Author Interviews, JAMA, Pain Research, Stroke / 08.03.2017 Interview with: Alessandro Pezzini, MD, FESO Professore Associato di Neurologia Dipartimento di Scienze Cliniche e Sperimentali Clinica Neurologica Università degli Studi di Brescia Italia 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. (more…)
Author Interviews, Lancet, Stroke / 07.03.2017 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 : 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 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. (more…)
Author Interviews, Stroke / 06.03.2017 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 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. (more…)
Author Interviews, Mental Health Research, Pediatrics, Social Issues, Stroke / 28.02.2017 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 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). (more…)
Author Interviews, Stroke / 26.02.2017 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 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. (more…)
Author Interviews, Race/Ethnic Diversity, Social Issues, Stroke / 26.02.2017 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 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. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Geriatrics, Heart Disease, Stroke / 26.02.2017 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 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. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 25.02.2017 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 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. (more…)
Author Interviews, Stroke, Technology / 23.02.2017 Interview with: Michel Piotin, MD PhD Principal investigator and Interventional Neuroradiologist Rothschild Fondation Hospital, Paris 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. (more…)
Author Interviews, Heart Disease, JAMA, Neurological Disorders, Stroke / 13.02.2017

  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 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 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. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Pain Research, Stroke / 13.01.2017 Interview with: Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia Harvard Medical School Clinical Director, Critical Care Division 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. (more…)
Author Interviews, Emergency Care, JAMA, Stroke, Surgical Research / 13.01.2017 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 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? (more…)
AHA Journals, Author Interviews, Duke, Social Issues, Stroke / 19.12.2016 Interview with: Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University 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. (more…)
Author Interviews, Depression, JAMA, McGill, Pharmacology, Stroke / 09.12.2016 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 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. (more…)
Author Interviews, CMAJ, Heart Disease, Stroke / 27.11.2016 Interview with: 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 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. (more…)
Author Interviews, Gender Differences, JAMA, Stroke / 19.11.2016 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 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. (more…)
Author Interviews, Columbia, JAMA, OBGYNE, Stroke / 24.10.2016 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. 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. (more…)
Author Interviews, Imperial College, Stroke, Technology / 06.10.2016 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 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. (more…)
Author Interviews, JAMA, Stroke / 27.09.2016 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 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. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, Stroke / 13.09.2016 Interview with: Menno Huisman, MD, PhD Associate professor Department of Medicine Leiden University Medical Center The Netherlands What is the background for this study? What are the main findings? Response: GLORIA™-AF is one of the largest ongoing global registry programs examining the use of oral antithrombotic agents in real-world clinical practice. The program is designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation (NVAF) at risk for stroke, and to study patterns, predictors and outcomes of different regimens for stroke prevention. At the ESC Congress 2016, we presented the first Phase II results of GLORIA-AF from approximately 3,000 NVAF patients, which showed that treatment with PRADAXA was associated with low incidences of stroke, major bleeding and life threatening bleeding. Less than 1% of PRADAXA-treated patients experienced a stroke over two years (0.63%). Major bleeding occurred in 1.12% of PRADAXA-treated patients and 0.54% experienced a life-threatening bleed. (more…)
Author Interviews, BMJ, Heart Disease, Stroke / 12.09.2016 Interview with: Ayodele Odutayo, DPhil student Centre for Statistics in Medicine Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Oxford, UK What is the background for this study? What are the main findings? Response: Atrial fibrillation is associated with an increased risk of all cause mortality and stroke, as well as higher medical costs and a reduced quality of life. The association between atrial fibrillation and cardiovascular outcomes other than stroke is less clear. We found that atrial fibrillation is associated with a wide range of cardiovascular events, including cardiovascular mortality, major cardiovascular events, heart failure, ischaemic heart disease, chronic kidney disease, and sudden cardiac death, as well as stroke and all cause mortality. The relative and absolute risk increase associated with many of these events is greater than that of stroke. Interventions are needed to reduce the risk of non-stroke cardiovascular outcomes in adults with atrial fibrillation. (more…)
AHA Journals, Anemia, Author Interviews, Hematology, Stroke / 30.08.2016 Interview with: Raphae Barlas M.A 3rd year MBChB student The Institute of Applied Health Sciences Aberdeen What is the background for this study? What are the main findings? Response: Anemia and stroke are both common conditions. While previous studies have found an association between anemia on admission and increased mortality in stroke patients, this was not consistent throughout the literature. We aimed to comprehensively assess this association by conducting our own observational study, consisting of 8000 patients from UK regional stroke registry data. We then aggregated our findings into a systematic review and meta-analysis of the existing literature for a total study population of approximately 30,000 patients. (more…)
Author Interviews, Neurology, Stroke / 29.08.2016 Interview with: Dr. Ashkan Shoamanesh MD FRCPC Assistant Professor Division of Neurology, Department of Medicine McMaster University and Dr. Jose Rafael Romero, MD Associate Professor of Neurology Boston University School of Medicine What is the background for this study? What are the main findings? Response: The Framingham Heart Study is a population-based study of individuals residing in the community. Identifying people who are at risk for stroke can help us determine who would benefit most from existing or new therapies to prevent stroke. As inflammatory pathways are believed to contribute to vascular disease and stroke, we tested whether circulating biomarkers of inflammation and endothelial dysfunction could improve the predictive ability of the Framingham Stroke Risk Profile score, a model that contains classical vascular risk factors such as high blood pressure and diabetes. Our main observation was that inclusion of 4 biomarkers (C-reactive protein, tumor necrosis factor receptor-2, total homocysteine, and vascular endothelial growth factor) in the Framingham Stroke Risk Profile improved its ability to predict a stroke (net reclassification improvement of 0.34 [0.12–0.57]). (more…)
Author Interviews, Lancet, Stroke / 24.08.2016 Interview with: Dr Alexander Kunz MD Department of Neurology Charité-University Medicine Berlin Berlin, Germany What is the background for this study? Response: Systemic thrombolysis with tissue plasminogen activator (tPA) in acute ischemic stroke has been an approved therapy for over 20 years now. To date, tPA can be administered to eligible patients within a 4.5 hours time window after the onset of symptoms. Results from large thrombolysis trials and meta-analyses have shown, that the beneficial effects of tPA are inversely correlated with the delay from symptoms onset to start of tPA treatment. This relationship is frequently summarized in the slogan “Time is brain!” Currently, several research groups are evaluating the concept of pre-hospital thrombolysis using a mobile stroke treatment unit (MSTU) in order to achieve significant reductions in onset-to-treatment delays. MSTU are specialized ambulances equipped with a CT scanner and a mini-laboratory. In Berlin, Germany, we have been operating an MSTU (stroke emergency mobile vehicle, STEMO) since 2011. Previous studies had shown that start of tPA treatment was 25min earlier when patients were cared by STEMO than within conventional care, i.e. admission to hospital by regular ambulance and in-hospital tPA treatment. However, these studies did not prove, that earlier treatment in STEMO is associated with better outcome. Therefore, the aim of the current study was to compare 3-month functional outcome after tPA in patients with acute ischemic stroke who received STEMO care vs conventional care. (more…)
Author Interviews, Ophthalmology, Stroke / 15.08.2016 Interview with: Rong-Kung Tsai MD, PhD Professor and Director Institute of Eye Research Buddhist Tzu Chi Medical Center; Director, Institute of Medical Sciences Tzu Chi University, Hualien, Taiwan What is the background for this study? What are the main findings? Response: Non-arteritic anterior ischemic optic neuropathy (NAION) is pathogenetically different from stroke, stroke is caused by thromboembolism. However, they share many (but not all) systemic vascular risk factors. Previous small scale studies got controversial results. Using the National Health Insurance Research Database (NHIRD) in Taiwan to conduct the cohort study, 414 patients were included in the NAION group and 789 in the control group (base one million beneficiaries). The incidence of NAION is 3.72/100,000 person-years in Taiwan, and patients with NAION have more chances to develop ischemic stroke (p=0.003), but not hemorrhage stroke. The subgroup analyses further showed the risk of ischemic stroke among the subjects with NAION and with comorbidities was 3.35 times higher than those without NAION. However, in patients with NAION but no comorbidities, there is no increase risk of stroke development. (more…)
Author Interviews, Heart Disease, JACC, Stroke, Surgical Research / 12.08.2016 Interview with: Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future. While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR. (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity, Stroke / 27.07.2016 Interview with: Dr. Mary Vaughan Sarrazin PhD Associate Professor Department of Internal Medicine University of Iowa Roy and Lucille Carver College of Medicine, and Iowa City VA Medical Center, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) Iowa City What is the background for this study? Response: Atrial fibrillation is associated with a higher risk of stroke. The CHA2DS2VASc score (congestive heart failure, hypertension, age 75 or older, diabetes, previous stroke, vascular disease, age 65-74, female sex) reflects stroke risk and is used to guide decisions regarding anticoagulation. Our prior work suggests that African Americans have a higher risk of stroke compared to other patients with atrial fibrillation, even after risk factor adjustments. In the current study, we used Medicare data to test whether addition of black race to CHA2DS2VASc score improves stroke prediction in patients with atrial fibrillation. (more…)
Author Interviews, Health Care Systems, JAMA, Stroke / 25.07.2016 Interview with: Kimon Bekelis, MD Chief Resident Department of Neurosurgery Dartmouth-Hitchcock School of Medicine What is the background for this study? Response: Physicians often must decide whether to treat acute stroke patients locally, or refer them to a more distant Primary Stroke Center (PSC). There is little evidence on how much the increased risk of prolonged travel time offsets benefits of specialized  Primary Stroke Center care. (more…)