What’s new in stroke? The top 10 studies of 2009–2011. Part I

Five important studies from 2009-2011 that influence the clinical management of stroke and threatened stroke are summarized. Pooled analysis of individual patient data from 8 randomized trials testing intravenous tissue plasminogen activator confirmed important benefits for patients treated 3 to 4.5 hours after stroke onset, but treatment after 4.5 hours was associated with a higher mortality. Blood pressure lowering with candesartan in the first few days after stroke was of no benefit and was possibly harmful (SCAST trial). Thigh-length graduated compression stockings did not reduce venous thromboembolism after acute stroke and were associated with skin complications (CLOTS Trial 1). Long-term follow-up showed that endovascular coiling was as good as neurosurgical clipping for patients with small, ruptured intracranial aneurysms (ISAT trial). Percutaneous closure of a patent foramen ovale offered no apparent benefit to young patients with cryptogenic ischemic stroke based on the first randomized trial testing this intervention, but the number of stroke events was insufficient to draw definitive conclusions (CLOSURE I trial).