AHA Journals, Author Interviews, Stroke / 15.07.2014

Iftikhar J. Kullo, MD Division of Cardiovascular Diseases Mayo Clinic Rochester, MNMedicalResearch.com Interview with: Iftikhar J. Kullo, MD Division of Cardiovascular Diseases Mayo Clinic Rochester, MN   Medical Research: What are the main findings of the study? Dr. Kullo: The main findings of the study are: 1) Family history of stroke or heart attack is associated with presence of significant narrowing (greater than 70%) of the carotid arteries. These are the arteries that supply blood to the brain and narrowing or blockage of these arteries is associated with increased risk of stroke; 2) Having a sibling history of stroke or heart attack was more strongly associated with narrowing of the carotid artery than having a parent with such history; 3) The greater number of relatives with history of stroke or heart attack, the greater the odds of having narrowing in one of the carotid arteries.
AHA Journals, Author Interviews, Electronic Records, Medicare, Stroke / 04.07.2014

MedicalResearch.com Interview with Hiraku Kumamar, MD, MPH Department of Epidemiology Harvard School of Public Health, Boston, MA and Soko Setoguchi-Iwata, M.D. Duke Clinical Research Institute Durham, NC 27715 Medical Research: What are the main findings of the study? Answer: We evaluated the accuracy of discharge diagnosis of stroke in the Medicare claims database by linking it to a nationwide epidemiological study cohort with 30239 participants called REasons for Geographic And Racial Differences in Stroke (REGARDS). We found that among the 282 events captured using a strict claims definition of stroke, 91% were true events.  We also found that 12% of the overall strokes had been identified only by Medicare claims, strongly supporting the use of these readily available data for event follow-up in cohort studies.
Author Interviews, Heart Disease, NEJM, Stroke / 01.07.2014

MedicalResearch.com Interview with: Dr. Tommaso Sanna MD Institute of Cardiology Catholic University of the Sacred Heart Rome, Italy MedicalResearch: What are the main findings of the study? Dr. Sanna: In patients with cryptogenic stroke, continuous ECG monitoring with an implantable device, called the Reveal XT Insertable Cardiac Monitor (ICM), discovered Atrial Fibrillation in 6.4 times more patients than conventional diagnostic strategies at six months, 7.3 times more patients at 12 months, and 8.8 times more patients at 36 months. In more detail, after 36 months of follow-up, 30% of patients with cryptogenic stroke had at least one episode of atrial fibrillation.
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 25.06.2014

Wuwei (Wayne) Feng MD MS FANA Assistant Professor, Department of Neuroscience Department of Health Science & Research Medical University of South Carolina Stroke Center The Center of Rehabilitation Research in Neurological ConditionsMedicalResearch.com Interview with: Wuwei (Wayne) Feng MD MS FANA Assistant Professor, Department of Neuroscience Department of Health Science & Research Medical University of South Carolina Stroke Center The Center of Rehabilitation Research in Neurological Conditions MedicalResearch: What are the main findings of the study? Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years). By way of background: 84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites. Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001). This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes.
Author Interviews, Stroke, Wake Forest / 22.06.2014

Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC 27157MedicalResearch.com Interview with: Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC  27157 MedicalResearch: What are the main findings of the study? Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure).
Author Interviews, BMJ, Stroke / 26.05.2014

Michael T. C. Poon, MBChB, BMedSci (Hons) Junior Doctor, Wycombe General Hospital Buckinghamshire Healthcare NHS Trust, UKMedicalResearch.com Interview with: Michael T. C. Poon, MBChB, BMedSci (Hons) Junior Doctor, Wycombe General Hospital Buckinghamshire Healthcare NHS Trust, UK   MedicalResearch: What are the main findings of the study? Dr. Poon: At present, we know that the incidence and one-month case fatality of intracerebral haemorrhage (ICH) have remained static for the past two decades. However, any trend in long-term survival after ICH is less clear. Survivors face the risks of recurrent ICH as well as ischaemic events in the future. The balance between these risks has particular clinical implication on the decision about restarting antiplatelet/anticoagulant therapy after ICH. To address these questions, we undertook a systematic review and meta-analysis to determine whether long-term survival after intracerebral haemorrhage has changed over time, and to re-assess the balance between the risks of recurrent ICH and ischaemic events in studies quantifying both of these risks in the same population. The survival rates after ICH at 1 year and 5 years do not appear to have changed over time – 1 year survival was 46% and 5 year survival was 29%. The risk of recurrent ICH may be influenced by the ICH location, with lobar ICH having a higher rate of recurrence. In contrast to the previous systematic review, we found the risk of ischaemic stroke to be at least as high as the risk of recurrent ICH over 3 years after ICH. This reinforces the difficulty that clinicians and patients have in deciding about antithrombotic treatment after ICH.
AHA Journals, Author Interviews, Pain Research, Stroke / 15.05.2014

MedicalResearch Interview with: Dr. Teshamae Monteith MD Assistant professor of Neurology Chief of the Headache Division University of Miami Miller School of Medicine. MedicalResearch: What are the main findings of the study? Dr. Monteith:   
  • A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
  • No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
  • Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.
  • High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.
AHA Journals, Author Interviews, Nutrition, Stroke / 14.05.2014

MedicalResearch Interview with: Dr. Yan Qu Qingdao Municipal hospital Fruits and Vegetables Consumption and Risk of Stroke A Meta-Analysis of Prospective Cohort Studies MedicalResearch: What are the main findings of the study? Reply: First, both fruits and vegetables were found inversely associated with risk of stroke, and the relationships might be linear. Second, the inverse association of fruits and vegetables consumption with risk of stroke is consistent across subgroup analysis by outcome (stroke incidence and stroke mortality), location where the study was conducted (USA, Europe and Asia), sex (male and female), and stroke subtypes (ischemic and hemorrhagic). Third, citrus fruits, leafy vegetables and apples/pears were found inversely associated with risk of stroke. Fourth, very similar results were found in the subgroup analysis by status [yes: 0.78 (0.71-0.86) or no: 0.79 (0.74-0.85)] of adjusting for 6 or more of the 7 covariates (smoking, alcohol, blood pressure/hypertension, serum cholesterol, physical activity, body mass index, ≥3 dietary variables). These findings generally indicated that the association of fruits and vegetables consumption with the reduced risk of stroke may not be the result of confounding by the known factors.
Author Interviews, Brigham & Women's - Harvard, Calcium, Heart Disease / 13.05.2014

Dr. Julie Paik, MD MPH Instructor, Harvard Medical School Brigham and Women's Massachusetts GeneralMedicalResearch.com Interview with: Dr. Julie Paik, MD MPH MSc Instructor, Harvard Medical School Brigham and Women's Hospital MedicalResearch: What are the main findings of the study? Dr. Paik: Many women in the United States take calcium supplements. One study found that over 60% of women aged 60 and over in the United States were taking calcium supplements. However, the medical community is still not certain of the effects of calcium supplements in women, particularly on cardiovascular disease risk. For this reason, we studied 74,245 women participating in the Nurses' Health Study over a 24-year follow-up period for their risk of developing cardiovascular disease (heart disease or stroke). We found that there was no increased risk of heart disease or stroke among women taking calcium supplements during the 24-year follow-up period. Our paper has several distinct strengths compared to prior studies including the large sample size, long follow-up period, cases of cardiovascular disease that were confirmed by medical record review, detailed and repeated assessment of calcium supplement use, and detailed information about other risk factors for cardiovascular disease.
Cannabis, Neurology, Stroke / 09.05.2014

MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center MedicalResearch: What are the main findings of the study? Dr. Dutta: We analyzed data from the Stroke Prevention in Young Adults Study in order to evaluate for an association between self-reported marijuana use and ischemic stroke.   1,101 cases and 1,154 age, gender, and race-matched controls, aged 15-49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Interviews were conducted to assess for various potential stroke risk factors, including illicit drug, alcohol, and tobacco use. Individuals reporting use of vasoactive illicit drugs, including cocaine and amphetamines, were excluded, yielding 751 cases and 813 controls. Logistic regression analysis was used to determine the association between marijuana use and ischemic stroke, adjusting for age, gender, race, current tobacco use, current alcohol use, hypertension, and diabetes. We did not find a positive association between marijuana use and ischemic stroke risk in our population of young-onset stroke patients compared to matched controls, even after controlling for current tobacco and alcohol use, hypertension, and diabetes.   A statistically significant inverse relationship was observed between remote use (defined as any use over one year ago) and stroke risk (adjusted OR 0.77, CI 0.61-0.98, p = 0.03). We also looked to see whether recent use (in the past 30 days), and particularly recent heavy use, was associated with ischemic stroke risk as has been suggested in the medical literature. Though our data did not show this association, the number of patients reporting recent use in our study was very small­­­­­­­.
Author Interviews, Mayo Clinic, Neurology, Stroke / 06.05.2014

Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 MedicalResearch.com Interview with: Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 MedicalResearch: What are the main findings of the study? Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.
Author Interviews, Infections, Stroke / 01.05.2014

Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PTMedicalResearch.com Interview with: Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PT MedicalResearch.com: What are the main findings of the study? Dr. Allan: Using an experimental model of stroke it was found that animals with preceding Streptococcus pneumoniae infection had a worse outcome than uninfected animals. This confirms and extends previous data, both clinical and preclinical, that systemic inflammation is a key contributor to stroke outcome. Importantly, effects of infection were also demonstrated in animals with co-morbidities associated with stroke (atherosclerosis and age), with outcomes worse than observed in healthy young subjects. Exacerbating effects of infection on stroke are mediated via the pro-inflammatory cytokine, interleukin-1 (IL-1), shown by reversal of the increased ischaemic brain damage and functional impairments by treatment with the IL-1 receptor antagonist (IL-1Ra). Infection also leads to increased platelet activation and microvascular coagulation after stroke, which contributes to the increased injury. Collectively, these data are the first to show, how systemic inflammatory mechanisms induced by one of the most common non-invasive, human S.pneumoniae isolates, lead to critical illness after stroke in different rodent species and strains, and how common stroke comorbidities interact with infection to worsen outcome after stroke.
Author Interviews, Erasmus, Neurology, Stroke / 25.04.2014

M. Arfan Ikram, MD, PhD Assistant professor in Neuroepidemiology Erasmus Medical Center Rotterdam, the NetherlandsMedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD Assistant professor in Neuroepidemiology Erasmus Medical Center Rotterdam, the Netherlands MedicalResearch.com: What are the main findings of this study? Dr. Ikram: We show that the risk of stroke might be increased due to an increased risk of ischemic stroke or increased risk of hemorrhagic stroke. Because these subtypes of stroke require different -often opposite- clinical management, currently available prediction rules for any stroke are insufficient. We propose a novel prediction rule that provides separate risks for ischemic stroke and hemorrhagic stroke.
Author Interviews, JAMA, Stroke, UCLA / 24.04.2014

Dr. Gregg C. Fonarow MD Director, Ahmanson-UCLA Cardiomyopathy Center UCLA CHAMP - Cholesterol, Hypertension, and Atherosclerosis Management Program Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine Los Angeles, CAMedicalResearch.com Interview with: Dr. Gregg C. Fonarow MD Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine Los Angeles, CA MedicalResearch.com: What are the main findings of the study? Dr. Fonarow: This study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke, which aims to increase the number of stroke patients treated with clot-busting drugs for ischemic stroke within 60 minutes or less after hospital arrival.  Initiated nationwide in 2010, Target: Stroke provided 10 key strategies as well as tools to facilitate timely tPA administration, as well as additional approaches to improve stroke care and outcome. Data from 71,169 tPA-treated stroke patients at 1,030 hospitals participating in Target: Stroke were analyzed to compared the time to treatment and incidence of complications before implementation, from 2003 to 2009, to the post-implementation years, from 2010 to 2013. This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. In addition, the average time to treatment dropped by 15 minutes, from 74 to 59 minutes. Faster treatment was associated with lower rates of complications, including death. Before Target: Stroke, 9.9% of stroke patients died in the hospital, compared to 8.3% of patients treated after the initiative started, a difference which was statistically significant. In addition, patients treated by Target: Stroke strategies were less likely to develop the complication of symptomatic intracranial hemorrhage.
Author Interviews, JAMA, Outcomes & Safety, Stroke / 22.04.2014

Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Oberarzt der Klinik und Hochschulambulanz für Neurologie am Campus Charité Mitte Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Charitéplatz 1 | 10117 Berlin | GermanyMedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Oberarzt der Klinik und Hochschulambulanz für Neurologie am Campus Charité Mitte Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Charitéplatz 1 | 10117 Berlin | Germany MedicalResearch.com: What are the main findings of the study? Dr. Ebinger: The main findings of our study was a significant time reduction during randomized weeks with prehospital thrombolysis compared to control weeks with regular care.
Author Interviews, Blood Pressure - Hypertension, CMAJ, McGill, Stroke / 14.04.2014

Finlay A McAlister MD Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit Epidemiology Coordinating and Research (EPICORE) Centre McGill University, Montréal, QuebecMedicalResearch.com Interview with: Finlay A McAlister MD University of Alberta, Edmonton, Canada MedicalResearch.com: What are the main findings of the study? Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets). The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician. The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians.  However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor. Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) .
Author Interviews, Outcomes & Safety, Stroke / 02.04.2014

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine New York, NY 10016. MedicalResearch.com: What are the main findings of your study? Dr. Bangalore: Patients with transient ischemic attack (TIA) are at increased risk of future full blown stroke, making institution of secondary prevention measures critical Our data from 858,835 patients from 1545 sites indicate that hospital adherence to evidence-based secondary prevention discharge measures was consistently less for patients with transient ischemic attack when compared with those with ischemic stroke, thus representing a missed opportunity at instituting preventive measures to reduce the risk of future stroke.
AHA Journals, Author Interviews, Social Issues, Stroke / 25.03.2014

Jill Cameron, PhD M.Ed., B.Sc. O.T CIHR New Investigator, Associate Professor, Department of Occupational Science and Occupational Therapy Graduate Department of Rehabilitation Science Faculty of Medicine, University of Toronto Adjunct Scientist, UHN-Toronto Rehabilitation InstituteMedicalResearch.com Interview with: Jill Cameron, PhD CIHR New Investigator, Associate Professor, Department of Occupational Science and Occupational Therapy Graduate Department of Rehabilitation Science Faculty of Medicine, University of Toronto Adjunct Scientist, UHN-Toronto Rehabilitation Institute MedicalResearch.com: What are the main findings of the study? Dr. Cameron: In our study with 399 stroke survivor, caregiver dyads, caregivers reported more psychological wellbeing when they provided more assistance to stroke survivors who had fewer symptoms of depression, better cognitive functioning, and who had more severe strokes.  In addition, caregivers who maintained participation in valued activities, had more mastery, gained personally providing care, were in better physical health, and were older reported more psychological wellbeing.
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke, University of Michigan / 14.03.2014

Lynda D. Lisabeth, PhD Interim Chair and Associate Professor Department of Epidemiology University of Michigan Ann Arbor, MichiganMedicalResearch.com Interview with: Lynda D. Lisabeth, PhD Interim Chair and Associate Professor Department of Epidemiology University of Michigan Ann Arbor, Michigan MedicalResearch.com: What are the main findings of the study? Dr. Lisabeth: The main findings were that Mexican Americans scored worse than non-Hispanic whites on all outcomes measured at 90 days following stroke, including neurologic, functional and cognitive outcomes, after adjustment for confounding factors. Further, we found that one-third of Mexican American stroke survivors have post-stroke dementia. Mexican Americans experienced more aphasia than non-Hispanic whites. Levels of functional impairment were substantial, with Mexican Americans on average experiencing moderate functional disability. Mexican Americans reported significantly greater difficulty than non-Hispanic whites with all activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that were studied.
AHA Journals, Author Interviews, Stroke / 14.03.2014

Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital L4C, Grattan St, Parkville VIC 3050, Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, FinlandMedicalResearch.com Interview with: Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, Finland MedicalResearch.com: What are the main findings of the study? Dr. Meretoja: We used observational prospective data of consecutive stroke patients (n=2258) treated with intravenous thrombolysis in Australian and Finnish centers and a pooled analysis of thrombolysis trials to model the shift in patient outcomes with reducing treatment delays. We found out that each minute the treatment can be delivered faster granted on average 1.8 days of extra healthy life (95% prediction interval 0.9 to 2.7). In practice, this means that each 15 minute decrease in treatment delays provides an average equivalent of one month of additional disability-free life.
Author Interviews, Blood Pressure - Hypertension, Stroke / 12.03.2014

MedicalResearch.com Interview with: Dingli Xu, MD From Department of Cardiology Nanfang Hospital, Southern Medical University, Guangzhou, China MedicalResearch.com:  What are the main findings of the study? Answer：Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low-range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension.
Author Interviews, Diabetes, Diabetologia, Gender Differences, Stroke / 27.02.2014

MedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, LouisianaGang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana MedicalResearch.com: What are the main findings of the study? Dr. Gang Hu:  Our study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years.
AHA Journals, Author Interviews, Stroke / 26.02.2014

MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Neurologist, Associate Professor Department of Neurology Helsinki University Central Hospital MedicalResearch.com: What are the main findings of the study?  Dr. Strbian: That even if the SEDAN score had the best performance, none of the scores showed better than a moderate performance.
Brigham & Women's - Harvard, Duke, Medical Research Centers, Stroke, UCLA / 18.02.2014

Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA; Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of MedicineMedicalResearch.com Interview with: Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA; Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Fonarow: The study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke. The primary aim of Target: Stroke is to increase the number of stroke patients treated with tPA for acute ischemic stroke within 60 minutes or less after hospital arrival. The study demonstrated that patients received stroke therapy significantly faster in hospitals that participated in Target: Stroke. Between 2010 and 2013, the time between hospital arrival and use of tPA (door-to-needle time) dropped by 15 minutes, from 74 to 59 minutes, in hospitals that participated in Target: Stroke. This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. Faster treatment was associated with improved patient outcomes and fewer complications, including death.
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 08.01.2014

Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of OxfordMedicalResearch.com Interview with Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of Oxford MedicalResearch.com: What are the main findings of the study? Dr. Sheppard: The aim of our study was to develop a decision-tree model which estimates the cost-effectiveness and potential implementation costs of a series of interventions which increase thrombolysis rates in acute stroke. The model examined all possible acute stroke patient pathways and was based on real life patient data. We found all proposed interventions to be cost saving whilst increasing patient quality of life after stroke. We estimate that, assuming a "willingness-to-pay"  of USD $30,000 per quality adjusted life year gained, the potential budget available to deliver interventions which improve acute stroke care range from USD $50,000 to USD $144,000.
Author Interviews, Stroke / 23.11.2013

Andrew D. Barreto, M.D. Assistant Professor of Neurology University of Texas, HoustonMedicalResearch.com Interview with: Andrew D. Barreto, M.D. Assistant Professor of Neurology University of Texas, Houston   MedicalResearch.com: What are the main findings of the study? Dr. Barreto: Applying a novel, operator-independent device used to produce ultrasound energy through the skull of stroke patients receiving IV-tPA (intravenous clot-busting medication that is the standard treatment for stroke patients) was safe – no signal of increased risk of symptomatic intracerebral hemorrhage (brain bleeding). Rates of recanalization (clot dissolution) were consistent with prior work that suggest aiming transcranial Doppler ultrasound energy at the clot amplifies the clot-busting effect of tPA alone.
Addiction, Author Interviews, Cannabis, Stroke / 22.11.2013

W. Scott Burgin, MD Professor and Chief Cerebrovascular Division Director, Comprehensive Stroke Center Department of Neurology USF College of Medicine Tampa General Hospital Stroke CenterMedicalResearch.com Interview with: W. Scott Burgin, MD Professor and Chief, Cerebrovascular Division Director, Comprehensive Stroke Center Department of Neurology USF College of Medicine Tampa General Hospital Stroke Center. MedicalResearch.com What are the main findings of the study? Dr. Burgin: Two cases of stroke, of embolic appearance, shortly after smoking synthetic marijuana.
AHA Journals, Author Interviews, Lancet, Stroke / 07.11.2013

Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USAMedicalResearch.com Interview with: Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USA MedicalResearch.com: What are the main findings of the study?  Dr. Derdeyn: The primary results indicate that medical management, consisting of dual antiplatelets for 3 months after a transient ischemic attack (TIA) or stroke, and rapid, effective control of blood pressure (systolic BP less than 140 mm Hg and 130 mm Hg if diabetic) and LDL-cholesterol (less than 70 mg/dl), in addition to management of other risk factors, is superior to angioplasty and stenting in addition to the same medical regimen for reducing the risk of future stroke in patients with severe atherosclerotic stenosis (>70%) of a major intracranial artery.    In addition, while there were subgroups at higher risk for stroke on medical treatment (older age, female gender, prior stroke in the territory),  none of these subgroups appeared to have a benefit from stenting (i.e. stroke rates in the stenting groups in these subgroups was higher too).