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Adam de Havenon, Jennifer J Majersik, Gregory Stoddard, Ka-Ho Wong, J Scott McNally, A Gordon Smith, Natalia S Rost, David L Tirschwell
Background and Purpose- Increased systolic blood pressure variability (BPV) is associated with worse outcome after acute ischemic stroke and may also have a negative impact after intracerebral hemorrhage. We sought to determine whether increased BPV was detrimental in the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial. Methods- The primary outcome of our study was a 3-month follow-up modified Rankin Scale of 3 to 6, and the secondary outcome was a utility-weighted modified Rankin Scale...
August 2018: Stroke; a Journal of Cerebral Circulation
Mohammad Hassan Shariat, Javad Hashemi, Saeed Gazor, Damian P Redfearn
Cardiac mapping systems are based on the time/frequency feature analyses of intracardiac electrograms recorded from individual bipolar/unipolar electrodes. Signals from each electrode are processed independently. Such approaches fail to investigate the interrelationship between simultaneously recorded channels of any given mapping catheter during atrial fibrillation (AF). We introduce a novel signal processing technique that reflects regional dominant frequency (RDF) components. We show that RDF can be used to identify and characterize variation and disorganization in wavefront propagation- wave breaks...
2018: Frontiers in Cardiovascular Medicine
Adnan I Qureshi, Yuko Y Palesch, Lydia D Foster, William G Barsan, Joshua N Goldstein, Daniel F Hanley, Chung Y Hsu, Claudia S Moy, Mushtaq H Qureshi, Robert Silbergleit, Jose I Suarez, Kazunori Toyoda, Haruko Yamamoto
BACKGROUND AND PURPOSE: We compared the rates of death or disability, defined by modified Rankin Scale score of 4 to 6, at 3 months in patients with intracerebral hemorrhage according to post-treatment systolic blood pressure (SBP)-attained status. METHODS: We divided 1000 subjects with SBP ≥180 mm Hg who were randomized within 4.5 hours of symptom onset as follows: SBP <140 mm Hg achieved or not achieved within 2 hours; subjects in whom SBP <140 mm Hg was achieved within 2 hours were further divided: SBP <140 mm Hg for 21 to 22 hours (reduced and maintained) or SBP was ≥140 mm Hg for at least 2 hours during the period between 2 and 24 hours (reduced but not maintained)...
June 2018: Stroke; a Journal of Cerebral Circulation
Ashkan Shoamanesh, Andrea Morotti, Javier M Romero, Jamary Oliveira-Filho, Frieder Schlunk, Michael J Jessel, Alison M Ayres, Anastasia Vashkevich, Kristin Schwab, Mohammad R Afzal, Christy Cassarly, Renee H Martin, Adnan I Qureshi, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein
Importance: Response to intensive blood pressure (BP) lowering in acute intracerebral hemorrhage (ICH) might vary with the degree of underlying cerebral small vessel disease. Objectives: To characterize cerebral microbleeds (CMBs) in acute ICH and to assess the potential for interaction between underlying small vessel disease (as indicated by CMB number and location) and assignment to acute intensive BP targeting for functional outcomes and hematoma expansion. Design, Setting, and Participants: Preplanned subgroup analyses in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial were performed...
July 1, 2018: JAMA Neurology
Andrea Morotti, Dar Dowlatshahi, Gregoire Boulouis, Fahad Al-Ajlan, Andrew M Demchuk, Richard I Aviv, Liyang Yu, Kristin Schwab, Javier M Romero, M Edip Gurol, Anand Viswanathan, Christopher D Anderson, Yuchiao Chang, Steven M Greenberg, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
BACKGROUND AND PURPOSE: Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. METHODS: After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241)...
May 2018: Stroke; a Journal of Cerebral Circulation
Andrea Morotti, H Bart Brouwers, Javier M Romero, Michael J Jessel, Anastasia Vashkevich, Kristin Schwab, Mohammad Rauf Afzal, Christy Cassarly, Steven M Greenberg, Renee Hebert Martin, Adnan I Qureshi, Jonathan Rosand, Joshua N Goldstein
Importance: The computed tomographic angiography (CTA) spot sign is associated with intracerebral hemorrhage (ICH) expansion and may mark those patients most likely to benefit from intensive blood pressure (BP) reduction. Objective: To investigate whether the spot sign is associated with ICH expansion across a wide range of centers and whether intensive BP reduction decreases hematoma expansion and improves outcome in patients with ICH and a spot sign. Design, Setting, and Participants: SCORE-IT (Spot Sign Score in Restricting ICH Growth) is a preplanned prospective observational study nested in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized clinical trial...
August 1, 2017: JAMA Neurology
Shahram Majidi, Jose I Suarez, Adnan I Qureshi
Acute hypertensive response is elevation of systolic blood pressure (SBP) in the first 24 h after symptom onset which is highly prevalent in patients with intracerebral hemorrhage (ICH). Observational studies suggested association between acute hypertensive response and hematoma expansion, peri-hematoma edema and death and disability, and possible reduction in these adverse outcomes with treatment of acute hypertensive response. Recent clinical trials have focused on determining the clinical efficacy of early intensive SBP reduction in ICH patients...
October 2017: Neurocritical Care
Adnan I Qureshi, Yuko Y Palesch, William G Barsan, Daniel F Hanley, Chung Y Hsu, Renee L Martin, Claudia S Moy, Robert Silbergleit, Thorsten Steiner, Jose I Suarez, Kazunori Toyoda, Yongjun Wang, Haruko Yamamoto, Byung-Woo Yoon
BACKGROUND: Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. METHODS: We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4...
September 15, 2016: New England Journal of Medicine
Cléverson O Silva, Jéssica M S Soumaille, Fabiano C Marson, Patrícia S Progiante, Dimitris N Tatakis
AIM: The objective of this prospective study was to assess clinical and patient-centred outcomes of aesthetic crown lengthening surgery for the treatment of altered passive eruption. MATERIALS AND METHODS: Twenty-two patients were treated and followed up for 6 months. The evaluated clinical parameters included, among others, probing depth, clinical attachment level, clinical crown length (CLc ), cemento-enamel junction to alveolar bone crest distance, gingival width (GW) and gingival display (GD)...
December 2015: Journal of Clinical Periodontology
Syeda L Alqadri, Varun Sreenivasan, Adnan I Qureshi
Acute elevation in blood pressure (acute hypertensive response) is commonly observed in the early period of both ischemic and hemorrhagic stroke. The management of acute hypertensive response depends upon the underlying intracranial pathology. Management of acute hypertensive response has been the focus of many trials and studies such as the SCAST trial, CHHIPS trial, COSSACS trial, INTERACT, and ATACH trial, which are discussed here. However, there were many limitations to these trials including time of presentation, different pathophysiology of ischemic strokes versus hemorrhagic strokes, and patient related factors...
December 2013: Current Cardiology Reports
Haitham M Hussein, Nauman A Tariq, Yuko Y Palesch, Adnan I Qureshi
BACKGROUND AND PURPOSE: The reliability of hematoma volume (HV) measurement using the ABC/2 method in multicenter clinical trials is unknown. We determined the accuracy of ABC/2 method as an on-site test in comparison with the gold standard central HV-assessment and semiautomatic HV-assessment. Method- We analyzed data from an acute intracerebral hemorrhage multicenter clinical trial. HV was measured by site investigators to determine enrollment eligibility (<60 cm(3)) using the ABC/2 method (on-site HV), and independently by the core-imaging laboratory using computer-based analysis (Medical Image Processing, Analysis, and Visualization [MIPAV] HV)...
January 2013: Stroke; a Journal of Cerebral Circulation
Syeda L Alqadri, Adnan I Qureshi
Spontaneous intracerebral hemorrhage (ICH) is intra-parenchymal bleeding that may lead to localized hematoma formation. The hematoma can enlarge over a period of time, and directly contribute to neurological deterioration and death. Several studies have shown a relationship between acute hypertensive response and poor prognosis among patients with ICH; however, it is somewhat unclear whether hematomal expansion, is a cause or a result of elevated blood pressure (BP). Current AHA guidelines state MAP should be maintained <130 mmHg and systolic blood pressure (SBP) <180 mmHg...
August 2012: Current Atherosclerosis Reports
Erin M Grise, Opeolu Adeoye
PURPOSE OF REVIEW: Acute stroke, including the subtypes of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), typically involves significant fluctuations in blood pressure (BP). Treatment of BP after all stroke types is controversial. In each case, there are theoretical dangers to leaving BP alone as well as altering it artificially. In this article, we review the role of BP in each stroke subtype and the existing evidence for BP optimization. RECENT FINDINGS: Except in patients receiving thrombolytic therapy, there is insufficient evidence to recommend active BP management in ischemic stroke...
April 2012: Current Opinion in Critical Care
Adnan I Qureshi, Yuko Y Palesch, Renee Martin, Jill Novitzke, Salvador Cruz-Flores, Asad Ehtisham, Mustapha A Ezzeddine, Joshua N Goldstein, Jawad F Kirmani, Haitham M Hussein, M Fareed K Suri, Nauman Tariq, Yuan Liu
BACKGROUND: There is some evidence that hyperglycemia increases the rate of poor outcomes in patients with intracerebral hemorrhage (ICH). We explored the relationship between various parameters of serum glucose concentrations measured during acute hospitalization and hematoma expansion, perihematomal edema, and three month outcome among subjects with ICH. METHODS: A post-hoc analysis of a multicenter prospective study recruiting subjects with ICH and elevated systolic blood pressure (SBP) ≥170 mmHg who presented within 6 h of symptom onset was performed...
December 2011: Neurocritical Care
(no author information available yet)
OBJECTIVE: To determine the feasibility and acute (i.e., within 72 hrs) safety of three levels of systolic blood pressure reduction in subjects with supratentorial intracerebral hemorrhage treated within 6 hrs after symptom onset. DESIGN: A traditional phase I, dose-escalation, multicenter prospective study. SETTINGS: Emergency departments and intensive care units. PATIENTS: Patients with intracerebral hemorrhage with elevated systolic blood pressure > or = 170 mm Hg who present to the emergency department within 6 hrs of symptom onset...
February 2010: Critical Care Medicine
Adnan I Qureshi
This trial is a multicenter open-labeled pilot trial to determine the tolerability and safety of three escalating levels of antihypertensive treatment goals for acute hypertension in 60 subjects with supratentorial intracerebral hemorrhage (ICH). The pilot trial is the natural development of numerous case series evaluating the effect of antihypertensive treatment of acute hypertension in subjects with ICH. The proposed trial will have important public health implications by providing necessary information for a definitive phase III study regarding the efficacy of antihypertensive treatment of acute hypertension in subjects with ICH...
2007: Neurocritical Care
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