Author Interviews, Heart Disease, Nutrition, Stroke / 16.07.2018

MedicalResearch.com Interview with: “Milk” by Mike Mozart is licensed under CC BY 2.0Marcia C. de Oliveira Otto, PhD, FAHA Assistant Professor Division of Epidemiology, Human Genetics and Environmental Sciences University of Texas Houston, TX 77030-3900 | MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research adds to a growing body of evidence showing no harm in relation to heart disease or overall mortality associated with consumption of whole-fat dairy foods. The findings also indicate that one of three fatty acids present in dairy fat was linked to lower risk of stroke among older adults. To the best of our knowledge, ours was the first large study to use repeated measures of fatty acids over time and evaluate association with mortality in older adults, which allowed us to expand and contribute to this important debate regarding fat intake and health. (more…)
Author Interviews, Emergency Care, Neurology, Stroke / 13.07.2018

MedicalResearch.com Interview with: Perttu JLindsberg, MD, PhD Professor of Neurology Clinical Neurosciences and Molecular Neurology Research Programs Unit, Biomedicum Helsinki University of Helsinki Helsinki, Finland MedicalResearch.com: What is the background for this study? Response: The past 20 years in shaping the Helsinki model in stroke thrombolysis have proven that we can be very fast in examining the patient, completing the imaging and starting thrombolytic therapy. This is a university hospital center that receives roughly three stroke suspects per day for evaluation of recanalization therapies. Already seven years ago we were able to push the median ’door-to-needle’ time permanently below 20 minutes. What we had not been monitoring was how well we had kept up the accuracy of our emergengy department (ED) diagnostic process. Prehospital emergency medical services (EMS) have been trained to focus on suspecting thrombolysis-eligible stroke and we usually get also pre-notifications of arriving stroke code patients during transportation, but the diagnosis on admission is an independent clinical judgment as the CT findings are largely nondiagnostic for acute changes. The admission evaluation of suspected acute stroke is therefore a decisive neurologic checkpoint, building the success of acute treatments such as recanalization therapy, but is complicated by differential diagnosis between true manifestations of stroke and numerous mimicking conditions. Although we have invested a lot on training and standardized ED procedures, time pressure and therapy-geared expectations may blur the diagnostic process. With this background, we embarked on an in-depth-analysis of the admission and final diagnoses of stroke code patients, as well as misdiagnoses, immediate treatment decisions and their consequences. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Stroke / 10.06.2018

MedicalResearch.com Interview with: Dr. Alain Lekoubou Looti, MD Msc Clinical Neurophysiology Department of Neurosciences College of Medicine Medical University of South Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypertension is strongly associated with stroke. Individuals who suffer a stroke are more likely to have another stroke. They also die at a rate twice as high as those who experience a first event. We have evidence that treating hypertension reduces the risk of recurrence stroke among stroke survivors. Prior hypertension guidelines defined hypertension for a systolic blood pressure (top number) equal or greater than 140 and a diastolic blood pressure (lower number) equal or greater than 90. The American college of cardiology/American heart association have published a new guideline to help healthcare providers identify and treat blood pressure including among stroke survivors. The threshold to define blood pressure has been lowered to 130 for the top number and 80 for the lower number for everyone. Unlike the general population, pharmacological treatment for stroke survivors is now recommended for systolic blood pressure greater than or equal than 130 and diastolic blood pressure greater than or equal to 80. In the same line achieving a blood pressure of less than 130/80 mmHg in stroke survivors is now recommended. In the stroke community, there has been mounting evidence to suggest that achieving lower blood pressure goal was desirable. When the new guidelines were published, we could not wait any longer to see the impact of the new guidelines on the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target. We were also curious to see how the new guidelines would potentially affect mortality among stroke survivors.  We have found that the new guidelines would result in a nearly 67% (from 29.9% to 49.8%) to relative increase in the proportion of U.S. stroke survivors diagnosed with hypertension and 54% (from 36.3% to 56%) relative increase in those not within the recommended BP target.  We have also found that if the new guidelines were applied, this would result in a 33% relative drop in mortality.  (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 19.05.2018

MedicalResearch.com Interview with: Anna Gundlund, MD, PhD Herlev-Gentofte Hospital, Department of Cardiology Denmark  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial fibrillation increases a person’s risk of ischemic strokes up to 5-fold. Oral anticoagulation therapy lowers this risk effectively (>60%) and is therefore recommended for patients with atrial fibrillation and at least 1-2 other risk factors for stroke. Our study show, that oral anticoagulation therapy is still underused in patients with atrial fibrillation – even after a stroke event. In stroke survivors with atrial fibrillation, oral anticoagulation therapy were associated with better outcomes than no oral anticoagulation therapy.  (more…)
Author Interviews, NEJM, Stroke, University Texas / 16.05.2018

MedicalResearch.com Interview with: Dr. S. Claiborne "Clay" Johnston MD, PhD Dean Vice President for Medical Affairs Frank and Charmaine Denius Distinguished Dean’s Chair Dell Medical School The University of Texas at Austin MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior studies have shown that the risk of a stroke or other ischemic events is high in the days to weeks after a TIA or minor stroke. We sought to test whether blocking platelet aggregation more effectively with clopidogrel plus aspirin could reduce this risk compared to aspirin alone.  We found that the combination did reduce risk of major ischemic events.  It also showed a small increase in risk of major hemorrhage, but for most people the benefits would outweigh the potential risk. (more…)
Author Interviews, NEJM, Stroke / 30.04.2018

MedicalResearch.com Interview with: A/Prof Bruce Campbell MBBS(Hons), BMedSc, PhD, FRACP Consultant Neurologist, Head of Stroke Department of Neurology, Royal Melbourne Hospital Principal Research Fellow,Melbourne Brain Centre @ RMH Department of Medicine University of Melbourne Australia  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Patients with stroke due to a large blood vessel in the brain receive a clot-dissolving medication followed by clot retrieval surgery performed via an angiogram. The standard clot dissolving medication "alteplase" rarely opens the artery prior to clot retrieval surgery. Tenecteplase is genetically modified form of alteplase that may be more effective and is widely available (it is the standard clot dissolving medication used for heart attacks). It can be given over 10 seconds instead of the 1 hour required to infuse alteplase, meaning that patients can be transferred between hospitals to receive treatment more easily. Tenecteplase is also less expensive than alteplase. In EXTEND-IA TNK we found that tenecteplase doubles the number of patients who have blood flow restored to the brain earlier than is possible with clot retrieval surgery (22% vs 10%) and improves patient outcomes compared to the current standard medication called alteplase. 1 in 5 tenecteplase treated patients have blood flow rapidly restored and do not require clot retrieval surgery compared to 1 in 10 with alteplase. (more…)
Author Interviews, Emory, Hematology, JAMA, Neurological Disorders, Stroke / 23.04.2018

MedicalResearch.com Interview with : Dr. Hyacinth I Hyacinth MD Aflac Cancer and Blood Disorder Center, Emory Children’s Center, Department of Pediatrics, Emory University School of Medicine Atlanta, GA 30322 MedicalResearch.com: What is the background for this study? This study was conducted against the backdrop of a significantly higher risk for stroke among African Americans compared to non-Hispanic Whites, despite adjusting for traditional risk factors. Also, sickle cell disease is a well-known genetic risk factor for stroke and recent studies show that sickle cell trait is a risk factor for chronic kidney disease, venous thromboembolism and pulmonary embolism, all of which are potential risk factors for stroke. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, JAMA, Stroke / 16.04.2018

MedicalResearch.com Interview with: Dr. Joshua Goldstein MD, PhD J. Philip Kistler Stroke Research Center Division of Neurocritical Care and Emergency Neurology, Department of Neurology MGH Harvard Medical School, Boston Department of Emergency Medicine Massachusetts General Hospital for the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) and the Neurological Emergencies Treatment Trials (NETT) Network Investigators   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: It’s hard to know how aggressively to lower blood pressure in acute intracerebral hemorrhage (ICH).  Randomized controlled trials have been conflicting. We thought that we could use the presence of severe small vessel disease (SVD) - manifested by microbleeds seen on brain magnetic resonance imaging (MRI) – to guide treatment decisions.  On the one hand, those with severe SVD may be most vulnerable to continued bleeding, and specifically need more intensive blood pressure lowering.  On the other hand, if they have impaired regulation of cerebral blood flow, they might be harmed by rapid drops in blood pressure, and maybe we have to be more careful with them. To answer this, we performed a subgroup analysis of the multi-centre ATACH-2 clinical trial of intensive blood pressure lowering. This was the first study to assess the effect of randomized acute stroke treatment on patients with more severe SVD, manifested by microbleeds.  We found that no matter what your small vessel disease burden on MRI, you’ll respond the same to early blood pressure management. (more…)
Author Interviews, BMJ, Heart Disease, Pain Research, Stroke / 04.04.2018

MedicalResearch.com Interview with: Islam Elgendy MD Division of Cardiovascular Medicine University of Florida   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events. This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.  (more…)
AHA Journals, Author Interviews, Stroke, Surgical Research / 29.03.2018

MedicalResearch.com Interview with: J.H.L. Mulder, MD PhD Neurology resident Erasmus MC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current information about safety and efficacy of endovascular treatment (EVT) for acute ischemic stroke is primarily derived from patients treated in the setting of a randomized controlled trial. However, inherent to this setting, external validity of the results can be jeopardized by patient selection and intensive monitoring. Therefore, an important question remained unanswered: could the positive effect of endovascular treatment be reproduced in standard clinical practice?  (more…)
Author Interviews, Ophthalmology, Stem Cells, Stroke / 28.03.2018

MedicalResearch.com Interview with: Steven Levy MD CEO, MD Stem Cells Study Director, Stem Cell Treatment Studies MedicalResearch.com: What is the background for this study? Response: MD Stem Cells is the sponsor of the Stem Cell Ophthalmology Treatment Study II (SCOTS 2) the largest stem cell study currently addressing retinal and optic nerve disease (NCT 03011541). SCOTS uses autologous bone marrow derived stem cells (BMSC) typically provided to the eyes by combining retrobulbar, subtenons and intravenous injections. Many retinal and optic nerve diseases are eligible including Retinitis Pigmentosa (RP), Age Related Macular Degeneration (AMD), Stargardts, Ushers, Glaucoma, Ischemic Optic Neuropathy, Optic Atrophy and others. Statistically significant improvements have been documented in key diseases and positive responses have been noted across most conditions treated. Mechanisms of action may include differentiation of the CD34 cells into neurons, secretion of neurotrophic factors, transfer of mitochondria and release of mRNA. These may benefit existing stressed cells as well as provide replacement of damaged or absent cells. (more…)
Author Interviews, Stroke, Technology / 14.02.2018

MedicalResearch.com Interview with E. Paul Zehr PhD Professor & Director Centre for Biomedical Research, Rehabilitation Neuroscience Laboratory, McKinnon Division of Medical Sciences Exercise Science, Physical & Health Education International Collaboration on Repair Discoveries (ICORD)| Affiliate, Division of Neurology, Department of Medicine, UBC MedicalResearch.com: What is the background for this study? What are the main findings? Response: For many years we explored the role of the spinal cord in regulating rhythmic arm and leg movements like we do during walking, running and swimming.  Although we humans tend to move and locomote around on our two legs as bipeds, we are basically quadrupeds in terms of how our nervous system controls our limbs during walking. We have an extensive network of brain and spinal cord connections that help coordinate our limbs while we move. A lot of our work showed that using the arms rhythmically, like during arm cycling, strongly affected the activity of the spinal cord controlling leg muscles. Getting the spinal cord for leg muscles more coordinated and activated is a major goal of rehabilitation  of walking after neurotrauma so we wanted to see if training the arms could help with this. This is particularly important because a lot of the time, the arms are not engaged at all in rehabilitation training for the legs. We found that after only 5 weeks of arm cycling (3 x 30 minutes each week), neural excitability, strength, and leg function were increased along with enhanced clinical tests of balance and walking ability. (more…)
Author Interviews, Heart Disease, JACC, Stroke / 13.02.2018

MedicalResearch.com Interview with: João Pedro Ferreira, MD, PhD & Faiez Zannad, MD, PhD National Institute of Health and Medical Research (INSERM)Center for Clinical Multidisciplinary Research 1433INSERM U1116University of LorraineRegional University Hospital of NancyFrench Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative–Cardiovascular and Renal Clinical Trialists, Nancy, France Department of Physiology and Cardiothoracic SurgeryCardiovascular Research and Development UnitFaculty of MedicineUniversity of Porto, Porto, Portugal MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is uncertain whether patients with a myocardial infarction with systolic dysfunction but without atrial fibrillation have increased risk for stroke. In this study including >22,000 patients and 600 stroke events we found a subgroup of patients at high risk for stroke despite not having atrial fibrillation. These patients are older, have worse renal function, frank signs of pulmonary congestion, hypertension and previous stroke history. We created a simple and “ready to use” score that allows the identification of these patients in routine clinical practice.  (more…)
AHA Journals, Author Interviews, Stroke / 07.02.2018

MedicalResearch.com Interview with: Todd C. Villines, M.D. FSCCT Professor of Medicine Uniformed Services University School of Medicine Director of Cardiovascular Research and Cardiac CT Cardiology Fellowship Program Director Walter Reed National Military Medical Center Bethesda, Maryland Assistant Professor of Medicine Georgetown School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was a retrospective, observational real-world analysis assessing the safety and effectiveness of novel oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) treated through the U.S. Department of Defense Military Health System. The study examined major bleeding and stroke rates in NVAF patients who had initiated treatment with dabigatran compared to those treated with rivaroxaban or apixaban. The study examined two cohorts: one that resulted in 12,763 propensity score matched dabigatran (150 mg bid) and rivaroxaban (20 mg daily) patients, and another that resulted in 4,802 propensity score matched dabigatran (150 mg bid) and apixaban (5 mg bid) patients. Dabigatran patients demonstrated lower rates of major bleeding compared to rivaroxaban patients (2.08 percent vs 2.53) percent and similar rates of stroke (0.60 percent vs 0.78 percent). In the exploratory analysis, dabigatran and apixaban patients showed similar rates of major bleeding (1.60 percent vs 1.21 percent) and stroke (0.44 percent vs 0.35 percent). (more…)
Author Interviews, BMJ, Heart Disease, Pain Research, Stroke / 01.02.2018

MedicalResearch.com Interview with: “Headache.” by Avenue G is licensed under CC BY 2.0Kasper Adelborg, MD, PhD Postdoctoral Fellow Department of Clinical Epidemiology Aarhus University Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Around one billion people worldwide are affected by migraine. Migraine has considerable impact on quality of life and imposes a substantial burden on society. Migraine is primarily a headache disorder, but previous studies have suggested a link between migraine and stroke and myocardial infarction, particularly among women, while the link between migraine and other heart problems are less well known. In this large register-based Danish study published in the BMJ, we confirmed that migraine is associated with increased risks of stroke and myocardial infarction, but we also found that migraine was associated with increased risks of other cardiovascular diseases (specifically, venous thromboembolism and atrial fibrillation). Migraine was not associated with increased risks of heart failure or peripheral artery disease. In contrast to most previous studies, our study had a very large sample size and an age- and sex- matched comparison cohort from the general population, which allowed us to put migraine in a population context and to perform several subgroup analyses. Here, we found several interesting findings.
  • In general, the associations were strongest in the first year after diagnosis but persisted in the long term (up to 19 years after diagnosis).
  • Most associations applied to both migraine patients with aura (warning signs before a migraine, such as seeing flashing lights) and in those without aura, and in both women and in men. 
(more…)
Author Interviews, Stroke / 26.01.2018

MedicalResearch.com Interview with: Dr. J. Mocco, MD Professor Neurosurgery Mount Sinai Beth Israel Mount Sinai St. Luke's and Mount Sinai West The Mount Sinai Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Numerous trials have demonstrated that Endovascular therapy is strongly beneficial for emergent large vessel stroke patients. The majority of patients in those trials were treated with Stent retrievers.  COMPASS was designed to evaluate a different type of Endovascular therapy called aspiration Thrombectomy.  (more…)
Author Interviews, Stroke, Technology / 23.01.2018

MedicalResearch.com Interview with: Professor Alireza Gharabaghi Univ.-Prof. Dr. med. Alireza Gharabaghi Ärztlicher Leiter Sektion Funktionelle und Restaurative Neurochirurgie Neurochirurgische Universitätsklinik Eberhard Karls Universität Tübingen  MedicalResearch.com: What is the background for this study? What are the main findings? Response: According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. Stroke is the leading cause of serious, long-term disability. About half of all stroke survivors will never be able to use their affected hand for activities of daily living again. The current study investigates a novel technology which may lead to new therapeutic options for these patients.  (more…)
Anesthesiology, Author Interviews, JAMA, Stroke / 18.01.2018

MedicalResearch.com Interview with: Dr. Claus Z. Simonsen, MD, PhD Department of Neurology Aarhus University Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Retrospective studies find worse outcome when performing (Endovascular Therapy) EVT under General Anesthesia (GA). The main finding is that infarct growth in the Conscious Sedation (CS) and GA are not different. And that patients who had EVT under GA had a better outcome after 90 days. This is probably explained by better reperfusion rates under GA which was another part of the study that was surprising. Our neurointerventionalist are comfortable performing EVT under CS, but our study indicates that maybe it is easier to achieve reperfusion it the patient is anesthesized. (more…)
Author Interviews, Cancer Research, JAMA, Stroke / 13.01.2018

MedicalResearch.com Interview with: Babak B. Navi MD, MS Department of Neurology Weill Cornell Medicine New York, New York MedicalResearch.com: What is the background for this study? Response: About 10% of patients with ischemic stroke have comorbid cancer and these patients face an increased risk of stroke recurrence. Many strokes in patients with cancer are attributed to unconventional mechanisms from acquired hypercoagulability. Therefore, many physicians recommend anticoagulation, especially low molecular weight heparins, for the treatment of cancer-associated stroke. However, hypercoagulable stroke mechanisms, such as nonbacterial thrombotic endocarditis, are rarely definitively diagnosed in cancer patients antemortem; while atherosclerosis, which is generally treated with antiplatelet medicines such as aspirin, is common in cancer patients. In addition, many historic indications for anticoagulation in ischemic stroke have been disproven by randomized trials because any reductions in stroke risk were offset by increased risks of bleeding. Given these considerations, we believed that a randomized trial comparing anticoagulation with enoxaparin to antiplatelet therapy with aspirin was necessary to determine the superior strategy, prompting implementation of the TEACH pilot randomized trial. The primary aim of TEACH was to determine whether the random assignment of different antithrombotic strategies to cancer patients with acute ischemic stroke would be sufficiently feasible and safe to proceed with a larger efficacy trial.  (more…)
Author Interviews, Biomarkers, JAMA, Stroke / 23.11.2017

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  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. (more…)
Author Interviews, Coffee, Heart Disease, Red Meat, Stroke / 15.11.2017

MedicalResearch.com Interview with: Coffee being poured Coffee pot pouring cup of coffee.  copyright American Heart AssociationLaura 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. (more…)
Author Interviews, Boehringer Ingelheim, Clots - Coagulation, Stroke / 05.10.2017

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 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. (more…)
Author Interviews, Cancer Research, Stroke / 15.09.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, NEJM, Stroke, Surgical Research / 13.09.2017

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  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. (more…)
Author Interviews, CDC, Stroke / 08.09.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Stroke, Technology / 01.08.2017

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. (more…)
AHA Journals, Author Interviews, Stroke, Weight Research / 17.07.2017

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 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. (more…)
Author Interviews, NEJM, Stroke / 22.06.2017

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 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 (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Neurological Disorders, Stroke / 22.06.2017

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. (more…)