The International Journal of Stroke

The International Journal of Stroke published by Wiley- Blackwell is the official journal of the World Stroke Organization (WSO), incorporating the International Stroke Society (ISS) and the World Stroke Federation (WSF). The journal's vision is to build a global stroke community, sharing ideas, information and energy across all stroke specialties including genetics, imaging, pediatrics, rehabilitation and more.


Highlights from the latest issue of the International Journal of Stroke:

Targeted temperature management after intracerebral hemorrhage (TTM‐ICH): methodology of a prospective randomized clinical trial

Thursday, January 23, 2014, 3:35 AM

Rationale Intracerebral hemorrhage causes 15% of strokes annually in the United States, and there is currently no effective therapy. Aims and hypothesis This is a clinical trial designed to study the safety, feasibility, and efficacy of a protocol of targeted temperature management to moderate hypothermia in intracerebral hemorrhage patients. Methods The targeted temperature management after intracerebral hemorrhage trial is a prospective, single‐center, interventional, randomized, paralle... Read More >>


CHADS2 score/CHA2DS2‐VASc score and major artery occlusion in cardioembolic stroke patients with nonvalvular atrial fibrillation

Wednesday, January 22, 2014, 5:20 AM

Objective The associations between the CHADS2 score/CHA2DS2‐VASc score, and the presence of cerebral vessel occlusion on admission were examined in cardioembolic stroke patients with nonvalvular atrial fibrillation. Methods The subjects were 546 consecutive patients hospitalized between April 2007 and December 2012 with onset of cardioembolic stroke associated with nonvalvular atrial fibrillation within 24 h. The associations between the CHADS2 score/CHA2DS2‐VASc score and the presence of oc... Read More >>


Plasma free fatty acids and risk of stroke in the Cardiovascular Health Study

Wednesday, January 22, 2014, 5:20 AM

Background Although free fatty acids have been positively associated with risk factors for stroke, the role of plasma free fatty acids in the development of stroke has not been elucidated in older adults. Aims We sought to examine the association between plasma free fatty acids and incident stroke. Methods Prospective cohort of 4369 men and women ≥65 years of age in the Cardiovascular Health Study. Plasma levels of free fatty acids were measured at the 1992–1993 examination and stroke even... Read More >>


Aortic arch atheroma and further cardiovascular events in stroke patients

Tuesday, January 21, 2014, 3:45 AM



Arterial stiffness in patients with ischemic attack

Tuesday, January 21, 2014, 3:45 AM



Methodology of the Field Administration of Stroke Therapy – Magnesium (FAST‐MAG) phase 3 trial: Part 2 – prehospital study methods

Tuesday, January 21, 2014, 3:45 AM

Rationale In acute stroke, the volume of salvageable brain tissue is maximal at onset and declines rapidly with time. Prehospital start of clinical trial interventions would enable delivery of neuroprotective agents, such as magnesium sulfate, to stroke patients in the hyperacute period when they are potentially most effective. Aims A broad aim of the FAST‐MAG study is to develop and validate techniques to perform pivotal trials of neuroprotective therapies for acute stroke in the prehospita... Read More >>


Telemedicine, FAST‐MAG and participation in clinical trials

Tuesday, January 21, 2014, 3:45 AM



Endovascular therapy did not improve expected prognosis after i.v. fibrinolysis: a retrospective analysis based on a nationwide Danish registry

Tuesday, January 21, 2014, 3:45 AM



Stroke: More than a ‘brain attack’

Tuesday, January 21, 2014, 3:45 AM

Stroke is a life‐altering event that potentially affects stroke survivors, their families, healthcare resources, and society in general. Stroke has often been described as ‘brain attack’, denoting emergency emphasis on the vascular pathology. Consequently, many national and provincial stroke strategies have emphasized vascular care through primary prevention strategies and thrombolysis. Despite being important initiatives, this has resulted in a stroke system that emphasizes the frontloading of... Read More >>


Methodology of the Field Administration of Stroke Therapy – Magnesium (FAST‐MAG) phase 3 trial: Part 1 – rationale and general methods

Monday, January 13, 2014, 9:29 AM

Rationale Prehospital initiation by paramedics may enable delivery of neuroprotective therapies to stroke patients in the hyperacute period when they are most effective in preclinical studies. Magnesium is neuroprotective in experimental stroke models and has been shown to be safe with signals of potential efficacy when started early after onset of human cerebral ischemia. Aims (a) To demonstrate that paramedic initiation of the neuroprotective agent magnesium sulfate in the field is an effi... Read More >>


Health service management study for stroke: A randomized controlled trial to evaluate two models of stroke care

Friday, January 3, 2014, 8:34 AM

Background The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial. Methods Patients with acute stroke were randomized on day one of admission to combined, co‐located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care. Outcomes measured at baseline and 90 days postdischarge included functional independence measure, length of hos... Read More >>


Hypothermia protects human neurons

Friday, January 3, 2014, 8:34 AM

Background and Aims Hypothermia provides neuroprotection after cardiac arrest, hypoxic‐ischemic encephalopathy, and in animal models of ischemic stroke. However, as drug development for stroke has been beset by translational failure, we sought additional evidence that hypothermia protects human neurons against ischemic injury. Methods Human embryonic stem cells were cultured and differentiated to provide a source of neurons expressing β III tubulin, microtubule‐associated protein 2, and the ... Read More >>


Intravenous insulin treatment in acute stroke: a systematic review and meta‐analysis of randomized controlled trials

Monday, December 30, 2013, 5:22 AM

Introduction Poststroke hyperglycemia has been associated with unfavorable outcome. Several trials investigated the use of intravenous insulin to control hyperglycemia in acute stroke. This meta‐analysis summarizes all available evidence from randomized controlled trials in order to assess its efficacy and safety. Methods We searched PubMed until 15/02/2013 for randomized clinical trials using the following search items: ‘intravenous insulin’ or ‘hyperglycemia’, and ‘stroke’. Eligible studie... Read More >>


Prehospital factors determining regional variation in thrombolytic therapy in acute ischemic stroke

Monday, December 23, 2013, 12:15 PM

Background Treatment rates with intravenous tissue plasminogen activator vary by region, which can be partially explained by organizational models of stroke care. A recent study demonstrated that prehospital factors determine a higher thrombolysis rate in a centralized vs. decentralized model in the north of the Netherlands. Aim To investigate prehospital factors that may explain variation in thrombolytic therapy between a centralized and a decentralized model. Methods A consecutive case o... Read More >>


Patients with single distal MCA perfusion lesions have a high rate of good outcome with or without reperfusion

Monday, December 23, 2013, 12:15 PM

Background Reperfusion is associated with good functional outcome after stroke. However, minimal data are available regarding the effect of reperfusion on clinical outcome and infarct growth in patients with distal MCA branch occlusions. Aim The aim of this study was to evaluate this association and to determine the impact of the perfusion‐diffusion mismatch. Methods Individual patient data from three stroke studies (EPITHET, DEFUSE and DEFUSE 2) with baseline MRI profiles and reperfusion ... Read More >>


Changes to volumetric bone mineral density and bone strength after stroke: A prospective study

Monday, December 23, 2013, 12:15 PM

Rationale and aim Stroke survivors experience accelerated bone loss and increased fracture risk, particularly in paretic weight bearing limbs. Understanding how these changes unfold and their relationship to stroke severity and physical activity could help in the development of targeted interventions to prevent or reduce the severity of these outcomes. The primary aim of this study is to investigate the time course and magnitude of changes in volumetric bone mineral density within the first ye...



An update on Italian Stroke Organization guidelines on carotid endarterectomy and stenting

Monday, December 23, 2013, 3:41 AM

One hundred and fifty‐three authors, 45 Italian scientific societies, and two Italian patients’ associations participated in drafting the Italian Stroke Organization document, which has become the national guideline for the prevention and treatment of stroke in Italy. For the surgical therapy section of the Italian Stroke Organization document, the main trials on carotid endoarterectomy and stenting were critically reviewed in order to formulate recommendations for these procedures. Recommendat... Read More >>


Tissue kallikrein preventing the restenosis after stenting of symptomatic MCA atherosclerotic stenosis (KPRASS)

Friday, December 20, 2013, 10:20 AM

Rationale Many recent studies suggest that the kallikrein‐kinin system play a protective role in the impairment of vascular smooth muscle cells and vascular endothelial cell. Aims The study aims to determine whether tissue kallikrein is efficacy for preventing the long‐term in‐stent restenosis after stenting of symptomatic atherosclerotic stenosis of the middle cerebral artery M1 segment. Design This is a Phase II, randomized, single‐blinded, controlled trial. In line with SAMMPRIS stentin... Read More >>


Differences in lipid profiles in two Hispanic ischemic stroke populations

Thursday, December 19, 2013, 11:30 AM

Background and Purpose The study aims to compare lipid profiles among ischemic stroke patients in a predominantly Caribbean‐Hispanic population in Miami and a Mestizo Hispanic population in Mexico City. Methods We analyzed ischemic stroke Hispanic patients with complete baseline fasting lipid profile enrolled contemporaneously in the prospective registries of two tertiary care teaching hospitals in Mexico City and Miami. Demographic characteristics, risk factors, medications, ischemic stroke... Read More >>


Social competence following neonatal and childhood stroke

Thursday, December 19, 2013, 11:29 AM

Background Social functioning encompasses a range of important skills that an individual uses to interact with the social world. Previous studies suggest that social functioning (outcomes) may be impaired after childhood stroke, but research is limited. Aims We examined the following: (1) the effect of ischemic stroke upon social outcomes in children; (2) the correlation of cognitive abilities and problem behaviors with social outcomes; and (3) the role of infarct characteristics as predicto... Read More >>


Granulocyte colony‐stimulating factor does not promote neurogenesis after experimental intracerebral haemorrhage

Thursday, December 19, 2013, 11:29 AM

Background Hematopoietic growth factors have been suggested to induce neuroprotective and regenerative effects in various animal models of cerebral injury. However, the pathways involved remain widely unexplored. Aims This study aimed to investigate effects of local and systemic administration of granulocyte colony‐stimulating factor on brain damage, functional recovery, and cerebral neurogenesis in an intracerebral haemorrhage whole blood injection model in rats. Methods Eight‐week‐old ma... Read More >>


Women Stroke Association statement on stroke

Thursday, December 19, 2013, 11:29 AM

We describe the current and future objectives of the Women Stroke Association, a nonprofit multidisciplinary organization promoting research awareness on medical, psychological, and social issues concerning women affected by cerebro‐cardiovascular disease. In this paper, we deal with only cerebrovascular disease, whereas cardiovascular disorders will be addressed in a future paper. Gender differences in the clinical presentation of cerebrovascular diseases have been repeatedly suggested, and so... Read More >>


Processes of early stroke care and hospital costs

Thursday, December 19, 2013, 9:50 AM

Background The relationship between processes of early stroke care and hospital costs remains unclear. Aims We therefore examined the association in a population‐based cohort study. Methods We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010. The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance ima... Read More >>


Quality in Acute Stroke Care (QASC): process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke

Monday, December 2, 2013, 3:32 AM

Background Our randomized controlled trial of a multifaceted evidence‐based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three‐days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. Methods Blinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation ... Read More >>


Are patients with intracerebral haemorrhage disadvantaged in hospitals?

Thursday, November 21, 2013, 10:19 AM

Background and Aims Providing evidence‐based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence‐based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes. Methods The New South Wales acute stroke dataset was used. This included data from 50–100 con... Read More >>


Diagnostic and prognostic value of multimodal MRI in transient ischemic attack

Thursday, November 21, 2013, 10:19 AM

Background The clinical diagnosis of transient ischemic attack is highly subjective, and the risk prediction after transient ischemic attack using the clinical parameters still remains unsatisfactory. Aims We aimed to investigate the diagnostic and prognostic value of multimodal magnetic resonance imaging in transient ischemic attack patients. Methods We prospectively performed diffusion‐weighted imaging, perfusion‐weighted imaging, and intracranial and extracranial magnetic resonance angi... Read More >>


The impact of cerebrovascular disease in Panama

Thursday, November 21, 2013, 10:19 AM

Background In Latin America, the cerebrovascular disease is considered a catastrophic public health problem. The objective of this publication is to describe the demographic characteristics and risk factors of cerebrovascular disease in Panama. Methods A hospital‐based stroke registry was carried out between 2005 and 2006 to record all patients with cerebrovascular disease admitted to the two major teaching public hospital in Panama City. A comparative analysis was realized of the risk facto... Read More >>


Reperfusion after 4·5 hours reduces infarct growth and improves clinical outcomes

Thursday, November 21, 2013, 10:19 AM

Background The currently proven time window for thrombolysis in ischemic stroke is 4·5 h. Beyond this, the risks and benefits of thrombolysis are uncertain. Aims To determine whether thrombolysis and reperfusion were beneficial after 4·5 h, we examined clinical and radiological outcomes in patients treated with tissue plasminogen activator or placebo within 4·5–6 h, using data from the Echoplanar Imaging Thrombolytic Evaluation Trial. Methods In the Echoplanar Imaging Thrombolytic Evaluati... Read More >>


Establishment of an effective acute stroke telemedicine program for Australia: protocol for the Victorian Stroke Telemedicine project

Wednesday, October 23, 2013, 4:45 AM

Rationale Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. Aim The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. Design A formative program evaluation research design wa... Read More >>


FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke: Neural correlates and prognostic indicators

Thursday, September 12, 2013, 11:08 AM

Rationale Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy. Aims To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional... Read More >>


Rationale, design, and baseline features of a randomized controlled trial to assess the effects of statin for the secondary prevention of stroke: the Japan Statin Treatment Against Recurrent Stroke (J‐STARS)

Tuesday, September 10, 2013, 4:10 AM

Background Although statin therapy is beneficial for preventing first strokes, the benefit for recurrent stroke and its sub‐types remains unknown in Asian populations. The aim of this study is to examine the role of pravastatin in the secondary prevention of stroke in Japanese patients. Methods This is a multicenter, randomized, open‐label, parallel group study of patients with noncardioembolic ischemic stroke (atherothrombotic infarction, lacunar infarction, and infarction of undetermined e... Read More >>


Combining magnetic resonance imaging within six‐hours of symptom onset with clinical follow‐up at 24 h improves prediction of ‘malignant’ middle cerebral artery infarction

Tuesday, July 9, 2013, 10:00 AM

Background A large diffusion‐weighted imaging lesion ≤six‐hours of symptom onset was found to predict the development of ‘malignant’ middle cerebral artery infarction with high specificity, positive predictive value, and negative predictive value, but sensitivity was low. Hypothesis We tested the hypothesis that sensitivity can be improved by adding information from clinical follow‐up examination after 24 h. Methods We analyzed data from a prospective, multicenter, observational cohort stu... Read More >>


Regression analysis of ordinal stroke clinical trial outcomes: An application to the NINDS t‐PA trial

Thursday, June 27, 2013, 11:29 AM

Background The modified Rankin scale (mRS) is the most common functional outcome assessed in stroke trials. The proportional odds model is commonly used to analyze this ordinal outcome but it requires a restrictive assumption that a single odds ratio applies across the entire outcome scale. Aims The study aims to model the effect of tissue‐type plasminogen activator on ordinal mRS, test model assumptions, and compare fits and predictive ability of the statistical models. Methods Several or... Read More >>


Cerebral CT perfusion in patients with perimesencephalic and those with aneurysmal subarachnoid hemorrhage

Friday, March 22, 2013, 4:21 AM

Background The cause of perimesencephalic hemorrhage is unknown, but a venous source is suggested. If perimesencephalic hemorrhage is of venous origin, less elevation of the intracranial pressure and less perfusion deficits are expected than after aneurysmal subarachnoid hemorrhage. Aims We compared perfusion in the acute stage after perimesencephalic hemorrhage and aneurysmal subarachnoid hemorrhage. Methods We included 45 perimesencephalic hemorrhage patients and 45 aneurysmal subarachno... Read More >>


The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke

Tuesday, March 19, 2013, 11:58 AM

Rationale Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during acute stroke is feasible and can be accomplished safely but has not been fully assessed for efficacy. Aims The Stroke Hyperglycemia Insulin Network Effort trial aims to determine the safety and efficacy of standard vs. intensive glucose control with insulin in hyperglycemic acute ischemic stroke patients. Design This is a randomized, blinded... Read More >>


Representation of people with aphasia in randomized controlled trials of acute stroke interventions

Tuesday, March 19, 2013, 11:58 AM

Background Aphasia affects up to a third of the stroke population and is associated with poor social participation and quality of life. Yet people with aphasia may be excluded from some types of stroke research due to challenges in informing, consenting, and conducting follow‐up in this population. Aims and/or hypothesis We described the representation of those with aphasia in acute stroke clinical research, the level of inclusion across international trial sites, and whether there have been... Read More >>


Evaluation of plasma d‐dimer plus fibrinogen in predicting acute CVST

Tuesday, March 19, 2013, 11:58 AM

Background Prompt diagnosis of cerebral venous sinus thrombosis is a challenge owing in part to its complex and non‐specific early clinical symptoms. Objective This study aims to evaluate the value of clinically useful biomarkers (d‐dimer and fibrinogen) for cerebral venous sinus thrombosis prediction. Methods Two‐hundred and thirty‐three suspected cerebral venous sinus thrombosis patients were enrolled in this prospective study. Thirty‐four cases confirmed as cerebral venous sinus thrombo... Read More >>


Efficacy and safety of warfarin vs. antiplatelet therapy in patients with systolic heart failure and sinus rhythm: a systematic review and meta‐analysis of randomized controlled trials

Tuesday, March 19, 2013, 11:47 AM

Background and purpose Heart failure is an independent risk factor for stroke. Anticoagulation is effective for prevention of cardio‐embolic stroke secondary to atrial fibrillation or mechanical heart valves but is of uncertain benefit in heart failure patients. We performed this meta‐analysis to obtain the best estimates of the efficacy and safety of warfarin as compared with antiplatelet therapy in patients with systolic heart failure who are in sinus rhythm. Methods and results A systemat... Read More >>


Functional connectivity magnetic resonance imaging in stroke: an evidence‐based clinical review

Tuesday, March 19, 2013, 11:46 AM

Stroke is a common condition that may lead to various degrees of neurological deficit and long‐term disability. It has become increasingly recognized that cortical reorganization of neuronal networks plays a significant role in regaining function following a focal brain injury. However, the mechanisms involved in this process are still not fully understood. Resting‐state functional connectivity magnetic resonance imaging is a rapidly evolving scanning technique that has the potential to shed li... Read More >>


Emergency transfer of acute stroke patients within the East Saxony telemedicine stroke network: a descriptive analysis

Tuesday, March 19, 2013, 11:46 AM

Background Telemedicine may facilitate the selection of stroke patients who require emergency transfer to a comprehensive stroke center to receive additional therapies other than intravenous tissue plasminogen activator. Aims and/or hypothesis We sought to analyze frequency, patient characteristics, and specific therapies among emergently transferred patients within the telemedical Stroke East Saxony Network. Methods We reviewed consecutive patients who were transferred emergently from rem... Read More >>


Is the rate of cerebral hemorrhages declining among stroke patients in South America?

Tuesday, March 19, 2013, 11:46 AM

Recent stroke registries suggest that the rate of cerebral hemorrhages is declining among stroke patients in South America. High rates of cerebral hemorrhages (approaching 40% of stroke cases) reported in pioneer registries during the 1990s have not been duplicated in more recent studies. In contrast, almost all studies recruiting patients from 2003 on, reported less than 20% of cerebral hemorrhages among their stroke patients. Intermediate rates of hemorrhagic strokes (from 25% to 27%) were no... Read More >>


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Improving Life After Stroke

Developed to focus on the need for improved long-term stroke management.

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