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Latest & greatest articles for stroke
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stroke not eligible for thrombolytic therapy, hypertension in the setting of acute ischemicstroke or transientischemicattack should not be routinely treated (Grade D; revised wording ). Extreme BP increases (e.g., SBP >220 mm Hg or DBP >120 mm Hg) may be treated to reduce the BP by approximately 15% (Grade D), and not more than 25%, over the first 24 hours with gradual reduction thereafter (Grade D). Avoid excessive lowering of BP because this might exacerbate existing ischemia or might induce (...) be given to the initiation of antihypertensive therapy after the acute phase of a stroke or transientischemicattack (Grade A). It is well established that antihypertensive therapy is associated with substantial reductions in cardiovascular events in patients who have suffered a stroke or TIA . Patients with hypertension who have had a stroke are at a high risk of recurrence, which can be reduced by antihypertensive therapy (RR, 0.72; 95%CI, 0.61 to 0.85) . 2. After the acute phase of a stroke, BP
. Warfarin was the base case, and non-vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis.Community-dwelling adults.33 434 adults with incident AF.Quality-adjusted life-years (QALYs).Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation for these patients was least using stroke rates from the ATRIA (AnTicoagulation (...) Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation. Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown.To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation.Markov model decision analysis
Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute IschemicStroke. Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemicstroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design.To examine recanalization over time across a range (...) of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemicstroke treated with intravenous alteplase or not treated with alteplase.Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemicstroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA).Demographics, clinical characteristics, time from alteplase to recanalization
Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability (...) and safety of the therapy.We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant
Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial Family caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing (...) their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver's depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential
Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI.This study sought (...) to compare rates of stroke after CABG and PCI and the impact of procedural stroke on long-term mortality.We performed a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents; ERACI II (Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS (Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine, Angioplasty, or Surgery
Efficacy of Endovascular Therapy in Acute IschemicStroke Depends on Age and Clinical Severity Efficacy of endovascular treatment (EVT) for ischemicstroke because of large vessel occlusion may depend on patients' age and stroke severity; we, therefore, developed a prognosis score based on these variables and examined whether EVT efficacy differs between patients with good, intermediate, or poor prognostic score.A total of 4079 patients with an acute ischemicstroke were identified from (...) the Paris Stroke Consortium registry. We developed the stroke checkerboard (SC) score (SC score=1 point per decade ≥50 years of age and 2 points per 5 points on the National Institutes of Health Stroke Scale) to predict spontaneous outcome. The primary outcome was the adjusted common odds ratio for an improvement in the modified Rankin Scale at 90 days after EVT, in patients with low, intermediate, or high SC scores. To rule out potential selection biases, a nested case-control analysis, with individual
ischemic injury in a PRACTICE PARAMETER 3 Acute Stroke defined vascular distribution, or clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting >24 hours or until death, and other etiologies excluded. (Note: CNS infarction includes hemorrhagic infarctions (HI), types I and II; see “Hemorrhagic Infarction” [15-18].) Diagnostic catheter angiography – a minimally invasive procedure involving percutaneous catheterization of any of the arteries or veins (...) and/or recommendations regarding performance and reporting of the endovascular procedure and periprocedural care, and v) recommendations on quality control and performance improvement. Every year in the United States, an estimated 795,000 people suffer an ischemicstroke. It is estimated that at least approximately 10%, or nearly 80,000, of these strokes will be caused by an emergent large-vessel occlusion (ELVO) affecting the intracranial internal carotid artery, the proximal middle cerebral artery
Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial Dysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this group of patients. We aimed to replicate and extend this single-centre experience.We did a prospective, single (...) -blind, randomised controlled trial across nine sites (seven acute care hospitals, two rehabilitation facilities) in Germany, Austria, and Italy. Patients with recent stroke who required tracheotomy were randomly assigned to receive 3 days of either PES or sham treatment (1:1). All patients had the stimulation catheter inserted; sham treatment was applied by connecting the PES base station to a simulator box instead of the catheter. Randomisation was done via a computerised interactive system
Clinical Prediction Rules to Classify Types of Stroke at Prehospital Stage: Japan Urgent Stroke Triage (JUST) Score Background and Purpose- Endovascular therapy is effective against acute cerebral large vessel occlusion (LVO). However, many patients do not receive such interventions because of the lack of timely identification of the type of stroke. If the types of stroke (any stroke, LVO, intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were to be predicted at the prehospital (...) stage, better access to appropriate interventions would be possible. Japan Urgent Stroke Triage (JUST) score was clinical prediction rule to classify suspected patients of acute stroke into different types at the prehospital stage. Methods- We obtained information for signs and symptoms and medical history of consecutive suspected patients of acute stroke at prehospital stage from paramedics and final diagnosis from the receiving hospital. We constructed derivation cohort in the historical
. The proximal landing of the stent graft was in zone 0 in 22 patients, zone 1 in 23 patients, and zone 2 in 32 patients. The shagginess score of each patient was calculated from preoperative contrast-enhanced computed tomography images of the aorta using a workstation. The relationships between preoperative factors, including the shagginess score, and the development of perioperative stroke and late survival were analyzed retrospectively.Perioperative ischemicstroke occurred in nine patients (...) , and no patient died within 30 days postoperatively. Univariate analyses demonstrated that the shagginess score was significantly higher in patients who developed postoperative cerebralinfarction than in those who did not (P = .04). The median follow-up period was 1570 days, and the 5-year cumulative survival rate was 69.2%. Cox proportional hazards analyses showed that comorbid hypercholesterolemia was significantly associated with all-cause mortality (hazard ratio [HR], 3.22; 95% confidence interval [CI
Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.A pilot, randomized, single-blind, controlled trial.Stroke rehabilitation inpatient unit.Participants (N=48 (...) ) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity-based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.Primary outcome measures were changes in Fugl-Meyer Assessment
and unpublished data.We included one pilot trial with nine participants. The trial was a feasibility trial that included participants with an unknown onset of stroke and signs on perfusion computed tomography of ischaemic tissue at risk of infarction, who were randomised to alteplase (0.9 mg/kg) or placebo. One trial was prematurely terminated due to signs of efficacy of the intervention arm; we did not include this trial because we were not able to obtain data for the portion of the participants with wake-up (...) Recanalisation therapies for wake-up stroke. About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have traditionally been considered ineligible for thrombolytic treatment because the time of stroke onset is unknown. However, some studies suggest that these people may benefit from recanalisation therapies.To assess the effects of intravenous thrombolysis and other recanalisation therapies versus control in people with acute ischaemicstroke presenting
Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation.This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke (...) rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption.We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions
. Further, AF may be newly diagnosed with prolonged cardiac monitoring modalities in nearly a quarter of patients after stroke or transientischemicattack . The American Heart Association, American College of Cardiology, and . Given the associated morbidity of AF and significant stroke risk reduction with oral anticoagulation , should patients be screened for AF in primary stroke prevention? Opportunistic versus systematic screening Opportunistic screening is offered during a routine (...) the Atiral Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J . 2005;149(4):657-63. Lubitz SA, Yin X, McManus DD, et al. Stroke as the initial manifestation of atrial fibrillation: the Framingham Heart Study. 2017;48(2):490-2. Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transientischaemicattack: a systematic review and meta-analysis. Lancet Neurol . 2015;14(4):377-87. January CT, Wann LS
The effect of Tai Chi training on the dual-tasking performance of stroke survivors: a randomized controlled trial To compare the effect of Tai Chi training with conventional exercise on dual-tasking performance among stroke survivors.An assessor-blinded, randomized controlled trial.Community-dwelling stroke survivors.Community centers and university.Subjects in the Tai Chi group and the conventional exercise group were trained with the corresponding exercises for 12 weeks (1 hour/session, 2 (...) effect on dual-tasking performance compared with conventional exercise among stroke survivors. Further studies with larger sample size, longer training, and follow-up periods are needed.
Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial The risk of stroke associated with carotid artery restenosis after stenting or endarterectomy is unclear. We aimed to compare the long-term risk of restenosis after these treatments and to investigate if restenosis causes stroke in a secondary analysis of the International Carotid Stenting Study (ICSS).ICSS (...) is a parallel-group randomised trial at 50 tertiary care centres in Europe, Australia, New Zealand, and Canada. Patients aged 40 years or older with symptomatic carotid stenosis measuring 50% or more were randomly assigned either stenting or endarterectomy in a 1:1 ratio. Randomisation was computer-generated and done centrally, with allocation by telephone or fax, stratified by centre, and with minimisation for sex, age, side of stenosis, and occlusion of the contralateral carotid artery. Patients were
Clinical Utility of Electronic Alberta Stroke Program Early Computed Tomography Score Software in the ENCHANTED Trial Database Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke.All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemicstroke who participated in the alteplase (...) dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded. Included scans had e-ASPECTS scores correlated with baseline neurological severity (National Institutes of Health Stroke Scale scores) and 90-day disability outcomes (modified Rankin Scale scores). Multivariable logistic regression models were used to determine the predictive ability of e-ASPECTS