Racial Differences in Plasma Biomarker May Partially Explain Stroke Disparities

MedicalResearch.com Interview with:

Pankaj Arora MD, FAHA Assistant Professor, Cardiology Division University of Alabama at Birmingham Section Editor, Circulation: Cardiovascular Genetics American Heart Association

Dr. Arora

Pankaj Arora MD, FAHA
Assistant Professor, Cardiology Division
University of Alabama at Birmingham
Section Editor, Circulation: Cardiovascular Genetics
American Heart Association 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Natriuretic peptides are hormones produced by the heart in response to increased wall stress in the atria and ventricles. It is well known that blacks have increased prevalence of cardiovascular disease which contributes to racial disparities in outcomes.

In the current work, we tested the hypothesis that black race is a natriuretic peptide deficiency state using a stratified random cohort of 4,415 participants selected from the REGARDS study (a national population-based cohort study evaluating racial and geographic disparities in stroke in US adults aged ≥45 years of age or older). Next, we looked for published results on the percentage difference in N-terminal proB-type NP (NTproBNP) levels by race in participants free of cardiovascular disease from other population cohorts. Lastly, we explored whether association of natriuretic peptides with all-cause mortality and CV mortality in apparently healthy individuals from REGARDS differs by race.

We found that in multivariable adjustment, NTproBNP levels were up to 27% lower in black individuals as compared with white individuals in the REGARDS study. We pooled our results and found that in meta-analysis of the 3 cohorts, NTproBNP levels were 35% lower in black individuals than white individuals (more than 13,000 individuals in total). Lastly, we found that the higher NTproBNP levels were associated with higher incidence of all-cause mortality, and cardiovascular mortality in healthy blacks and white individuals, and this association did not differ by race.

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AI Study Supports Association of Increased Coffee Consumption With Decreased CVD Risk

MedicalResearch.com Interview with:
Coffee being poured Coffee pot pouring cup of coffee.  copyright American Heart Association
Laura Stevens
University of Colorado
Aurora, CO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:
We started with asking ourselves how we could better predict cardiovascular and stroke outcomes.  In an ideal world, we would be able to predict cardiovascular disease (CVD) and stroke with 100% accuracy long before the occurrence of the event.  The challenge here is there are so many potential risk factors, and testing each one using traditional methods would be extremely time consuming, and possibly infeasible.

Therefore, we used artificial intelligence to find potential risk factors that could be important for risk of CVD and stroke.  The results of this analysis pointed to consumption of coffee cups per day and the number of times red meat was consumed per week as being potentially important predictors of CVD.

We then looked into these findings further using traditional statistical analyses to determine that increased coffee consumption and red meat consumption appeared to be associated with decreased risk of CVD.  The study initially used data from the Framingham Heart Study (FHS) original cohort.

The findings from this data were then tested using data from 2 independent studies, the Cardiovascular Heart Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC), which both supported the association of increased coffee consumption with decreased CVD risk.

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Standard or Low Dose Alteplase in Acute Ischemic Stroke–Does It Matter?

MedicalResearch.com Interview with:

Craig Anderson | MD PhD FRACP Executive Director  Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney Neurologist, Neurology Department, Royal Prince Alfred Hospital The George Institute for Global Health at Peking University Health Science Center Haidian District | Beijing, 100088 P.R. China

Prof. Anderson

Craig Anderson | MD PhD FRACP
Executive Director
Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney
Neurologist, Neurology Department, Royal Prince Alfred Hospital
The George Institute for Global Health at Peking University Health Science Center
Haidian District | Beijing, 100088 P.R. China

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  There is much controversy over the benefits of a lower dose of intravenous alteplase, particularly in Asia, after the Japanese regulatory authorities approved a dose of 0.6 mg/kg 10 years ago compared to the US FDA and other regulatory authorities approving 0.9 mg/kg 20 years ago.  The investigator inititiated and conducted ENCHANTED trial aimed to determine the effectiveness and safety of these two doses in an international multicentre pragmatic open design.

The main results did not confirm the low-dose to be statistically ‘non-inferior’ partly due to the primary outcome measure chosen and partly due to the statistical approach, but it did confirm that the lower dose was safer with less risk of the major complication of this treatment, that of major bleeding in the brain.  However, it would appear that this safety effect was offset by some reduce efficacy in terms of functional recovery.

The aim of this secondary analysis of the trial data was to examine in more detail the differences between low and standard dose alteplase according to the participants’ age, ethnicity (Asian vs non-Asian) and severity of neurological deficit at the time of treatment.  We did this because the popular belief is that a lower dose might be preferred in older people, and Asians, because of the potential for more likelihood of bleeding, and preferentially to use the standard dose in those with more severe strokes potentially due to greater ‘clot burden’ from a blocked artery to the brain.

The results showed that the main findings on the outcome of surviving free of disability were the same according to age, ethnicity and stroke severity – that is, there was no preferential dose in any of these groups.  Similarly, the safety benefit of low dose alteplase on brain haemorrhage, did not clearly translate into clinical disability outcomes in any of the patient groups studied.

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Ischemic Stroke As Cancer Predecessor and Associated Predictors

MedicalResearch.com Interview with:

Jacobo Rogado

Dr. Rogado

Dr Jacobo Rogado
Medical oncology fellow
Hospital de La Princesa
Madrid, Spain

MedicalResearch.com: What is the background for this study?

Response: Some publications have suggested that there is an association between stroke and the subsequent diagnosis of cancer, although others have not confirmed this.

We have addressed this issue with a study conducted at our hospital during two years. We studied a population of about 1000 patients with stroke. We evaluated the incidence of cancer in this population during the follow-up of 18 months, as well as whether there were factors associated with its occurrence.

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Which Is Better? Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

MedicalResearch.com Interview with:

Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris 

Prof. Jean Louis MAS

Prof. Jean-Louis MAS
Université Paris Descartes
INSERM UMR S 894
Service de Neurologie et Unité Neurovasculaire
Hôpital Sainte-Anne
Paris 

MedicalResearch.com: What is the background for this study?

Response: Stroke is a major cause of death, disability and dementia affecting 17 million people each year worldwide. About 80% of strokes are ischemic strokes due to occlusion of a cerebral artery by a thrombus, itself the consequence of various arterial or heart diseases. In 30 to 40% of cases, no definite cause of ischemic stroke can be identified. Cryptogenic stroke is the term used to refer to these strokes of unknown etiology.

The patent foramen ovale (PFO) is a defect between the upper two heart chambers (called atria) though which a thrombus of venous origin may reach the systemic circulation and cause a stroke. This mechanism is called paradoxical embolism. Several case-control studies have shown an association between PFO and cryptogenic ischemic stroke, particularly in patients less than 60 years old, in those who have an atrial septal aneurysm (defined as an abnormal protrusion of the interatrial septum in the right or the left atrium or both) in addition to a PFO, and in those who have a PFO with a large right-to-left shunt. These findings suggested that a PFO might be responsible for stroke and that PFO closure with a device may decrease the risk of stroke recurrence. However, the causative relationship between PFO and stroke and the best strategy to prevent stroke recurrence have long been a hot topic of debate. Three previous randomized clinical trials failed to demonstrate any superiority of PFO closure over antithrombotic therapy.

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CDC Reports Progress In Reducing Strokes Has Stalled

MedicalResearch.com Interview with:

Quanhe Yang, PhD Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion CDC

Dr. Yang

Quanhe Yang, PhD
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ≥ 35 years by age, sex, race/ethnicity, state, and census region.

Declines in stroke death rates have slowed down in 3 out of every 4 states from 2000 to 2015, and the stroke death rates increased significantly in southern states and among Hispanics from 2013 to 2015.

An estimated 30,000 excess stroke deaths might have occurred because of the unfavorable changes in the rate of decline in stroke mortality during 2013–2015.

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ASTER Study Opens Door To New Tool To Remove Clot in Ischemic Stroke

MedicalResearch.com Interview with:
Bertrand LAPERGUE, MD, PhD
Hôpital Foch, University Versailles Saint Quentin en Yvelynes
Department of Stroke Center, Diagnostic and Interventional Neuroradiology
Suresnes, France.
Michel PIOTIN, MD
Department of Diagnostic and Interventional Neuroradiology
Fondation Rothschild, Paris, France.
on behalf of the ASTER Trial Investigators.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion (LVO).

Favorable outcome is strongly associated with the successful reperfusion status (TICI 2b/3= 71% with SR, Hermes Study group).
New techniques for MT such as ADAPT (A Direct first pass Aspiration Technique) seem promising to increase reperfusion status and clinical outcome in retrospective studies.

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Obesity Paradox: Overweight and Mildly Obese Stroke Patients Have Better Prognosis

MedicalResearch.com Interview with:

Hugo J. Aparicio, MD, MPH Assistant Professor Vascular Neurology, Department of Neurology Investigator, The Framingham Heart Study www.framinghamheartstudy.org Boston University School of Medicine Boston, MA 02118-2526

Dr. Aparicio

Hugo J. Aparicio, MD, MPH
Assistant Professor
Vascular Neurology, Department of Neurology
Investigator, The Framingham Heart Study
www.framinghamheartstudy.org
Boston University School of Medicine
Boston, MA 02118-2526

MedicalResearch.com: What is the background for this study?

Response: The association of body weight with survival after stroke has been studied before and is a controversial topic. Results have varied between studies and have often been contradictory. The observational findings that carrying extra weight can be protective after having a disease, like stroke or heart attack, has been called an obesity paradox, since obesity in itself is a risk factor for cardiovascular disease and mortality in the general population. Stroke research has focused on hospitalized stroke patients with weight measured at the time of the stroke. BMI is often missing in this group of patients, especially when a stroke is severe or the patients cannot report their weight. In the FHS we have data regarding weight prior to stroke, obtained during regularly scheduled research exams, with multiple data points on body weight and vascular risk factors over time. All before the stroke occurs. And have also compared survival outcomes with a group of control participants, those without stroke, to see if the so-called ‘obesity paradox’ is a non-specific finding seen in older adults or seen specifically in stroke patients.

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Does Head Positioning Matter In Acute Stroke?

MedicalResearch.com Interview with:

Craig Anderson | MD PhD FRACP Executive Director  Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney Neurologist, Neurology Department, Royal Prince Alfred Hospital The George Institute for Global Health at Peking University Health Science Center Haidian District | Beijing, 100088 P.R. China

Prof. Anderson

Craig Anderson | MD PhD FRACP
Executive Director
Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney
Neurologist, Neurology Department, Royal Prince Alfred Hospital
The George Institute for Global Health at Peking University Health Science Center
Haidian District | Beijing, 100088 P.R. China

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Preliminary small studies indicate that lying flat increases blood flow and oxygenation to the brain.  Thus, patients with acute ischemic stroke may benefit from lying flat in bed.  Conversely, sitting up in bed, with the head elevated to at least 30 degrees, may reduce swelling in the brain for patients who have large ischemic or hemorrhagic forms of stroke.  The optimal head position to produce the best outcome from acute stroke, and avoid potential risks, such as aspiration pneumonia, is unknown.  We undertook a large scale multicentre randomized controlled trial where 114 hospitals were randomised to sequentially apply lying flat or sitting up head positioning as a policy of care to a consecutive series of patients, that overall totalled over 11000 patients, presenting with acute stroke.  The study showed there was no difference in the chance of good physical recovery for patients between the two head positions but also that there were no excessive harms for either.

In other words, head positioning alone didn’t produce any benefits or harms in patients with acute stroke

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Intensive Blood Pressure Reduction and Spot Sign in Intracerebral Hemorrhage

MedicalResearch.com Interview with:
Andrea Morotti, M.D.
Research Fellow in Neurology
Massachusetts General Hospital
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The CT angiography (CTA) spot sign is a validated marker of Intracerebral Hemorrhage (ICH) expansion and may identify those subjects more likely to benefit from intensive blood pressure reduction.

We observed that less than 20% of ICH patients received a CTA as part of their diagnostic workup in a large, international randomized clinical trial. The performance of the spot sign in predicting ICH growth was suboptimal compared with what was reported in previous studies. Intensive blood pressure reduction did not improve functional outcome in spot sign positive patients.

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Increase In Risk Factors Contribute To More Strokes in Rural Areas

MedicalResearch.com Interview with:

George Howard, Dr.PH PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study Department of Biostatistics University of Alabama at Birmingham Birmingham, AL

Dr. Howard

George Howard, Dr.PH
PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Department of Biostatistics
University of Alabama at Birmingham
Birmingham, AL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Rural areas have been known to have a higher death rate than urban, and higher death from stroke in rural areas is a major contributor to this disparity.

The goal of the research was to assess if the higher deaths from stroke was because rural people are more likely to have a stroke, or more likely to die from a stroke once it occurs.   This distinction is critically important, since intervention to reduce stroke deaths in rural area would focus on stroke prevention if the former, but would focus on improving stroke care (after the stroke) if the latter.

We found that the higher mortality from stroke appears to be almost completely due to more people having stroke.   As such, we need to focus on efforts to reduce the risk of rural areas.   While there are well-documented differences in stroke care between urban and rural areas, resolving these differences will not be likely reduce the rural excess death from stroke.

It would seem that the higher risk of having a stroke could be due to the observation that those in rural areas are more likely to have major stroke risk factors, including hypertension, diabetes and cigarette smoking; however, the higher prevalence of these risk factors don’t seem to explain the higher risk.   So what causes the higher risk remains a mystery.

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Comparison of NOACs with Warfarin In Atrial Fibrillation Patients With Single Stroke Risk Factor

MedicalResearch.com Interview with:

Gregory Y. H. Lip, MD Professor of Cardiovascular Medicine University of Birmingham, UK; Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark National Institute for Health Research (NIHR) Senior Investigator. Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK Visiting Professor of Cardiology, University of Belgrade, Serbia; Visiting Professor, University of Leeds, UK Honorary Professor, Chinese PLA Medical School, Beijing, China; Honorary Professor, Nanjing Medical University, Nanjing, China; Visiting Professor, National Yang-Ming University, Taipei, Taiwan Institute of Cardiovascular Sciences City Hospital Birmingham England UK

Dr. Lip

Gregory Y. H. Lip, MD
Professor of Cardiovascular Medicine
University of Birmingham
Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark
National Institute for Health Research (NIHR) Senior Investigator.
Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK
Institute of Cardiovascular Sciences
City Hospital
Birmingham England UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The randomized clinical trials comparing non-Vitamin K antagonist oral anticoagulants (NOACs) vs warfarin largely focused on recruitment of high risk atrial fibrillation(AF) patients with >2 stroke risk factors, with only the trials testing dabigatran or apixaban including a minority of patients with 1 stroke risk factor.

Despite this, regulatory approvals of all NOACs have been for stroke prevention in AF patients with ≥1 stroke risk factors. No difference between NOACs compared to warfarin in risk of ischemic stroke/systemic embolism, was seen but for ‘any bleeding’, this was lower for apixaban and dabigatran compared to warfarin.

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Cirrhosis May Raise Risk of Hemorrhagic Stroke

MedicalResearch.com Interview with:
Neal S. Parikh, M.D.
Administrative Chief Resident
Department of Neurology
Weill Cornell Medicine & NewYork-Presbyterian Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In contrast to the gastrointestinal and systemic hemorrhagic and thrombotic complications of cirrhosis, little was known about the risk of cerebrovascular complications.

In this analysis of Medicare beneficiaries’ claims data, we found cirrhosis to be associated with stroke, with associations appearing to be stronger for hemorrhagic stroke than for ischemic stroke. We controlled for demographic variables and stroke risk factors and relevant comorbidities, and our results were essentially unchanged in multiple sensitivity analyses.

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Acupuncture Therapy and Incidence of Depression After Stroke

MedicalResearch.com Interview with:
Chung-Yen Lu, MD, PhD

Assistant Professor
Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan; Department of Chinese Medicine, Taipei Hospital, Ministry of Health and Welfare,
New Taipei, Taiwan 

MedicalResearch.com: What is the background for this study?

Response: Post-stroke depression is a common mood complication of patients with stroke and may deteriorate motor function and cognitive function. Acupuncture therapy is an alternative and supplementary medical care often used worldwide. Previous studies have reported that acupuncture therapy for post-stroke depression may involve multiple therapeuticeffects including treating neurological disorders and physical disabilities following stroke, which are predictors of post-stroke depression. However, population-based evaluations on the association between acupuncture treatment and prevention of post-stroke depression are rare.  Continue reading

Most Strokes In Women With Preeclampsia During Pregnancy Occur After Delivery

MedicalResearch.com Interview with:

Eliza Miller, M.D. Vascular neurology fellow New York-Presbyterian Hospital/Columbia University Medical Center New York City

Dr. Eliza Miller

Eliza Miller, M.D.
Vascular neurology fellow
New York-Presbyterian Hospital/Columbia University Medical Center
New York City 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Preeclampsia is a common disorder that causes high blood pressure during pregnancy. It affects about 1 in 20 pregnant women. Women with preeclampsia are at higher risk for stroke during pregnancy and post-partum, but it’s very difficult to predict who is going to have a stroke. Our study looked at a large dataset of billing data from New York State, and compared women who had preeclampsia and strokes to women who had preeclampsia but did not have a stroke.

We found that preeclamptic women with urinary tract infections, bleeding or clotting disorders, or preexisting high blood pressure were at higher risk of having strokes during pregnancy or postpartum.

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Efficient Protocol Allows Primary Stroke Centers To Ensure Access To Thrombectomies

MedicalResearch.com Interview with:

Ryan A. McTaggart M.D. Assistant Professor of Diagnostic Imaging, Neurology, and Neurosurgery @mobilestroke4U Warren Alpert School of Medicine at Brown University Rhode Island Hospital

Dr. Ryan  McTaggart

Ryan A. McTaggart M.D.
Assistant Professor of Diagnostic Imaging, Neurology, and Neurosurgery
@mobilestroke4U
Warren Alpert School of Medicine
Brown University
Rhode Island Hospital

MedicalResearch.com: What is the background for this study?

Response: Stroke is the #1 cause of disability and 5th leading cause of death. Mechanical thrombectomy (direct mechanical removal of the obstructing blood clot) is a dramatically effective treatment for the most devastating of all acute ischemic strokes – emergency large vessel occlusion (ELVO).

Access to this treatment can be optimized with the use of

1) mobile stroke unit technology,

2) changing our Emergency medical services triage algorithms so that stroke matches that of trauma (using field severity to transport the right patient, to the right hospital, the first time, whenever possible), and

3) improving in-hospital processes at Primary Stroke Centers (PSCs) so that patients with suspected ELVO who present to a PSC (a hospital that does not offer mechanical thrombectomy) do not get left behind and untreated.

This study reflects an effort to address and improve the third item.

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Carotid Artery Stenting vs Endarterectomy: Similar Efficacies, Different Safety Profiles

MedicalResearch.com Interview with:
Jay S. Giri, MD, MPH
Director, Peripheral Intervention
Assistant Professor of Clinical Medicine
Penn Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We analyzed data from 6,526 patients in the 5 most recent randomized trials comparing carotid artery stenting to carotid endarterectomy.  These procedures are performed to prevent long-term stroke in patients with severe narrowings of their carotid arteries.  We learned that the procedures are equally effective in preventing stroke over the long-term.  However, the procedures have quite different safety profiles, defined as adverse events that the patients experienced within 30 days of their procedure.

Carotid artery stenting was associated with a higher risk of stroke in the initial 30 days after the procedure.  Carotid endarterectomy was associated with greater risks of myocardial infarction (heart attack) and cranial nerve palsy, a variable condition that most often results in difficulty with swallowing or speaking, over this timeframe.

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Blood Pressure Variability May Trigger Stroke, Especially During Sleep

MedicalResearch.com Interview with:

Shyam Prabhakaran, MD, MS</strong> Department of Neurology Feinberg School of Medicine Northwestern University Chicago, IL

Dr. Prabhakaran

Shyam Prabhakaran, MD, MS
Department of Neurology
Feinberg School of Medicine
Northwestern University
Chicago, IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Wake-up stroke, or stroke onset during sleep, accounts for one-quarter of stroke presentations. Yet, there are few studies exploring mechanisms or triggers of onset during sleep. We explored whether blood pressure variability which is known to have circadian patterns could trigger wake-up stroke. We found that in the first 24 hours after stroke, those with wake-up stroke had greater blood pressure variability than non-wake up stroke patients.

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Fewer Heart Attacks and Strokes After Trans-Fat Restriction Laws in New York

MedicalResearch.com Interview with:

Eric J. Brandt, MD Yale University Cardiovascular Disease Fellow

Dr. Eric Brandt

Eric J. Brandt, MD
Yale University
Cardiovascular Disease Fellow

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: From previous studies we know that industrial trans fatty acid (trans fat) consumption is linked to elevated risk for cardiovascular disease. Even small amounts of consumption can be deleterious to cardiovascular health. In New York state, there were 11 counties that restricted the use of trans fatty acids in eateries. We compared hospitalization for heart attacks and stroke from 2002 through 2013 in counties that did and did not have restrictions.

Our study found that when comparing populations within New York state that restricted the use of trans fat, compared to those that did not, there was an associated additional decline beyond temporal trends for heart attacks and stroke events combined by 6.2%.

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Risk Factors and Stroke Rising Among Young Adults

MedicalResearch.com Interview with:

Mary G. George, MD, MSPH Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia

Dr. George

Mary G. George, MD, MSPH
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, Georgia

MedicalResearch.com: What is the background for this study?

Response: Stroke is the fifth leading cause of death in the United States, killing more than 130,000 Americans each year—that’s 1 of every 20 deaths—and costs the nation $33 billion annually, including the cost of health care services, medications, and lost productivity.

And, stroke is leading cause of serious disability. An ischemic stroke, sometimes called a brain attack, is a stroke that occurs when there is a blockage of the blood supply to the brain.

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Why Do So Many Stroke Survivors Give Up On Preventive Medications?

MedicalResearch.com Interview with:
Anna De Simoni

NIHR Academic Clinical Lecturer in Primary Care Research
Centre for Primary Care and Public Health
Barts and The London School of Medicine and Dentistry
London E1 2AB

MedicalResearch.com: What is the background for this study?

Response: Three in 10 stroke survivors will go on to have a further stroke, which causes greater disability or even death. Secondary prevention medications, including antihypertensives, blood thinning and lipid lowering agents, such as statins, can reduce risk of stroke recurrence by up to 75 per cent. However, patients’ persistence with these medications decreases over time because a minority of people experience side effects, which are mild in most cases.

The analysis, involving Queen Mary University of London and the University of Cambridge and published in the journal Family Practice, was performed on the archives from TalkStroke, a UK online forum hosted by the Stroke Association. The forum is used by patients with stroke and their carers, and generated 21,596 posts during 2004-2011. 50 participants were found to discuss GP advice on prevention medications in 43 discussion threads.

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Ischemic Stroke: Collateral Blood Vessels Detected by Arterial Spin Labeling MRI Correlates With Good Neurological Outcome

MedicalResearch.com Interview with:
Jalal B. Andre M.D., D.A.B.R.®

Drector of neurological MRI and
MRI safety officer at Harborview Medical Center
University of Washington 

MedicalResearch.com: What is the background for this study?

Response: Acute ischemic stroke (AIS) patients with good collaterals have better clinical outcomes. AIS is characterized by an ischemic penumbra, a region of salvageable brain tissue, that surrounds a core of irreversible ischemic infarct. The penumbra is tenuously perfused by collateral blood vessels which, if extensive enough, can maintain penumbral perfusion, improving the odds that a larger volume of brain tissue will survive. Standard, first-line methods for evaluating collaterals in the acute setting include CT angiography, MR angiography, and (less commonly) digital subtraction angiography. Arterial spin labeling (ASL) is an emerging MRI technique that assesses cerebral perfusion. Its advantages include relatively short scan time (4-6 minutes), lack of ionizing radiation, and independence from an exogenous contrast agent (contraindicated in patients with impaired renal function or documented sensitivity). Collaterals can be identified within ASL images as foci of curvilinear hyperintensity bordering regions of hypoperfusion. We sought to explore a novel relationship between the presence of ASL collaterals (ASLc) and neurological outcome in acute ischemic stroke patients.

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Cannabis Users Have Increased Risk of Stroke and Heart Failure

MedicalResearch.com Interview with:

Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center, Philadelphia

Dr. Aditi Kalla

Aditi Kalla, MD
Cardiology Research Fellow
Einstein Medical Center
Philadelphia

MedicalResearch.com: What is the background for this study?

Response: As of the recent 2016 election, decriminalization of cannabis passed in several states bringing the total count up to 28 states and D.C. where cannabis is now legal for medicinal and/or recreational purposes. From a physician’s perspective, it is rare that a drug has “hit the market” so to speak without undergoing clinical trials to determine safety and efficacy. Hence, we sought out to study if cannabis had any effects (positive or negative) on the cardiovascular system.

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Appropriate Anticoagulation Underutilized in Atrial fibrillation

MedicalResearch.com Interview with:
Dr. Ying Xian
 MD PhD
Department of Neurology,
Duke Clinical Research Institute
Duke University Medical Center
Durham, North Carolina

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is the most common arrhythmia. AF increases the risk for stroke and accounts for 10% to 15% of all ischemic strokes. While the burden of AF-related stroke is high, AF is a potentially treatable risk factor. Numerous studies have demonstrated that vitamin K antagonists, such as warfarin, or non-vitamin K antagonist oral anticoagulants (NOACs), reduce the risk of ischemic stroke. Based on these data, current guidelines recommend adjusted-dose warfarin or NOACs over aspirin for stroke prevention in high-risk patients with Atrial fibrillation.

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Natural History of Ruptured But Untreated Intracranial Aneurysms

MedicalResearch.com Interview with:
Dr. Miikka Korja
Chief Innovation Officer
Neurosurgeon
Associate Professor of Neurosurgery
HUS, Helsinki University Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Helsinki University Hospital, one of the largest hospital organizations in industrialized countries, has a very long history in conducting studies on brain aneurysms and aneurysmal subarachnoid hemorrhage. The one and only study on the natural history of ruptured aneurysms has also been conducted in Helsinki 50 years ago (published in 1967). The term “natural history” refers to an approach where the cause of a patient’s disease is not treated at all. In this case, it means that ruptured aneurysms in patients with devastating brain hemorrhage, aneurysmal subarachnoid hemorrhage, were left untreated.

Therefore, these patients have a high risk of a rebleeding from the once ruptured aneurysm. As ruptured aneurysms are nowadays unexceptionally treated, if the patient survives the primary bleeding event, such natural history studies are impractical to conduct.

We wanted to update the 50 years old data by using a historical patient registry. Back in the old days, many of aneurysmal subarachnoid hemorrhage patients were not treated because for example surgery was considered too risky or patients were classified as too old for surgery. By using the historical data, we showed that aneurysmal SAH, if not treated, is even more devastating disease than believed. Based on our results, we can state that 75-89% of today’s patients die in a year without treatments.

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Migraine Associated With Cervical Artery Dissection In Some Young Adults

MedicalResearch.com Interview with:
Alessandro Pezzini, MD, FESO

Professore Associato di Neurologia
Dipartimento di Scienze Cliniche e Sperimentali
Clinica Neurologica
Università degli Studi di Brescia
Italia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Scarce reports have suggested that a relation might exist between migraine and cervical artery dissection (CEAD), the most frequent cause of ischemic stroke in young adults in Western countries. However, data available so far were obtained from few studies conducted on small cohorts of patients, which limits the generalizability of their findings.

In our study we analysed the data from the Italian Project on Stroke in Young Adults (IPSYS) project, one of the largest registries of young ischemic stroke patients, and observed that migraine, especially the subtype without aura was strongly and independently associated to CEAD. This seems particularly true for men and for people younger than 39 years.

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Intensive Therapy Facilitates Language Recovery in Chronic Aphasia After Stroke

MedicalResearch.com Interview with:
Caterina Breitenstein, PhD
Department of General Neurology, University of Muenster, Germany
Annette Baumgärtner, PhD
Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Hamburg, Germany

MedicalResearch.com : What is the background for this study? What are the main findings?

Response: For a long time, it has been assumed that language recovery is limited to the first months after the initial stroke. During the past two decades, however, several clinical studies and systematic reviews have challenged this dogma by demonstrating functional gains in stroke survivors during the chronic post-stroke stage (at least 6 months post the initial stroke) whenever speech and language therapy (SLT) intensity was sufficiently high (i.e., at least 5 h/week for several weeks). These studies, however, lacked the methodological quality required for evidence-based interventions (for criteria, please refer to http://www.cebm.net/ocebm-levels-of-evidence). Until now, this lack in evidence severely hampers stroke survivors’ access to language rehabilitation services .

The present multicenter randomized controlled healthcare trial FCET2EC (acronym stands for “From Controlled Experimental Trial to=2 Everyday Communication) is the first study worldwide to compare three weeks of intensive SLT provided under routine clinical conditions to an equally long period of no (or low intensity) SLT. After 3 weeks of intensive individualized therapy, the 156 stroke survivors with chronic aphasia verbally expressed themselves more effectively in daily-life communicative situations, like changing a doctor’s appointment by a telephone call. Additionally, patients and their significant other rated their communication-related quality of life as significantly improved.

Last but not least, therapy effects remained stable over a follow-up period of six months after the intensive intervention.

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Vagus Nerve Stimulation Safe and Feasible For Stroke Rehabilitation

MedicalResearch.com Interview with:

Jesse Dawson MD, BSc (Hons), FRCP, FESO Clinical Reader / Honorary Consultant Clinical Lead Scottish Stroke Research Network / NRS Stroke Research Champion Chair MVLS Research Ethics Committee Institute of Cardiovascular and Medical Sciences College of Medical, Veterinary & Life Sciences University of Glasgow

Dr. Jesse Dawson

Jesse Dawson MD, BSc (Hons), FRCP, FESO
Clinical Reader / Honorary Consultant
Clinical Lead Scottish Stroke Research Network / NRS Stroke Research Champion
Chair MVLS Research Ethics Committee
Institute of Cardiovascular and Medical Sciences
College of Medical, Veterinary & Life Sciences
University of Glasgow

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:    Many patients suffer long term arm weakness after stroke and there are few effective treatments. We are assessing whether stimulation of the vagus nerve can improve recovery after stroke. Stimulation of the vagus nerve, called VNS for short, triggers the release of neurotransmitters in the brain. These neurotransmitters are important for learning and memory. Pre-clinical studies have shown that combining vagus nerve stimulation with movement or rehabilitation tasks enhances brain plasticity, improves motor learning and leads to better recovery after stroke.

Based on this, we performed a clinical trial in patients with arm weakness after stroke and found promising changes in the patients treated with VNS paired with rehabilitation compared to rehabilitation alone.

In this study we performed a double blind sham stimulation controlled study of VNS paired with rehabilitation vs sham stimulation in patients with long term arm weakness due to ischaemic stroke. All participants were implanted with a VNS device and underwent a course of therapy. We didn’t see a statistically significant difference after 6 weeks of intensive in-clinic therapy but saw a large and significant difference after a further 60 days home exercise treatment with VNS.  There were differences on several measures, including the clinical response rate which was 88% with VNS and 33% with controls.

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Pradaxa: Compared To Warfarin, Lower Risk of Stroke and Bleeding in Non-Valvular AFib

MedicalResearch.com Interview with:

Sabine Luik, M.D. Senior vice president, Medicine & Regulatory Affairs Boehringer Ingelheim Pharmaceuticals, Inc.

Dr. Sabine Luik

Sabine Luik, M.D.
Senior vice president, Medicine & Regulatory Affairs
Boehringer Ingelheim Pharmaceuticals, Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Data from more than 20,000 patients with non-valvular atrial fibrillation (NVAF) were included in this study and the results demonstrate that Pradaxa® (dabigatran etexilate mesylate) was associated with a lower risk of stroke and major bleeding compared to warfarin. The study analyzed 7,245 PRADAXA patients and 14,490 warfarin patients with NVAF who had no prior use of an oral anticoagulant (OAC), using data from an administrative claims database from October 1, 2010, to April 30, 2014.

Compared to warfarin, PRADAXA was associated with a 26 percent reduced risk of stroke (HR, 0.74; 95% Cl, 0.58-0.94) and a 20 percent reduced risk of major bleeding (HR, 0.80; 95% Cl, 0.69-0.92). PRADAXA was associated with a lower risk for serious secondary outcomes, including a 68 percent reduced risk of hemorrhagic stroke (HR, 0.32; 95% Cl, 0.14-0.76), an 18 percent reduced risk of major extracranial bleeding (HR, 0.82; 95% Cl, 0.70-0.96), a 48 percent reduced risk of venous thromboembolism (HR, 0.52; 95% Cl, 0.38-0.70), and a 27 percent reduced risk of death (HR, 0.73; 95% Cl, 0.61-0.88).

MedicalResearch.com: What should readers take away from your report?
Response: These results support the benefits of PRADAXA therapy for patients with NVAF and are consistent with those of previous studies evaluating PRADAXA and warfarin. Through a robust clinical trial, Pradaxa was proven superior to warfarin in reducing the risk of stroke in patients with NVAF.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Real-world data are critical for improving our understanding of treatment for patients with chronic conditions such as NVAF. We believe by working with diverse stakeholders to continue to study PRADAXA in the real world, we can help the community better understand gaps in treatment, identify opportunities to improve care and increase patient and physician assurance in treatment decisions.

MedicalResearch.com: Is there anything else you would like to add?

Response: Pradaxa has the longest real-world experience of any available NOAC. This research includes seven clinical trials with more than 32,000 patients and real-world experience through 11 studies and assessments, including more than 120,000 PRADAXA patients with NVAF.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

INTERNATIONAL STROKE CONFERENCE ORAL ABSTRACTSSESSION TITLE: PREVENTIVE STRATEGIES ORAL ABSTRACTS
Abstract 75: Bleeding and Ischemic Stroke Risk in Patients with Atrial Fibrillation Standard or Low Dose Dabigatran and Concomitant P-gp Inhibitors
Mary Vaughan Sarrazin, Alexander Mazur, Michael P Jones, Elizabeth Chrischilles
Stroke. 2017;48:A75

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Following Stroke, Children Face Behavioral and Emotional Difficulties

MedicalResearch.com Interview with:

Emily C. Maxwell, Ph.D. Pediatric Neuropsychology Bugher Fellow Division of Neurology Instructor | Department of Pediatrics University of Colorado School of Medicine Aurora, CO 80045

Dr. Maxwell

Emily C. Maxwell, Ph.D.
Pediatric Neuropsychology Bugher Fellow
Division of Neurology
Instructor | Department of Pediatrics
University of Colorado School of Medicine
Aurora, CO 80045 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has found increased psychological problems and significantly higher rates of psychiatric disorders after pediatric stroke. However, past studies have mainly used global indices, without comparison to age-based norms. Thus, little is known about the discrete symptomatology exhibited by these children and how discrepant these symptoms may be from normative expectations.

At the University of Colorado Denver and Children’s Hospital Colorado, we studied 50 patients who suffered an arterial ischemic stroke during childhood. The parents of these patients completed the Child Behavior Checklist, a questionnaire assessing emotional and behavioral problems. We found that children with stroke had higher symptoms of depression, anxiety, physical complaints, and behavioral difficulties compared to a normative sample of same-aged peers. Additionally, levels of anxiety were higher in children who had a stroke at an early age (before 6 years of age) compared to children who had a stroke at a later age (after 10 years of age).

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Stroke Prevention: No Advantage To Taking Three Blood Thinners After First Stroke

MedicalResearch.com Interview with:

Professor Philip Bath Stroke Association Professor of Stroke Medicine/Head of Division of Clinical Neuroscience Faculty of Medicine & Health Sciences University of Nottingham

Prof. Philip Bath

Professor Philip Bath
Stroke Association Professor of Stroke Medicine/Head of Division of Clinical Neuroscience
Faculty of Medicine & Health Sciences
University of Nottingham 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Blood thinning (antiplatelets) drugs reduce further strokes (recurrence) after stroke and mini-stroke (TIA). One antiplatelet, such as aspirin, is better than none, and two different drugs are better than one. The question then is whether three would be better still, providing excess bleeding is not problematic.

3096 patients with ischaemic stroke (stroke due to a blood clot) or mini-stroke were enrolled within 48 hours. They were randomised to take intensive separate antiplatelet therapy (three drugs comprising aspirin, clopidogrel and dipyridamole) or guideline therapy (either clopidogrel alone, or combined aspirin and dipyridamole) for 30 days (after which they took guideline treatment). At 90 days we assessed whether patients had had another stroke or mini-stroke, and how dependent or disabled this had left them.

There were slightly fewer recurrent strokes and mini-strokes between intensive and guideline treatment but the difference was not different statistically, so a neutral trial. In contrast, major bleeding was significantly increased in the intensive group as compared with guideline treatment. When looking at the net benefit/harm, there was no difference between the treatment groups.

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Rank, Not Race, Associated with Stroke Outcomes in Military

MedicalResearch.com Interview with:

Matthew D. Holtkamp, D.O. CPT, MC, USA Medical Director, Intrepid Spirit, Traumatic Brain Injury Clinic Staff Neurologist, Department of Medicine Teaching Fellow, Uniformed Services University Carl R. Darnall Army Medical Center Fort Hood, Texas 76544

Dr. Mathew Holtkamp,

Matthew D. Holtkamp, D.O. CPT, MC, USA
Medical Director, Intrepid Spirit, Traumatic Brain Injury Clinic
Staff Neurologist, Department of Medicine
Teaching Fellow, Uniformed Services University
Carl R. Darnall Army Medical Center
Fort Hood, Texas 76544

MedicalResearch.com: What is the background for this study?

Response: Racial and Socioeconomic disparities in the outcomes of stroke patients is well documented in the US Civilian Healthcare system.

That Healthcare system has wide variations in access to care and in the levels of available care. In contrast, the Military Healthcare system is a single payer system meaning that every member has the same healthcare benefits.

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Stopping Warfarin in Dementia Patients with Atrial Fib Associated With Increased Risk of Stroke and Death

MedicalResearch.com Interview with:

Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Instructor in Medicine, Harvard Medical School

Dr. Ariela Orkaby

Ariela Orkaby, MD, MPH
Geriatrics & Preventive Cardiology
Associate Epidemiologist
Division of Aging, Brigham and Women’s Hospital
Instructor in Medicine, Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial Fibrillation is a common heart rhythm that affects 1 in 25 adults over age 60 and 1 in 10 adults over age 80. The feared consequence of atrial fibrillation is stroke, leading to the prescription of blood thinning medications (anticoagulants such as warfarin) to prevent strokes. However, there is an underutilization of these life-saving medications in older adults, and particularly in those who have dementia. In part, this is due to a lack of research and inclusion of older adults with dementia in prior studies.

In this study, we used clinical Veterans Administration data, linked to Medicare, to follow 2,572 individuals over age 65 who had atrial fibrillation and until a diagnosis of dementia. The average age was 80 years, and 99% were male. We found that only 16% remained on warfarin. We used statistical methods to account for reasons why a patient would or would not be treated with warfarin and found that those who continued to take warfarin had a significantly lower risk of stroke (HR 0.74, 95% Confidence interval 0.54- 0.99, p=0.47) and death (HR 0.72, 95% CI 0.60-0.87, p<0.01) compared to those who did not continue to take warfarin, without an increased risk of bleeding.

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Which AFib Patients Should Resume Warfarin After Intracranial Hemorrhage?

MedicalResearch.com Interview with:
Peter Brønnum Nielsen MD PhD
Aalborg Thrombosis Research Unit
Department of Clinical Medicine
Faculty of Health
Department of Cardiology, Atrial Fibrillation Study Group
Aalborg University Hospital
Aalborg, Denmark
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.

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Food Insecurity Common Among Inner City Stroke Patients

MedicalResearch.com Interview with:

Dr. Lakshmi Warrior MD Assistance Professor, Neurology Cook County Health & Hospitals System Chicago

Dr. Lakshmi Warrior

Dr. Lakshmi Warrior MD
Assistance Professor, Neurology
Cook County Health & Hospitals System
Chicago

MedicalResearch.com: What is the background for this study?

Response: In 2015, 42.2 million Americans lived in food insecure households. Food insecurity is defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”. Previous work has demonstrated associations between food insecurity and chronic diseases such as hypertension, diabetes, hyperlipidemia.

Cook County Health and Hospitals System serves a population of largely uninsured and underinsured patients. This pilot study sought determine the prevalence of food insecurity in our population of patients who were recently discharged home from the hospital with the diagnosis of stroke.

MedicalResearch.com: What are the main findings?

Response: We found that food insecurity is a prevalent problem in our patient population with more than 1 in 5 identifying as food insecure. It also appears that food insecure stroke patients had a higher prevalence of diabetes (54% vs 28%)and hypertension (86% vs. 67%) as compared to food secure patients.

MedicalResearch.com: What should readers take away from your report?

Response: Food insecurity is a prevalent issue in our patient population. There should be consideration for food insecurity screening in high-risk populations as food insecurity can complicate the management of diet-related diseases such as hypertension and diabetes. For patients with food insecurity, a multi-disciplinary approach using case and social workers in addition to medical management should be considered.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further study of this topic is needed. A larger, retrospective review of our stroke patients is currently underway. We are also planning for a prospective study of our inpatient stroke patients to evaluate if these patients are at higher risk for not only vascular risk factors but also re-hospitalization and poor outcomes.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation: Abstract presented at the  AHA/ASA International Stroke Conference February 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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ASTER Trial Supports Aspiration Of Clots in Acute Ischemis Stroke

MedicalResearch.com Interview with:

Michel Piotin, MD PhD Principal investigator and interventional neuroradiologis Rothschild Fondation Hospital Paris

Dr. Michel Piotin

Michel Piotin, MD PhD
Principal investigator and Interventional Neuroradiologist
Rothschild Fondation Hospital, Paris 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion

Thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. Favorable outcome is strongly associated with the successful reperfusion status. New techniques for MT such as ADAPT (A Direct first pass Aspiration Technique) is promising to increase reperfusion status and clinical outcome in retrospective studies. Our study objective was to determine which technique should be used in frontline strategy (ADAPT or Stent Retriever) to achieve maximum reperfusion. The ASTER study is the first independent large randomized controlled trial focusing on ADAPT technique with blinded assessment data.

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Medtronic Pipeline Embolization Device Found Safe For Smaller Aneurysms

MedicalResearch.com Interview with:

Ricardo A Hanel, MD PhD Endovascular and Skull Base Neurosurgery Director, Baptist Neurological Institute Endowed Chair, Stroke and Cerebrovascular Surgery Jacksonville, FL

Dr. Hanel

Ricardo A Hanel, MD PhD
Endovascular and Skull Base Neurosurgery
Director, Baptist Neurological Institute
Endowed Chair, Stroke and Cerebrovascular Surgery
Jacksonville, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medtronic Pipeline Embolization Device has been approved for carotid artery aneurysms over 10mm in size, from the petrous to clinoid segment but given the efficacy of results on these larger lesions, it has been widely utilized for treatment of smaller lesions. PREMIER came from the need of assessing the results , safety and efficacy, of pipeline for use of aneurysms under 12mm, located on the carotid artery, all segments, and V3 segment of the vertebral artery.
PREMIER enrolled 141 patients treated at 22 centers (21 US, 1 Canada). Primary Safety effectiveness defined as total aneurysm occlusion, core lab adjudicated , at 1 year was 83.5%; with safety endpoint of major stroke/death at 30 days of 1.4% (2 patients), with 1-year major stroke and death rate of 2.1%.

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Cerebral Microinfarcts Associated With Cardiac Biomarkers and Heart Disease

 

Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands

 

 

MedicalResearch.com Interview with:
Christopher Chen, FRCP

Department of Pharmacology
Yong Loo Lin School of Medicine
Memory Aging and Cognition Center
National University Health System
Singapore
Saima Hilal, PhD
Department of Pharmacology, National University of Singapore
Department of Radiology, Epidemiology and Nuclear Medicine
Erasmus Medical Center, Rotterdam, the Netherlands

MedicalResearch.com: What is the background for this study?

Response: Cerebral microinfarcts (CMIs) are defined as small (usually <1 mm) regions of ischemic change found in the brain which are not readily visible on gross examination or on standard 1.5-T magnetic resonance imaging (MRI). On microscopy they appear as foci of neuronal loss, gliosis, pallor, or cysts.

Previous post mortem studies have shown that the presence of CMIs is relatively common in elderly individuals without dementia (24%) but more common in patients diagnosed with Alzheimer disease (43%) or vascular dementia (62%).

Whilst a single CMI is likely to be “silent” as the region of brain affected is probably too small to produce symptoms or neurologic deficits, however, as a large number of CMIs exist in many individuals, especially in the cerebral cortex and watershed areas, the overall effect has clinical importance – as shown by neuropathologic studies which demonstrate an important role of CMIs in cognitive dysfunction and dementia. However in vivo studies have been hampered by the inability to detect CMIs reliably on neuroimaging, leading to CMIs being termed “invisible” during life.

The advent of high spatial-definition 7-T MRI enabled the identification of cortical  Cerebral microinfarcts in-vivo and importantly a study that directly compared 7-T and 3-T MRIs in the same patients reported that 3-T MRI detected about 1/3 of the lesions found on 7-T MRIs, suggesting that 3-T MRIs, which are more accessible than 7-T, may be able to detect larger cortical CMIs with a lower limit of approximately 1 mm in diameter.

Our group has made major contributions recently on the clinical associations of 3T MRI detected cortical CMIs in patients from memory clinics as well as in community based subjects. Associations were found with age, vascular risk factors, other MRI markers of cerebrovascular disease as well as cognition. However, the causes of CMIs remain unclear and may be heterogeneous with microembolism, microthrombosis, and foci of inflammation as possible causative factors.

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Migraine Increases Risk of Perioperative Stroke and Hospital Readmission

MedicalResearch.com Interview with:

Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Clinical Director, Critical Care Division

Dr. Matthias Eikermann

Dr. Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia
Harvard Medical School
Clinical Director, Critical Care Division 

MedicalResearch.com: What is the background for this study?

Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura.

Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year.

We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.

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tPA Plus Mechanical Thrombectomy in Acute Ischemic Stroke?

MedicalResearch.com Interview with:

Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto

Dr. Vitor Mendes Pereira

Vitor Mendes Pereira MD MSc
Division of Neuroradiology – Joint Department of Medical Imaging
Division of Neurosurgery – Department of Surgery
Toronto Western Hospital – University Health Network
Associate Professor of Radiology and Surgery
University of Toronto 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?

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Marital History Linked to Survival After Stroke

MedicalResearch.com Interview with:

Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University

Dr. Mathew Dupre

Matthew E. Dupre, Ph.D.
Associate Professor
Department of Community and Family Medicine &
Duke Clinical Research Institute (DCRI)
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke.

We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses.

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Strong SSRIs Linked To Increase Risk of Intracranial Hemorrhage

MedicalResearch.com Interview with:
Christel Renoux, MD, PhD
Assistant Professor, Dept. of Neurology & Neurosurgery
McGill University
Centre For Clinical Epidemiology
Jewish General Hospital – Lady Davis Research Institute
Montreal  Canada

MedicalResearch.com: What is the background for this study?

Response: Selective serotonin reuptake inhibitors (SSRIs) increase the risk for abnormal bleeding, in particular, gastrointestinal tract bleeding. Previous studies also suggested an increased risk for intracranial hemorrhage (ICH) in patients treated with SSRIs compared to non users. However, even if this risk exists, the comparison with a non-treated group may exaggerate the strength of a potential association and the comparison with a group of patients treated with other antidepressants may help better delineate the risk. The potential bleeding effect of antidepressants is linked to the strength of serotonin inhibition reuptake, and antidepressants that are strong inhibitors of serotonin reuptake have been associated with the risk for gastrointestinal or abnormal bleeding compared with weak inhibitors but the risk of ICH is unclear.

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Association Between Statin Use and Ischemic Stroke or Hemorrhage in Patients Taking Dabigatran for A Fib

MedicalResearch.com Interview with:

Dr-Tony-Antoniou.jpg

Dr. Tony Antoniou

Dr. Tony Antoniou, PhD Research Scholar
Department of Family and Community Medicine and a Scientist
Keenan Research Centre of the Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Assistant Professor in the Department of Family and Community Medicine and
Leslie Dan Faculty of Pharmacy
University of Toronto, Toronto, Ontario

MedicalResearch.com: What is the background for this study?
What are the main findings?

Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate.

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Gender-Specific Risk Factors for Stroke Outlined

MedicalResearch.com Interview with:

Catharina J. M. Klijn, MD Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery University Medical Center Utrecht, Utrecht Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience Department of Neurology Radboud University Nijmegen Medical Centre Nijmegen, the Netherlands

Dr. Catharina J. M. Klijn

Catharina J. M. Klijn, MD
Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery
University Medical Center Utrecht, Utrecht
Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience
Department of Neurology
Radboud University Nijmegen Medical Centre
Nijmegen, the Netherlands

MedicalResearch.com: What is the background for this study?

Response: The incidence of stroke is higher in men than in women. This difference attenuates with increasing age. Established risk factors for stroke, such as hypertension, cigarette smoking and ischemic heart disease are more prevalent in men but only partly explain the difference in stroke incidence. The contribution of oral contraceptive use and hormone therapy to stroke risk has been previously reviewed. We aimed to evaluate what is known on other female- and male specific risk factors for ischemic and hemorrhagic stroke incidence and stroke mortality through a systematic review and meta-analysis of 78 studies including over 10 million participants.

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Risk of Pregnancy-Associated Stroke Across Age Groups

MedicalResearch.com Interview with:
Eliza Miller, M.D
.
Vascular Neurology Fellow
New York-Presbyterian Hospital/Columbia University Medical Center
We collaborated with researchers at the Massachusetts General Hospital and with the New York State Department of Health.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prior research has found that older women of childbearing age are at higher risk of stroke during pregnancy and postpartum than younger women. We hypothesized that their increased stroke risk might not be due to pregnancy-related factors, but just due to the fact that stroke risk increases with age for all people. We used billing data from New York State hospitals to calculate incidence risk ratios for four age groups: 12-24, 25-34, 35-44 and 45-55. In each age group, we compared the incidence of stroke in women who were pregnant or postpartum to the incidence of stroke in women of the same age who were not pregnant.

As in prior studies, we found that the incidence of pregnancy-associated stroke was higher in older women compared to younger women (about 47/100,000 deliveries in the oldest group, versus 14/100,000 deliveries in the youngest group). However, the incidence ratios showed that pregnancy increased stroke risk significantly in women under 35, but did not appear to increase stroke risk in women over 35. In the youngest group (age 12-24), pregnancy more than doubled the risk of stroke, and in the 25-34 age group, pregnancy increased stroke risk by 60%. In women aged 35 and older, pregnancy did not increase stroke risk. Women who had pregnancy-related strokes tended to have fewer traditional vascular risk factors like hypertension and diabetes, compared to same-aged women with non-pregnancy related strokes.

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Digital Mobile Technology Gives Some Arm Function To Stroke Patients

MedicalResearch.com Interview with:

Dr Paul Bentley MA MRCP PhD Clinical Senior Lecturer in Clinical Neuroscience Honorary Consultant Neurologist Neurology Dept Imperial College NHS Healthcare Trust Charing Cross Hospital London

Dr Paul Bentley

Dr Paul Bentley MA MRCP PhD
Clinical Senior Lecturer in Clinical Neuroscience
Honorary Consultant Neurologist
Neurology Dept
Imperial College NHS Healthcare Trust
Charing Cross Hospital
London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: gripAble was designed to help people with arm disability practise physiotherapy when a physiotherapist is not available, or in between physiotherapy sessions. We know that the amount of physiotherapy provision in the UK, after stroke or arm injury, is typically below that which is recommended by professional bodies. Furthermore, increasing research suggests that higher-intensity training can boost functional outcomes. The innovation was designed to help people with a range of disabilities including severe paralysis engage with computer games with their weak arm. At the same time its designed to be portable for use at home or in bed, and low-cost.

gripAble also enables remote measurement and monitoring of arm function, by setting users a series of calibrated tasks played out on the tablet screen. This way doctors and physiotherapists can assess the needs of a patient, and gain an idea of how well a patient is responding to home physiotherapy.

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Ischemic Stroke Treatment Must Be Given Early To Be Effective

MedicalResearch.com Interview with:

Dr. Michael Hill, MSc, MD, FRCPC Professor for the Departments of Clinical Neurosciences, Community Health Sciences, Medicine and Radiology University of Calgary Director of the Stroke Unit Calgary Stroke Program Alberta Health Services

Dr. Michael Hill

Dr. Michael Hill, MSc, MD, FRCPC
Professor for the Departments of Clinical Neurosciences, Community Health Sciences, Medicine and Radiology University of Calgary
Director of the Stroke Unit
Calgary Stroke Program
Alberta Health Services

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The HERMES collaboration is a pooled individual patient meta-analysis of recent endovascular ischemic stroke trials. The current analysis assesses the role of time to treatment and outcome.

We show that there is a clear relationship between time from onset-to-treatment and outcome, with treatment gradually becoming less effective as time elapses from stroke onset. Treatment was still effect, on average, out to just beyond 7 hours from stroke onset.

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The Capillary Index Score as a Marker of Viable Cerebral Tissue in Stroke

MedicalResearch.com Interview with:

Firas Al-Ali, MD Departments of Neuro Interventional Surgery Cleveland Clinic Akron General, Akron, OH

Dr. Firas Al-Ali

Firas Al-Ali, MD
Departments of Neuro-Interventional Surgery
Cleveland Clinic Akron General, Akron, OH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Capillary Index Score (CIS) is based on the simple following assumption: “ the presence of capillary blush on diagnostic cerebral angiography, in an ischemic area, is an indicator of ischemic BUT viable cerebral tissue, while its absence indicate NONE- no viable tissue”

In previous publication we demonstrated that the CIS is a strong predictor of clinical outcome (CO) in patients presented acute ischemic stroke (AIS) . In previous studies AIS patients presented with Poor CIS (pCIS) did not have a good clinical outcome despite timely and full recanalization, while when patients presented with favorable CIS (fCIS) had 80-90% good clinical outcome when achieved good recanalization.

In this latest paper we tried to test our original assumption mentioned above. i.e. If the absence of capillary blush in a certain vascular cerebral territory signify no viable cerebral tissue then when an area on diagnostic cerebral cerebral angiogram (DCA) lack capillary blush BEFORE endovascular treatment, it will progress to infarcted tissue despite timely and full recanalization, seen as an area of hypodensity on the POST treatment Cat-Scan (CT).

While an area with Capillary blush in an ischemic area seen on the pre treatment DCA, will not show infarction on POST treatment CT if we obtain successful and timely recanalization.

In this paper we matched areas on the Pre and post -treatment CT to its corresponding location on the Pre-treatment DCA, and we demonstrated that when an area lacked capillary blush on the pre-treatment DCA had a very high chance to progress from normal on the Pre-treatment CT to hypodensity on the post treatment CT (infarcted cerebral tissue). while the areas with capillary blush on the rep treatment CT stayed normal on the post treatment CT when we achieve timely recanalization of the occluded vessel.

MedicalResearch.com: What should readers take away from your report?

Response: The Capillary Index Score is a powerful tool to assess residual viable tissue in a ischemic area, and has a great prognostic value for clinical outcome.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We are now enrolling patient in a multi-center prospective trial, the Capillary Index Score Trial, phase I, to prove the value of CIS prospectively, and to demonstrate that:
1- CIS is a powerful indicator of clinical outcome
2- Treatment patients with pCIS could harmful by demonstrating that most complications happen in the pCIS group.

In The CIS Trial, phase II, we will try to demonstrate that treating patients with pCIS is futile by randomizing them into two groups:
One offered endovascular treatment plus usual medical management and the second group offered only usual medical management.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

The Capillary Index Score as a Marker of Viable Cerebral Tissue
Proof of Concept—The Capillary Index Score in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Trial
Firas Al-Ali, Olvert A. Berkhemer, Wina P. Yousman, John J. Elias, Evin N. Bender, Hester F. Lingsma, Aad van der Lugt, Diederik W.J. Dippel,Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, William P. Dillon and Charles B.L.M. Majoie
Stroke: http://dx.doi.org/10.1161/STROKEAHA.116.013513
Published: September 1, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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