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A dark side of subcortical diffusion-weighted lesions? Characteristics, cause, and outcome in large subcortical infarction: the Bergen Norwegian stroke cooperation study.

https://arctichealth.org/en/permalink/ahliterature258806
Source
Stroke. 2014 Sep;45(9):2710-6
Publication Type
Article
Date
Sep-2014
Author
Christopher Elnan Kvistad
Halvor Oygarden
Nicola Logallo
Gunnar Moen
Lars Thomassen
Ulrike Waje-Andreassen
Halvor Naess
Source
Stroke. 2014 Sep;45(9):2710-6
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Brain Ischemia - physiopathology
Brain Stem - physiopathology
Cerebellum - physiopathology
Databases, Factual
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Norway
Prospective Studies
Registries
Stroke - diagnosis - physiopathology
Stroke, Lacunar - physiopathology
Treatment Outcome
Abstract
Diffusion-weighted imaging (DWI) is highly accurate in identifying and locating ischemic stroke injury. Few studies using DWI have investigated large subcortical infarctions (LSIs). We aimed to study clinical characteristics, cause, and outcome in patients with ischemic stroke with LSI diagnosed on DWI and compare these with those who had lacunar DWI lesions or DWI lesions located elsewhere.
Patients with stroke admitted between February 2006 and July 2013 were prospectively registered in a stroke database and examined with DWI. Patients with DWI lesions classified as LSI (subcortical, =15 mm) were compared with those with lacunar lesions (subcortical,
PubMed ID
25013025 View in PubMed
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NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population.

https://arctichealth.org/en/permalink/ahliterature282585
Source
Stroke. 2017 Feb;48(2):335-341
Publication Type
Article
Date
Feb-2017
Author
Aliona Nacu
Christopher E Kvistad
Halvor Naess
Halvor Øygarden
Nicola Logallo
Jörg Assmus
Ulrike Waje-Andreassen
Kathinka D Kurz
Gesche Neckelmann
Lars Thomassen
Source
Stroke. 2017 Feb;48(2):335-341
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Ischemia - diagnostic imaging - drug therapy - epidemiology
Female
Humans
Male
Middle Aged
Norway - epidemiology
Phospholipids - administration & dosage
Population Surveillance - methods
Prospective Studies
Single-Blind Method
Stroke - diagnostic imaging - drug therapy - epidemiology
Sulfur Hexafluoride - administration & dosage
Thrombolytic Therapy - methods
Tissue Plasminogen Activator - administration & dosage
Ultrasonography, Doppler, Transcranial - methods
Abstract
The NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study) aimed to assess effect and safety of contrast-enhanced ultrasound treatment in an unselected acute ischemic stroke population.
Patients treated with intravenous thrombolysis within 4.5 hours after symptom onset were randomized 1:1 to either contrast-enhanced sonothrombolysis (CEST) or sham CEST. A visible arterial occlusion on baseline computed tomography angiography was not a prerequisite for inclusion. Pulse-wave 2 MHz ultrasound was given for 1 hour and contrast (SonoVue) as an infusion for ˜30 minutes. Magnetic resonance imaging and angiography were performed after 24 to 36 hours. Primary study end points were neurological improvement at 24 hours defined as National Institutes of Health Stroke Scale score 0 or reduction of =4 National Institutes of Health Stroke Scale points compared with baseline National Institutes of Health Stroke Scale and favorable functional outcome at 90 days defined as modified Rankin scale score 0 to 1.
A total of 183 patients were randomly assigned to either CEST (93 patient) or sham CEST (90 patients). The rates of symptomatic intracerebral hemorrhage, asymptomatic intracerebral hemorrhage, or mortality were not increased in the CEST group. Neurological improvement at 24 hours and functional outcome at 90 days was similar in the 2 groups both in the intention-to-treat analysis and in the per-protocol analysis.
CEST is safe among unselected ischemic stroke patients with or without a visible occlusion on computed tomography angiography and with varying grades of clinical severity. There was, however, statistically no significant clinical effect of sonothrombolysis in this prematurely stopped trial.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01949961.
Notes
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PubMed ID
27980128 View in PubMed
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The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature259874
Source
BMC Neurol. 2014;14:106
Publication Type
Article
Date
2014
Author
Nicola Logallo
Christopher E Kvistad
Aliona Nacu
Halvor Naess
Ulrike Waje-Andreassen
Jörg Asmuss
Anne Hege Aamodt
Christian Lund
Martin W Kurz
Ole Morten Rønning
Rolf Salvesen
Titto T Idicula
Lars Thomassen
Source
BMC Neurol. 2014;14:106
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Brain Ischemia - drug therapy
Embolectomy
Endovascular Procedures
Fibrinolytic Agents - adverse effects - therapeutic use
Humans
Middle Aged
Norway
Prospective Studies
Stroke - drug therapy
Tissue Plasminogen Activator - adverse effects - therapeutic use
Treatment Outcome
Young Adult
Abstract
Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase.
NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4?mg/kg (single bolus) as compared with alteplase 0.9?mg/kg (10% bolus?+?90% infusion/60?minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted
Notes
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PubMed ID
24886064 View in PubMed
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Prevalence of intracranial stenosis in a Norwegian ischemic stroke population.

https://arctichealth.org/en/permalink/ahliterature260859
Source
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1611-5
Publication Type
Article
Date
Jul-2014
Author
Nicola Logallo
Halvor Naess
Ulrike Waje-Andreassen
Lars Thomassen
Source
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1611-5
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain - pathology
Brain Ischemia - diagnosis - epidemiology - etiology
Constriction, Pathologic - complications - diagnosis - epidemiology
Female
Humans
Intracranial Arteriosclerosis - complications - diagnosis - epidemiology
Male
Middle Aged
Norway - epidemiology
Prevalence
Stroke - diagnosis - epidemiology - etiology
Abstract
There is no data about prevalence of intracranial stenosis (IS) in Northern Europe. This study aimed to investigate the prevalence of symptomatic and asymptomatic IS in a Norwegian, community-based ischemic stroke population.
In a prospective study, all ischemic stroke or transient ischemic attack (TIA) patients were screened for IS by transcranial color-coded sonography, magnetic resonance angiography, and/or computed tomography angiography. Patients with IS and any cardiac arrhythmia or other possible causes of IS than atherosclerosis were excluded. IS was defined as symptomatic if the infarct/symptoms were related to the territory of the stenotic artery. Risk factors for cerebrovascular disease were registered on admission.
During an 18-month study period, 607 patients had an ischemic stroke or a TIA. Out of 69 patients with IS (11.4%), 7 patients were excluded because having atrial fibrillation, and IS of possible atherosclerotic etiology was therefore diagnosed in 62 patients (10.2%). IS was symptomatic in 45 patients (7.4%). Diabetes mellitus was the only risk factor significantly associated with symptomatic IS (odds ratio 2.39, 95% confidence interval [CI] 1.03-5.54, P=.04).
IS occurs in approximately 10% and is symptomatic in about 7% of a Norwegian ischemic stroke/TIA population. Diabetes mellitus appears to be the major risk factor for IS.
PubMed ID
24680085 View in PubMed
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Prior cancer in patients with ischemic stroke: the Bergen NORSTROKE study.

https://arctichealth.org/en/permalink/ahliterature259754
Source
J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):919-25
Publication Type
Article
Author
Henriette A Selvik
Lars Thomassen
Nicola Logallo
Halvor Næss
Source
J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):919-25
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Brain Ischemia - diagnosis - epidemiology
Chi-Square Distribution
Female
Humans
Logistic Models
Male
Middle Aged
Neoplasms - diagnosis - epidemiology
Norway - epidemiology
Prevalence
Prognosis
Proportional Hazards Models
Registries
Risk factors
Severity of Illness Index
Stroke - diagnosis - epidemiology
Time Factors
Young Adult
Abstract
To compare the prevalence of prior or on-going cancer in patients with ischemic stroke and in the general population. We hypothesized that cardioembolic stroke is the most common stroke etiology in patients with prior cancer and that the outcome for ischemic stroke patients (ISP) with prior cancer is poor.
All ISP registered in the Norwegian Stroke Research Registry (NORSTROKE) as part of the ongoing Bergen NORSTROKE Study were included. Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment criteria, and the severity of the stroke was defined from the National Institutes of Health Stroke Scale score. Information about prior or ongoing cancer disease and type was retrospectively obtained from the medical patient record and The Cancer Registry of Norway. The prevalence of cancer among stroke patients was compared with the prevalence of cancer in the general population.
Among 1456 ISP, 229 (15.7%) patients had 1 or more cancer diagnoses before the stroke. The prevalence of cancer was higher among stroke patients compared with the general population (P = .001). The most common cancer types were colorectal cancer (20.2%), prostate cancer (15.6%), breast cancer (12.7 %), cancer of the urinary tract system (10.3%), gynecological cancer (6.2%), and lung cancer (4.5%). Logistic regression analysis showed that patients with prior cancer had cardioembolic strokes at a higher rate (P = .03).
The prevalence of prior cancer is higher in ISP than in the general population. ISPs with prior cancer are more prone to cardioembolism.
PubMed ID
24075585 View in PubMed
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Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study.

https://arctichealth.org/en/permalink/ahliterature131045
Source
BMC Neurol. 2011;11:114
Publication Type
Article
Date
2011
Author
Nicola Logallo
Halvor Naess
Titto T Idicula
Jan Brogger
Ulrike Waje-Andreassen
Lars Thomassen
Author Affiliation
Department of Neurology, Haukeland University Hospital, Bergen, Norway. nalo@helse-bergen.no
Source
BMC Neurol. 2011;11:114
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Brain Ischemia - blood - drug therapy
Female
Humans
Male
Neuroprotective Agents - blood
Norway
Outcome and Process Assessment (Health Care) - statistics & numerical data
Prospective Studies
Severity of Illness Index
Stroke - blood - drug therapy
Thrombolytic Therapy - methods
Time Factors
Tissue Plasminogen Activator - therapeutic use
Uric Acid - blood
Abstract
A possible synergic role of serum uric acid (SUA) with thrombolytic therapies is controversial and needs further investigations. We therefore evaluated association of admission SUA with clinical improvement and clinical outcome in patients receiving rt-PA, early admitted patients not receiving rt-PA, and patients admitted after time window for rt-PA.
SUA levels were obtained at admission and categorized as low, middle and high, based on 33° and 66° percentile values. Patients were categorized as patients admitted within 3 hours of symptom onset receiving rt-PA (rt-PA group), patients admitted within 3 hours of symptom onset not receiving rt-PA (non-rt-PA group), and patients admitted after time window for rt-PA (late group). Short-term clinical improvement was defined as the difference between NIHSS on admission minus NIHSS day 7. Favorable outcome was defined as mRS 0 - 3 and unfavorable outcome as mRS 4 - 6.
SUA measurements were available in 1136 patients. Clinical improvement was significantly higher in patients with high SUA levels at admission. After adjustment for possible confounders, SUA level showed a positive correlation with clinical improvement (r = 0.012, 95% CI 0.002-0.022, p = 0.02) and was an independent predictor for favorable stroke outcome (OR 1.004; 95% CI 1.0002-1.009; p = 0.04) only in the rt-PA group.
SUA may not be neuroprotective alone, but may provide a beneficial effect in patients receiving thrombolysis.
Notes
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PubMed ID
21943291 View in PubMed
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Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial.

https://arctichealth.org/en/permalink/ahliterature286073
Source
Lancet Neurol. 2017 Oct;16(10):781-788
Publication Type
Article
Date
Oct-2017
Author
Nicola Logallo
Vojtech Novotny
Jörg Assmus
Christopher E Kvistad
Lars Alteheld
Ole Morten Rønning
Bente Thommessen
Karl-Friedrich Amthor
Hege Ihle-Hansen
Martin Kurz
Håkon Tobro
Kamaljit Kaur
Magdalena Stankiewicz
Maria Carlsson
Åse Morsund
Titto Idicula
Anne Hege Aamodt
Christian Lund
Halvor Næss
Ulrike Waje-Andreassen
Lars Thomassen
Source
Lancet Neurol. 2017 Oct;16(10):781-788
Date
Oct-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Ischemia - drug therapy
Double-Blind Method
Female
Fibrinolytic Agents
Humans
Male
Middle Aged
Norway
Outcome Assessment (Health Care)
Stroke - drug therapy
Tissue Plasminogen Activator - administration & dosage - adverse effects - pharmacology
Abstract
Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis.
This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway. We enrolled adults with suspected acute ischaemic stroke who were eligible for thrombolysis and admitted within 4·5 h of symptom onset or within 4·5 h of awakening with symptoms, or who were eligible for bridging therapy before thrombectomy. Patients were randomly assigned (1:1) to receive intravenous tenecteplase 0·4 mg/kg (to a maximum of 40 mg) or alteplase 0·9 mg/kg (to a maximum of 90 mg), via a block randomisation schedule stratified by centre of inclusion. Patients were not informed of treatment allocation; treating physicians were aware of treatment allocation but those assessing the primary and secondary endpoints were not. The primary outcome was excellent functional outcome defined as modified Rankin Scale (mRS) score 0-1 at 3 months. The primary analysis was an unadjusted and non-stratified intention-to-treat analysis with last observation carried forward for imputation of missing data. This study is registered with ClinicalTrials.gov, number NCT01949948.
Between Sept 1, 2012, and Sept 30, 2016, 1107 patients met the inclusion criteria and seven patients were excluded because informed consent was withdrawn or eligibility for thrombolytic treatment was reconsidered. 1100 patients were randomly assigned to the tenecteplase (n=549) or alteplase (n=551) groups. The median age of participants was 77 years (IQR 64-79) and the median National Institutes of Health Stroke Scale score at baseline was 4 points (IQR 2-8). A final diagnosis other than ischaemic stroke or transient ischaemic attack was found in 99 (18%) patients in the tenecteplase group and 91 (17%) patients in the alteplase group. The primary outcome was achieved by 354 (64%) patients in the tenecteplase group and 345 (63%) patients in the alteplase group (odds ratio 1·08, 95% CI 0·84-1·38; p=0·52). By 3 months, 29 (5%) patients had died in the tenecteplase group compared with 26 (5%) in the alteplase group. The frequency of serious adverse events was similar between groups (145 [26%] in the tenecteplase group vs 141 [26%] in the alteplase group; p=0·74).
Tenecteplase was not superior to alteplase and showed a similar safety profile. Most patients enrolled in this study had mild stroke. Further trials are needed to establish the safety and efficacy in patients with severe stroke and whether tenecteplase is non-inferior to alteplase.
Research Council of Norway.
PubMed ID
28780236 View in PubMed
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7 records – page 1 of 1.