra. We aimed to compare the utility of SWI and perfusion-weighted imaging (PWI) sequences for the evaluation of the penumbra in hyperacute middle cerebral artery (MCA) stroke, and to determine whether SWI-DWI mismatch is a neuroimaging marker of clinical outcome.

Methods: A total of 149 consecutive patients with MCA stroke were prospectively enrolled.

Functional Outcome of Hemorrhagic Transformation after Thrombolysis for Ischemic Stroke: A Prospective Study.

Background/aims: Hemorrhagic transformation (HT) is usually taken into account when symptomatic, but the role of asymptomatic HT is not well known. The aim of our study was to evaluate the link between HT after thrombolysis for ischemic stroke and functional outcome at 3 months, with particular emphasis on asymptomatic HT.

Methods: Our study was performed prospectively between June 2012 and June 2013 in the Stroke Unit of the University Hospital Center of Tours (France).

Quality of Life After Off-Label Thrombolysis for Ischemic Stroke in Elderly Patients.

Introduction: The use of intravenous thrombolysis with alteplase for ischemic stroke in Europe is restricted to subjects aged <80 years. Recent studies have reported the efficacy and safety of alteplase in older patients. However, data concerning the quality of life (QOL) of these elderly subjects are sparse.

Diagnostic and therapeutic value of echocardiography during the acute phase of ischemic stroke.

Background: Echocardiography is routinely used to identify potential cardiac sources of embolism (CSE) in the acute phase of ischemic stroke (IS). We know that transoesophageal echography (TEE) is superior to detect CSE than transthoracic echography (TTE). However, the indications of each technique remain controversial.

Could (18) F-DPA-714 PET imaging be interesting to use in the early post-stroke period?

Background: Cerebral stroke is a severe and frequent condition that requires rapid and reliable diagnosis. If administered shortly after the first symptoms manifest themselves, IV thrombolysis has been shown to increase the functional prognosis by restoring brain reperfusion. However, a better understanding of the pathophysiology of stroke should help to identify potential new therapeutic targets.

Is early surgical revascularization of symptomatic carotid stenoses safe?

Background: The objective of this exploratory study was to determine the rate of the complications of early surgery for symptomatic carotid stenosis, in 2 centers of Western France.

Methods: Between January 2011 and January 2013, we prospectively enrolled all the patients admitted for transient ischemic accident (TIA) or minor stroke (Rankin ≤ 3) associated with an ipsilateral carotid stenosis >50% (North American Symptomatic Carotid Endarterectomy Trial) and operated before the 14th day following the neurologic event at the University hospitals of Angers and Tours. The demographic data (gender, age, and medical history) and the characteristics of the procedures were recorded.

Placebo and other psychological interactions in headache treatment.

We present a theory according which a headache treatment acts through a specific biological effect (when it exists), a placebo effect linked to both expectancy and repetition of its administration (conditioning), and a non-specific psychological effect. The respective part of these components varies with the treatments and the clinical situations. During antiquity, suggestions and beliefs were the mainstays of headache treatment.

Psychopathology and quality of life burden in chronic daily headache: influence of migraine symptoms.

The aim of this study is to compare the psychopathology and the quality of life of chronic daily headache patients between those with migraine headache and those with tension-type headache. We enrolled 106 adults with chronic daily headache (CDH) who consulted for the first time in specialised centres. The patients were classified according to the IHS 2004 criteria and the propositions of the Headache Classification Committee (2006) with a computed algorithm: 8 had chronic migraine (without medication overuse), 18 had chronic tension-type headache (without medication overuse), 80 had medication overuse headache and among them, 43 fulfilled the criteria for the sub-group of migraine (m) MOH, and 37 the subgroup for tension-type (tt) MOH.

CADASIL and ALS: a link?

We report the case of a 66-year-old female who presented with dysarthria and dysphonia. Brain MRI abnormalities showed confluent white matter lesions and subcortical lacunar infarcts, suggesting cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), confirmed by the presence of a heterozygous mutation in the Notch3 gene. Clinical signs and course were consistent with amyotrophic lateral sclerosis (ALS) as was the electromyographic pattern.

The FHM1 mutation S218L: a severe clinical phenotype? A case report and review of the literature.

Familial hemiplegic migraine (FHM) is a rare autosomal dominant subtype of migraine with aura that is characterized by motor weakness during attacks. FHM1 is associated with mutations in the CACNA1A gene located on chromosome 19. We report a severe, prolonged HM attack in a young pregnant patient who had the S218L FHM1.