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…)
Author Interviews / 24.02.2017 Interview with: Jonah P. Zuflacht M.D. Candidate | Class of 2017 Columbia University, College of Physicians & Surgeons What is the background for this study? What are the main findings? Response: Recent evidence suggests that psychological distress, including the symptoms of psychiatric illness, may increase the risk of stroke. However, existing studies have been limited by small sample sizes, methodological bias, and poorly defined criteria for what constitutes psychological distress. We used a case-crossover design to assess the relationship between hospitalization or emergency department visit for a psychiatric condition and stroke in adults. We found that psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period following the diagnosis. This effect is particularly pronounced in younger patients. (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…)
AHA Journals, Author Interviews, Technology / 23.02.2017 Interview with: Ricardo A Hanel, MD PhD Endovascular and Skull Base Neurosurgery Director, Baptist Neurological Institute Endowed Chair, Stroke and Cerebrovascular Surgery Jacksonville, FL What is the background for this study? What are the main findings? Response: Medtronic Pipeline Embolization Device has been approved for carotid artery aneurysms over 10mm in size, from the petrous to clinoid segment but given the efficacy of results on these larger lesions, it has been widely utilized for treatment of smaller lesions. PREMIER came from the need of assessing the results , safety and efficacy, of pipeline for use of aneurysms under 12mm, located on the carotid artery, all segments, and V3 segment of the vertebral artery. PREMIER enrolled 141 patients treated at 22 centers (21 US, 1 Canada). Primary Safety effectiveness defined as total aneurysm occlusion, core lab adjudicated , at 1 year was 83.5%; with safety endpoint of major stroke/death at 30 days of 1.4% (2 patients), with 1-year major stroke and death rate of 2.1%. (more…)