View clinical trials related to Ischemic Stroke.
Filter by:The aim of this study is to assess the use of ASPECTS and stroke biomarkers to predict the outcome and cognitive impairment in acute ischemic stroke.
Atrial fibrillation (AF) is the most common sustained arrhythmia and the number of patients with AF is expected to increase substantially in the coming decades. AF affects approximately 3% of adults aged 20 years or older in Western countries with the prevalence increasing further with age and risk factor such as hypertension, structural heart disease, obesity, diabetes and chronic kidney disease. The presence of AF is independently associated with an increased risk of all-cause mortality and morbidity, largely due to stroke and heart failure, dementia and impaired health-related quality of life. The management of AF aims to reduce symptoms, improve quality of life and prevent AF-related complications. About one third of AF patients do not have any perceived AF-associated symptoms, silent AF, but up to one fourth of patients report severe symptoms. Patients with silent AF are still at risk for complications. Systemic embolization, particularly stroke, is the most frequent major complication of AF. Untreated AF, confers to a four- to fivefold increased risk of stroke compared to the general population. Oral anticoagulation (OAC) therapy can prevent the majority of ischaemic strokes in AF patients. The stroke risk in AF patients is commonly estimated using the CHA2DS2-VASc score and OAC therapy is recommended for men with a score of 2 or more, and for women with a score of 3 or more, and should be considered for men with a score of 1 and women with a score of 2. Interventional left atrial appendage occlusion may be considered in patients with a high risk of stroke, but with contraindications for long-term OAC therapy. Although OAC therapy is superior to no treatment or aspirin, underuse or premature termination of OAC therapy, especially in older people, is probably common. The stroke risk without OAC often exceeds the bleeding risk on OAC, even in the elderly, in patient with dementia and in patients with frequent falls. The bleeding risk on aspirin is increased without preventing stroke and should be avoided according to current guidelines. This study aims to determine the prevalence of patients with AF in Örebro County, to describe the prescribing of oral anticoagulants (OACs) in relation to stroke risk and to initiate OAC therapy or left atrial appendage occlusion in patients with a high risk for stroke, and to evaluate symptoms of AF in a general AF population. A retrospective cohort study design will be used. Patients aged 20 years or older with a diagnosis of AF from 1 January 2015 to 31 December 2018 will be identified from the National Patient Register, that covers all in-patient and outpatient physician visits from both private and public caregivers, and the Medrave 4 that is used in all public general practices. Both patients with first diagnosed AF and previously known AF will be included. OAC therapy will be defined as an active prescription issued for an OAC on 31 December 2019. Patients' records will be review for type of AF (paroxysmal, persistent or permanent AF), age, sex, comorbidities, medications, pacemaker or implantable defibrillator and prior catheter ablation. Prior OAC therapy and reason for discontinuing/ initiating treatment will be documented. Patients with a high risk of stroke (CHA2DS2-VASc of 2 or more in men and of 3 or more in women, or one point or more for age in both men and women), will be offered a clinical visit to an experienced physician at the Department of cardiology to assess stroke and bleeding risk and to possibly initiate OAC therapy or refer the patient for left atrial appendage occlusion. The study period will run from 2 September 2019 to 29 May 2020. All patients with a diagnosis of AF will also be administered an AF-specific questionnaire (AF6) to assess AF-specific symptoms in a general population.
EVTRNA is to analyze the differentiated expression pattern of circular RNA (circRNA), long non-coding RNA (lncRNA) and micro-RNA (miRNA) by next-generation sequencing in acute ischemic stroke patients before and/or after endovascular treatment. The candidate circRNA/lncRNA/miRNA will be verified as the biomarker and regulator for progression and prognosis of acute ischemic stroke with endovascular treatment. Further, the candidate non-coding RNA will be used to evaluate the effect of endovascular treatment on both peripheral and central immune after stroke.
The purpose of this pilot study is to assess the feasibility of implementing a home blood pressure self-management program in a population of recent stroke survivors in the Washington, D.C. area. The investigators hypothesize that hypertensive stroke survivors in the Washington, DC area who participate in the Home Blood Pressure Monitoring program will have a greater reduction in mean systolic blood pressure (SBP) from baseline to 3 months, as measured by automated office blood pressure (AOBP), as compared to usual care.
An open label, prospective, single center, pilot trial to assess feasibility and tolerability of short term blood pressure augmentation to minimize infarct progression in acute LVO stroke patients undergoing endovascular therapy.
The main objective of the BIO│STREAM.ICM France submodule is to provide clinical evidence from patients in France on safety and efficacy of the BIOMONITOR system
An extracranial-to-intracranial (EC-IC) revascularization is the most widely used treatment to improve cerebral perfusion in patients with moyamoya disease (MMD), and it has been shown to reduce the risk of subsequent stroke and neurological deficit. However, perioperative changes in cerebral hemodynamics can induce fluctuations in cerebral perfusion that may lead to transient or irreversible neurological deficits. Our preliminary single-center study suggests that postoperative intravenous administration of dl-3-n-butylphthalide (NBP) may alleviate perioperative neurological deficits and improve the neurological outcomes after EC-IC revascularization for MMD. This is a multicenter, randomized, double-blind, single-controlled, add-on to standard of care study of NBP in patients with MMD of high risk for ischemic cerebrovascular events after EC-IC revascularization surgery.
Recent endovascular thrombectomy (EVT) trial have proven the effectiveness of intraarterial revascularization in patients with larger cerebral artery occlusion. The success rate of EVT is close to 80%, but only 50% of patients improve to independent functional outcome. Therefore, new treatment strategies are needed to reduce the futile revascularization. However, updated guidelines recommend the indications for EVT based on the results of randomized clinical trials (RCT), management of post-revascularization is largely unknown. Current guidelines suggest that systolic blood pressure should be adjusted below 180 mmHg and diastolic blood pressure below 105 mmHg in patients undergoing intraarterial reopening. However, in the case of successful recanalization by EVT, same guideline is adopted even though the possibility of intracerebral hemorrhage or reperfusion injury by high blood pressure. On the other hand, too low blood pressure can worsen cerebral ischemia. Therefore, this study will compare the effectiveness of active blood pressure control group (with less than 140 mmHg systolic blood pressure) versus standard blood pressure control group (with less than 180 mmHg systolic blood pressure) during the first 24 hours in patients who underwent EVT and achieved successful recanalization (TICI 2b-3). The goal is to reach the target blood pressure within 60 minutes of randomization.
We undertook the STROKE-CARD trial (NCT02156778) between 2014 and 2018 with follow-up until 2019 to evaluate the efficacy of the Post-Stroke disease-management program STROKE-CARD care. To further investigate the long-term efficacy of STROKE-CARD care all participants of the original trial will be invited for a Long-term in Person follow-up (3 - 6 years).
Thrombolysis and endovascular thrombectomy are the most efficient treatments for acute ischemic stroke patients in time window. Although sufficient recanalization after thrombectomy is more than 80%, HERMES study indicated that nearly half of the ischemic stroke patients under thrombectomy suffered obvious disability. Artery reocclusion, hemorrhagic transformation, and no-reflow phenomenon are among the most important reasons of poor prognosis of acute ischemic stroke patients. The investigators speculate that a combination of argatroban, edaravone, and glucocorticoid may be helpful in preventing artery reocclusion, hemorrhagic transformation, and no-reflow phenomenon. This study intends to explore the safety, feasibility and efficacy of thrombectomy with sufficient recanalization bridged by intra-arterial cocktail therapy in acute ischemic stroke patients.