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Related Concept Videos

Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.

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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Informed consent: the rate-limiting step in acute stroke trials.

David Z Rose1, Scott E Kasner

  • 1Stroke Division, Department of Neurology, University of South Florida, Tampa General Hospital Tampa, FL, USA.

Frontiers in Neurology
|October 25, 2011
PubMed
Summary

Conducting randomized clinical trials (RCTs) for acute stroke is difficult, particularly obtaining informed consent from impaired patients. Overcoming consent barriers is key to advancing stroke treatment knowledge.

Keywords:
acute strokecerebral infarctionclinical trialinformed consent

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Area of Science:

  • Neurology
  • Clinical Trials
  • Neuroscience

Background:

  • Implementing randomized clinical trials (RCTs) for acute neurovascular emergencies like cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage presents significant challenges.
  • These challenges include rapid diagnosis among mimics and obtaining informed consent from vulnerable patients with acute neurological deficits.

Purpose of the Study:

  • To review the influences, barriers, and factors affecting the implementation of RCTs for acute stroke therapies.
  • To focus on informed consent as a critical, often rate-limiting, step for patient enrollment in acute stroke RCTs.

Main Methods:

  • Review of literature concerning barriers and facilitators in acute stroke clinical trials.
  • Analysis of the informed consent process, including challenges related to patient capacity, surrogate consent, and patient/surrogate understanding of trial methodology and therapeutic misconception.

Main Results:

  • Informed consent is a major impediment to acute stroke RCT enrollment, especially for patients with cognitive, sensory, or motor impairments.
  • Surrogate consent may not align with patient wishes, and misconceptions about trial design can hinder participation.
  • The use of exception from informed consent is rarely employed in stroke RCTs.

Conclusions:

  • Addressing barriers in the informed consent process is crucial for successful acute stroke RCTs.
  • Balancing ethical principles (autonomy, beneficence, justice) with the need to advance stroke treatment knowledge is essential for well-designed trials.