Author Interviews, Stroke / 26.01.2018 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 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 Interview with: Professor Alireza Gharabaghi Univ.-Prof. Dr. med. Alireza Gharabaghi Ärztlicher Leiter Sektion Funktionelle und Restaurative Neurochirurgie Neurochirurgische Universitätsklinik Eberhard Karls Universität Tübingen 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 Interview with: Dr. Claus Z. Simonsen, MD, PhD Department of Neurology Aarhus University Hospital 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 Interview with: Babak B. Navi MD, MS Department of Neurology Weill Cornell Medicine New York, New York 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 Interview with: Pankaj Arora MD, FAHA Assistant Professor, Cardiology Division University of Alabama at Birmingham Section Editor, Circulation: Cardiovascular Genetics American Heart Association 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 Interview with: Coffee being poured Coffee pot pouring cup of coffee.  copyright American Heart AssociationLaura Stevens University of Colorado Aurora, CO 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 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 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 Interview with: Dr Jacobo Rogado Medical oncology fellow Hospital de La Princesa Madrid, Spain 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 Interview with: Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris 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 Interview with: Quanhe Yang, PhD Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion CDC 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 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. 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 Interview with: Hugo J. Aparicio, MD, MPH Assistant Professor Vascular Neurology, Department of Neurology Investigator, The Framingham Heart Study Boston University School of Medicine Boston, MA 02118-2526 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 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 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 Interview with: Andrea Morotti, M.D. Research Fellow in Neurology Massachusetts General Hospital Harvard Medical School 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…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 18.06.2017 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 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. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 15.06.2017 Interview with: 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 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. (more…)
AHA Journals, Author Interviews, Hepatitis - Liver Disease, Stroke / 05.06.2017 Interview with: Neal S. Parikh, M.D. Administrative Chief Resident Department of Neurology Weill Cornell Medicine & NewYork-Presbyterian Hospital 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. (more…)
AHA Journals, Author Interviews, Depression, Stroke / 04.06.2017 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 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.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 27.05.2017 Interview with: Eliza Miller, M.D. Vascular neurology fellow New York-Presbyterian Hospital/Columbia University Medical Center New York City 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. (more…)
Author Interviews, Emergency Care, JAMA, Stroke / 18.05.2017 Interview with: Ryan A. McTaggart M.D. Assistant Professor of Diagnostic Imaging, Neurology, and Neurosurgery @mobilestroke4U Warren Alpert School of Medicine Brown University Rhode Island Hospital 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. (more…)
Author Interviews, JACC, Stroke, Surgical Research / 03.05.2017 Interview with: Jay S. Giri, MD, MPH Director, Peripheral Intervention Assistant Professor of Clinical Medicine Penn Medicine 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. (more…)
Author Interviews, Blood Pressure - Hypertension, Sleep Disorders, Stroke / 30.04.2017 Interview with: Shyam Prabhakaran, MD, MS Department of Neurology Feinberg School of Medicine Northwestern University Chicago, IL 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. (more…)
Author Interviews, Heart Disease, JAMA, Lipids, Nutrition, Stroke, Yale / 13.04.2017 Interview with: Eric J. Brandt, MD Yale University Cardiovascular Disease Fellow 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%. (more…)
Author Interviews, CDC, JAMA, Stroke / 10.04.2017 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 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. (more…)
Author Interviews, Compliance, Primary Care, Stroke / 09.04.2017 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 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. (more…)
Author Interviews, Medical Imaging, MRI, Stroke / 30.03.2017 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 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. (more…)
Author Interviews, Cannabis, Heart Disease, Stroke / 19.03.2017 Interview with: Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center Philadelphia 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. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 14.03.2017 Interview with: Dr. Ying Xian MD PhD Department of Neurology, Duke Clinical Research Institute Duke University Medical Center Durham, North Carolina 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. (more…)
AHA Journals, Author Interviews, Stroke / 08.03.2017 Interview with: Dr. Miikka Korja Chief Innovation Officer Neurosurgeon Associate Professor of Neurosurgery HUS, Helsinki University Hospital 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. (more…)