01 septiembre 2015

STROKE. Special Reports. Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

Pekka O. Talke, MD†; Deepak Sharma, MD, DM‡; Eric J. Heyer, MD, PhD§; Sergio D. Bergese, MD‖; Kristine A. Blackham, MD¶; Robert D. Stevens, MD#

Abstract: Literature on the anesthetic management of endovascular treatment of acute ischemic stroke (AIS) is limited. Anesthetic management during these procedures is still mostly dependent on individual or institutional preferences. Thus, the Society of Neuroscience in Anesthesiology and Critical Care (SNACC) created a task force to provide expert consensus recommendations on anesthetic management of endovascular treatment of AIS.

20 mayo 2014

STROKE. AHA/ASA Scientific Statement. Physical Activity and Exercise Recommendations for Stroke Survivors. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Sandra A. Billinger, PT, PhD, FAHA, Chair; Ross Arena, PT, PhD, FAHA, Co-Chair; Julie Bernhardt, PT, PhD; Janice J. Eng, BSc, PT/OT, PhD; Barry A. Franklin, PhD, FAHA; Cheryl Mortag Johnson, OTR; Marilyn MacKay-Lyons, BSc, MScPT, PhD; Richard F. Macko, MD; Gillian E. Mead, MD, MA, FRCP; Elliot J. Roth, MD, FAHA; Marianne Shaughnessy, PhD, RN, CRNP; Ada Tang, PT, PhD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, Council on Epidemiology and Prevention, and Council on Clinical Cardiology

Purpose: This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery.

01 mayo 2014

STROKE. AHA/ASA Guideline. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Walter N. Kernan, MD, Chair; Bruce Ovbiagele, MD, MSc, MAS, Vice Chair; Henry R. Black, MD; Dawn M. Bravata, MD; Marc I. Chimowitz, MBChB, FAHA; Michael D. Ezekowitz, MBChB, PhD; Margaret C. Fang, MD, MPH; Marc Fisher, MD, FAHA; Karen L. Furie, MD, MPH, FAHA; Donald V. Heck, MD; S. Claiborne (Clay) Johnston, MD, PhD; Scott E. Kasner, MD, FAHA; Steven J. Kittner, MD, MPH, FAHA; Pamela H. Mitchell, PhD, RN, FAHA; Michael W. Rich, MD; DeJuran Richardson, PhD; Lee H. Schwamm, MD, FAHA; John A. Wilson, MD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease

Abstract: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

27 marzo 2014

STROKE. AHA/ASA Scientific Statement. Palliative and End-of-Life Care in Stroke. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Robert G. Holloway, MD, MPH, Chair; Robert M. Arnold, MD; Claire J. Creutzfeldt, MD; Eldrin F. Lewis, MD, MPH; Barbara J. Lutz, PhD, RN, CRRN, FAHA, FAAN; Robert M. McCann, MD; Alejandro A. Rabinstein, MD, FAHA; Gustavo Saposnik, MD, MSc, FAHA, FRCPC; Kevin N. Sheth, MD, FAHA; Darin B. Zahuranec, MD, MS, FAHA; Gregory J. Zipfel, MD; Richard D. Zorowitz, MD, FAHA; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology

Background and Purpose: The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke.

30 enero 2014

STROKE. AHA/ASA Scientific Statement. Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Eelco F. M. Wijdicks, MD, PhD, FAHA, Chair; Kevin N. Sheth, MD, FAHA, Co-Chair; Bob S. Carter, MD, PhD; David M. Greer, MD, MA, FAHA; Scott E. Kasner, MD, FAHA; W. Taylor Kimberly, MD, PhD; Stefan Schwab, MD; Eric E. Smith, MD, MPH, FAHA; Rafael J. Tamargo, MD, FAANS; Max Wintermark, MD, MAS; on behalf of the American Heart Association Stroke Council

Background and Purpose: There are uncertainties surrounding the optimal management of patients with brain swelling after an ischemic stroke. Guidelines are needed on how to manage this major complication, how to provide the best comprehensive neurological and medical care, and how to best inform families facing complex decisions on surgical intervention in deteriorating patients. This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere.

01 marzo 2015

CIRCULATION. AHA Statistical Update. Executive Summary: Heart Disease and Stroke Statistics—2015 Update

Neuro News

Dariush Mozaffarian, MD, DrPH, FAHA; Emelia J. Benjamin, MD, ScM, FAHA; Alan S. Go, MD; Donna K. Arnett, PhD, MSPH, FAHA; Michael J. Blaha, MD, MPH; Mary Cushman, MD, MSc, FAHA; Sarah de Ferranti, MD, MPH; Jean-Pierre Després, PhD, FAHA; Heather J. Fullerton, MD, MAS; Virginia J. Howard, PhD, FAHA; Mark D. Huffman, MD, MPH, FAHA; Suzanne E. Judd, PhD; Brett M. Kissela, MD, MS, FAHA; Daniel T. Lackland, DrPH, MSPH, FAHA; Judith H. Lichtman, PhD, MPH; Lynda D. Lisabeth, PhD, MPH, FAHA; Simin Liu, MD, ScD, FAHA; Rachel H. Mackey, PhD, MPH, FAHA; David B. Matchar, MD, FAHA; Darren K. McGuire, MD, MHSc, FAHA; Emile R. Mohler III, MD, FAHA; Claudia S. Moy, PhD, MPH; Paul Muntner, PhD; Michael E. Mussolino, PhD, FAHA; Khurram Nasir, MD, MPH; Robert W. Neumar, MD, PhD; Graham Nichol, MD, MPH, FAHA; Latha Palaniappan, MD, MS, FAHA; Dilip K. Pandey, MD, PhD, FAHA; Mathew J. Reeves, PhD, FAHA; Carlos J. Rodriguez, MD, MPH, FAHA; Paul D. Sorlie, PhD; Joel Stein, MD; Amytis Towfighi, MD; Tanya N. Turan, MD, MSCR, FAHA; Salim S. Virani, MD, PhD; Joshua Z. Willey, MD, MS; Daniel Woo, MD, MS, FAHA; Robert W. Yeh, MD, MSc, FAHA; Melanie B. Turner, MPH; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

01 noviembre 2014

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease

Robert Zivadinov, MD, PhD, Stefano Bastianello, MD, PhD , Michael D. Dake, MD , Hector Ferral, MD , E. Mark Haacke, PhD , Ziv J Haskal, MD , David Hubbard, MD , Nikolaos Liasis, MD, PhD , Kenneth Mandato, MD , Salvatore Sclafani, MD , Adnan H. Siddiqui, MD, PhD , Marian Simka, MD, PhD , Paolo Zamboni, MD

Under the auspices of the International Society for Neurovascular Disease (ISNVD), four expert panel committees were created from the ISNVD membership between 2011 and 2012 to determine and standardize noninvasive and invasive imaging protocols for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency (CCSVI). The committees created working groups on color Doppler ultrasound (US), magnetic resonance (MR) imaging, catheter venography (CV), and intravascular US. Each group organized a workshop focused on its assigned imaging modality. Non–ISNVD members from other societies were invited to contribute to the various workshops. More than 60 neurology, radiology, vascular surgery, and interventional radiology experts participated in these workshops and contributed to the development of standardized noninvasive and invasive imaging protocols for the detection of extracranial venous abnormalities indicative of CCSVI. This ISNVD position statement presents the MR imaging and intravascular US protocols for the first time and describes refined color Doppler US and CV protocols. It also emphasizes the need for the use of for noninvasive and invasive multimodal imaging to diagnose adequately and monitor extracranial venous abnormalities indicative of CCSVI for open-label or double-blinded, randomized, controlled studies.

06 agosto 2013

STROKE. Special Reports. Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke

Osama O. Zaidat, MD; Albert J. Yoo, MD; Pooja Khatri, MD; Thomas A. Tomsick, MD; Rüdiger von Kummer, MD; Jeffrey L. Saver, MD; Michael P. Marks, MD; Shyam Prabhakaran, MD; David F. Kallmes, MD; Brian-Fred M. Fitzsimmons, MD; J. Mocco, MD; Joanna M. Wardlaw, MD; Stanley L. Barnwell, MD; Tudor G. Jovin, MD; Italo Linfante, MD; Adnan H. Siddiqui, MD; Michael J. Alexander, MD; Joshua A. Hirsch, MD; Max Wintermark, MD; Gregory Albers, MD; Henry H. Woo, MD; Donald V. Heck, MD; Michael Lev, MD; Richard Aviv, MD; Werner Hacke, MD; Steven Warach, MD; Joseph Broderick, MD; Colin P. Derdeyn, MD; Anthony Furlan, MD; Raul G. Nogueira, MD; Dileep R. Yavagal, MD; Mayank Goyal, MD; Andrew M. Demchuk, MD; Martin Bendszus, MD; David S. Liebeskind, MD for the Cerebral Angiographic Revascularization Grading (CARG) Collaborators, STIR Revascularization working group, and STIR Thrombolysis in Cerebral Infarction (TICI) Task Force

Intra-arterial therapy (IAT) for acute ischemic stroke (AIS) has dramatically evolved during the past decade to include aspiration and stent-retriever devices. Recent randomized controlled trials have demonstrated the superior revascularization efficacy of stent-retrievers compared with the first-generation Merci device.1,2 Additionally, the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) 2, the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and the Interventional Management of Stroke (IMS) III trials have confirmed the importance of early revascularization for achieving better clinical outcome.3–5 Despite these data, the current heterogeneity in cerebral angiographic revascularization grading (CARG) poses a major obstacle to further advances in stroke therapy. To date, several CARG scales have been used to measure the success of IAT.6–14 Even when the same scale is used in different studies, it is applied using varying operational criteria, which further confounds the interpretation of this key metric.10 The lack of a uniform grading approach limits comparison of revascularization rates across clinical trials and hinders the translation of promising, early phase angiographic results into proven, clinically effective treatments.6–14 For these reasons, it is critical that CARG scales be standardized and end points for successful revascularization be refined.6 This will lead to a greater understanding of the aspects of revascularization that are strongly predictive of clinical response.

22 mayo 2013

STROKE. AHA/ASA Policy Statement. Forecasting the Future of Stroke in the United States. A Policy Statement From the American Heart Association and American Stroke Association

Bruce Ovbiagele, MD, MSc, MAS, FAHA, Chair; Larry B. Goldstein, MD, FAHA; Randall T. Higashida, MD, FAHA; Virginia J. Howard, PhD, FAHA; S. Claiborne Johnston, MD, PhD; Olga A. Khavjou, MA; Daniel T. Lackland, DrPH, MSPH, FAHA; Judith H. Lichtman, PhD; Stephanie Mohl, BA; Ralph L. Sacco, MD, MSc, FAHA; Jeffrey L. Saver, MD, FAHA; Justin G. Trogdon, PhD on behalf of the American Heart Association Advocacy Coordinating Committee and Stroke Council

Background and Purpose: Stroke is a leading cause of disability, cognitive impairment, and death in the United States and accounts for 1.7% of national health expenditures. Because the population is aging and the risk of stroke more than doubles for each successive decade after the age of 55 years, these costs are anticipated to rise dramatically. The objective of this report was to project future annual costs of care for stroke from 2012 to 2030 and discuss potential cost reduction strategies.

07 mayo 2013

STROKE. AHA/ASA Expert Consensus Document. An Updated Definition of Stroke for the 21st Century. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Ralph L. Sacco, MD, MS, FAHA, FAAN, Co-Chair*; Scott E. Kasner, MD, MSCE, FAHA, FAAN, Co-Chair*; Joseph P. Broderick, MD, FAHA; Louis R. Caplan, MD; J.J. (Buddy) Connors, MD; Antonio Culebras, MD, FAHA, FAAN; Mitchell S.V. Elkind, MD, MS, FAHA, FAAN; Mary G. George, MD, MSPH, FAHA†; Allen D. Hamdan, MD; Randall T. Higashida, MD; Brian L. Hoh, MD, FAHA; L. Scott Janis, PhD‡; Carlos S. Kase, MD; Dawn O. Kleindorfer, MD, FAHA; Jin-Moo Lee, MD, PhD; Michael E. Moseley, PhD; Eric D. Peterson, MD, MPH, FAHA; Tanya N. Turan, MD, MS, FAHA; Amy L. Valderrama, PhD, RN†; Harry V. Vinters, MD on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Nutrition, Physical Activity and Metabolism

Abstract: Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term “stroke” is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

20 febrero 2014

STROKE. New Guidelines to Reduce Risk of Atherosclerotic Cardiovascular Disease. Implications for Stroke Prevention in 2014

Philip B. Gorelick, MD, MPH; Larry B. Goldstein, MD; Bruce Ovbiagele, MD, MSc, MAS

In November 2013, the American College of Cardiology/ American Heart Association (ACC/AHA) Task Force on Practice Guidelines released 1 new statement on general cardiovascular risk assessment and 3 statements focused on reducing the risks of cardiovascular disease and stroke, including lifestyle management, treatment of blood cholesterol, and the management of overweight and obesity (the latter written in collaboration with The Obesity Society).1–4 A fifth statement on effective approaches to high blood pressure (BP) control, a collaboration among AHA, ACC, and the Centers for Disease Control and Prevention (CDC), also was published.5 In addition, in December 2013, separate guidance statements from the Eighth Joint National Committee (JNC 8) and the American Society of Hypertension/International Society of Hypertension for management and control of hypertension to minimize cardiovascular risk and complications were released.6,7 Each of the new statements is relevant to reducing the burden of stroke, and although they all represent a major step forward, they are not without controversy.

30 enero 2014

STROKE. AHA/ASA Scientific Statement. Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling. A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Eelco F. M. Wijdicks, MD, PhD, FAHA, Chair; Kevin N. Sheth, MD, FAHA, Co-Chair; Bob S. Carter, MD, PhD; David M. Greer, MD, MA, FAHA; Scott E. Kasner, MD, FAHA; W. Taylor Kimberly, MD, PhD; Stefan Schwab, MD; Eric E. Smith, MD, MPH, FAHA; Rafael J. Tamargo, MD, FAANS; Max Wintermark, MD, MAS; on behalf of the American Heart Association Stroke Council

Background and Purpose: There are uncertainties surrounding the optimal management of patients with brain swelling after an ischemic stroke. Guidelines are needed on how to manage this major complication, how to provide the best comprehensive neurological and medical care, and how to best inform families facing complex decisions on surgical intervention in deteriorating patients. This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere.

01 mayo 2011

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Development of a Research Agenda for Evaluation of Interventional Therapies for Chronic Cerebrospinal Venous Insufficiency: Proceedings from a Multidisciplinary Research Consensus Panel

Gary P. Siskin, MD , Ziv J Haskal, MD , Gordon McLennan, MD , Michael D. Dake, MD , E. Mark Haacke, PhD , Sandy McDonald, MD , Walter Royal III, MD , Suresh Vedantham, MD , David Hubbard, MD , Salvatore J. Sclafani, MD , R. Torrance Andrews, MD , Heidi Sauder, PhD

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) that results in damage to myelin and, to a lesser extent, axons in the brain, spinal cord, and optic nerves. Presently, our understanding of the pathophysiology of MS centers on an immune-mediated attack against CNS myelin antigens (1, 2). The symptoms caused by MS are variable and can range from mild to quite debilitating. When a patient presents with the typical clinical manifestations, characteristic white matter lesions are often visualized with magnetic resonance (MR) imaging, which confirms the diagnosis of MS (2, 3). Significant research has been focused on different treatment strategies for MS, with attention often paid to disease-modifying drugs that seek to disable a component of the immune system or to prevent the neurodegeneration seen in progressive forms of the disease (4).

01 octubre 2009

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Research Reporting Standards for Percutaneous Vertebral Augmentation

Martin G. Radvany, MD , Kieran J. Murphy, MD, FRCPC , Steven F. Millward, MD , John Dean Barr, MD , Timothy W.I. Clark, MD , Neil J. Halin, DO , Thomas B. Kinney, MD , Sanjoy Kundu, MD, FRCPC , David Sacks, MD , Michael J. Wallace, MD , John F. Cardella, MD , Technology Assessment Committee of the Society of Interventional Radiology

SINCE the first description of vertebroplasty in 1987 for the treatment of aggressive hemangiomas (1), vertebroplasty has become established as a safe and effective, minimally invasive procedure that offers a therapeutic option for patients with back pain from osteoporotic or tumor-related fractures. This initial success has spawned additional techniques for percutaneous vertebral augmentation, in which imaging guidance is used to inject radiopaque bone cement into a painful osteoporotic or neoplastic lesion in the spine. The typical treatment for a vertebral compression fracture involves the injection of bone cement into the vertebral body to fixate the fracture. Two of the most common methods involve either injection of a low-viscosity cement directly into the vertebral body (ie, vertebroplasty) or the use of a balloon to create a void in the cancellous bone and injection of the bone cement into this created void (ie, balloon kyphoplasty). There are new vertebral augmentation systems that allow an injection of ultra–high-viscosity bone cement. The title of this document intentionally includes the phrase “Percutaneous Vertebral Augmentation” to be applicable to all vertebral techniques that are used to stabilize compression fractures by percutaneous cement injection.

01 enero 2013

STROKE. Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Edward C. Jauch, MD, MS, FAHA, Chair; Jeffrey L. Saver, MD, FAHA, Vice Chair; Harold P. Adams Jr, MD, FAHA; Askiel Bruno, MD, MS; J.J. (Buddy) Connors, MD; Bart M. Demaerschalk, MD, MSc; Pooja Khatri, MD, MSc, FAHA; Paul W. McMullan Jr, MD, FAHA; Adnan I. Qureshi, MD, FAHA; Kenneth Rosenfield, MD, FAHA; Phillip A. Scott, MD, FAHA; Debbie R. Summers, RN, MSN, FAHA; David Z. Wang, DO, FAHA; Max Wintermark, MD; Howard Yonas, MD on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates.