Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, February 23, 2020

FDA OK's New Cholesterol Drug

You'll want to talk to your doctor and read the comments associated with the article.

FDA OK's New Cholesterol Drug

First-in-class agent wins long-awaited approval

  • by Staff Writer, MedPage Today
WASHINGTON -- It's a green light for bempedoic acid (Nexletol): FDA approved the once-daily oral pill for low-density lipoprotein (LDL) cholesterol lowering as an adjunct to maximally tolerated statin therapy, the agency announced.
With this approval, bempedoic acid is now indicated for people with heterozygous familial hypercholesterolemia (FH) or established atherosclerotic cardiovascular disease who require additional lowering with hypercholesterolemia. Bempedoic acid is an oral adenosine triphosphate (ATP) citrate lyase inhibitor from Esperion Therapeutics that reduces cholesterol and fatty acid synthesis in the liver.
The pill is to be taken at 180 mg orally once daily with or without food. The drug label warns against concomitant use with simvastatin greater than 20 mg or pravastatin greater than 40 mg.
Bempedoic acid marks the first oral non-statin drug for LDL reduction to be approved in nearly two decades. Reuters reported the drug would be sold at roughly $10 a pill.
FDA approval for the drug was based on LDL-lowering and safety data from several phase III pivotal trials. The last of these to be reported was 2018's CLEAR Wisdom, which showed a 17% reduction in LDL with 12 weeks of bempedoic acid compared with placebo among 779 patients with atherosclerotic cardiovascular disease (ASCVD) or heterozygous FH already on maximally tolerated statin treatment.
Separately, the CLEAR Harmony safety study of 2,230 people showed that the drug reduced mean LDL cholesterol level by 16.5% but was associated with more adverse events leading to discontinuation and a higher incidence of gout.
Given bempedoic acid's modest magnitude of efficacy, its main clinical application is likely to be in combination with ezetimibe in patients unwilling to take a statin, according to Jennifer Robinson, MD, MPH, of the University of Iowa in Iowa City.
Esperion had waited years for the FDA to give the go-ahead to market bempedoic acid in the U.S.
In 2016, FDA first accepted the New Drug Application (NDA) for the fixed dose combination of bempedoic acid 180 mg and ezetimibe 10 mg. There was concern back then that the agency would cease to favor LDL as a surrogate endpoint when there were no data on hard outcomes like death and myocardial infarction to support the drug's actual clinical benefits.
In March 2017, the FDA said it would continue to consider LDL data in considering approval for an LDL-lowering indication for bempedoic acid. The agency stipulated, however, that it would still require a cardiovascular outcomes trial before approving the drug for a cardiovascular risk reduction indication.
In 2019, upon completion of the phase III studies, Esperion had a new round of NDAs accepted for bempedoic acid alone and in combination with ezetimibe.
The CLEAR outcomes trial won't have data reported until 2022 at the earliest. It is expected to enroll 12,600 statin-intolerant patients with or at high risk for cardiovascular disease.
"As we have seen for many drugs in the past, such as torcetrapib, estrogen, and others, a drug could lower LDL and still be bad for patients. Without data of clinical benefits, I will not be using bempedoic acid," said Rita Redberg, MD, of the University of California San Francisco Health.
In the meantime, patients with high cholesterol continue to have options such as statins and PCSK9 inhibitors.
"Statins are still first line and that shouldn't change given the extensive data for CVD lowering," commented Amit Khera, MD, of UT Southwestern Medical Center in Dallas. "However, there is a niche here for the patients that truly can't tolerate a statin or an adequate dose of statin. PCSK9 inhibitors are a good option but can be a challenge to obtain and are not cost effective in those without ASCVD, FH, or very high-risk conditions."
Bempedoic acid is not yet approved in Europe, though the European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended approval.
The bempedoic acid/ezetimibe combination tablet has yet to be approved by the FDA; its PDUFA date is Feb. 27.
The fixed-dose combination pill cut LDL by 32% in a phase III study reported in 2018 involving 382 patients with ASCVD, or at high risk for ASCVD, on maximally tolerated statins.

Medical resident stroke survivor tells his story

I see zero hope for other stroke survivors based on his experience. Only 10% fully recover and he is one of those outliers. If his doctors could objectively explain why he recovered and recreate that in others then I might see some hope. 

Medical resident stroke survivor tells his story


Not many people suffer a stroke before the age of 30, and even less have a successful recovery.
But that's the case for one young man, who thanks to his medical training now has a happy ending.
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"They were amazing," said Kain Weaver, Stroke Survivor. "I wouldn't be here today, if it wasn't for them."
And while Kain Weaver is thanking is doctors at Memorial Health, he's here today and walking with the assistance of a cane thanks to a variety of circumstances.
During a workout last may 24th, the then 28-year-old suffered a stroke.
"As I was a doing a dumbell row, I felt a pop on the right side of my head and it was kind of like like a poof and the right side of my head and it started to feel really warm," explained Weaver.
Fortunately for Weaver, he had recently graduated from Mercer Medical School and was in the middle of his residency, so he recognized right away what it was and called his mom and got help immediately.
"I think me recognizing the urgency of it because time really is brain, recognizing the urgency straight off was important to the outcome we have here," added Weaver.
"I think he's here with us today very much in part due to his medical training," said Dr. Ryan Lingo, Kain's Neurosurgeon, Memorial Health. "He was able to recognize that what he was experiencing was very abnormal and that it could likely represent a stroke."
But after months of rehab, Kain is doing remarkably well.
"It's absolutely remarkable," explained Dr. Lingo. "He certainly has youth on his side."
And there's a clear reason behind Kain sharing his story.
"There's hope for stroke survivors," said Weaver. "And I think that us a medical professionals it's our responsibility to speak encouragement and to speak hope to these patients because so often they feel like they don't have any."
Kain's remarkable story continues as he will return to his residency in Charlotte in July.

Potential benefits of music playing in stroke upper limb motor rehabilitation

Yes, we know all the benefits of music for years. Your job was to create a stroke protocol for music. Which you seem to have completely failed at and asked for followup research bookending your failures.  No action verbs at all here, so useless. 

Potential benefits of music playing in stroke upper limb motor rehabilitation

Thomas F.MüntecEckartAltenmüllerdEstherDuarteeAntoniRodríguez-Fornellsafg


Highlights

Music-based interventions in stroke upper limb motor rehabilitation integrate most of the principles of motor training and multimodal stimulation.
The use of music in rehabilitation can improve motor and cognitive functions of subacute and chronic stroke patients.
Stroke patients treated with music-based interventions have better mood and quality of life than patients treated with conventional approaches.
Future studies should better address methodological aspects of therapy protocols, the evaluation of patients and study designs to improve the level of evidence of these interventions.

Abstract

Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

But have you identified EXACTLY why they died? They didn't die from stroke, they died from a type of brain damage. If you don't know where and when you will never solve Hemorrhagic strokes.

Have you worked on solving these hemorrhage cascade of death problems?

 

 

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

— "We've tried surgery, we've tried medications" -- and not much to show for it

LOS ANGELES -- Improvements over the past decades in ischemic stroke mortality haven't been mirrored by even a budge in hemorrhagic stroke prognosis, a population-based study from the Netherlands showed.
In the Rotterdam Study, ischemic stroke mortality rates dropped starting around 1998 for a relative 29% reduction from 1991-1998 to 2008-2015 (29 vs 11 per 100 person-years, P<0.01).
Hemorrhagic stroke mortality rates, though, stayed steady (30 vs 25 per 100 person-years, P=0.93), Reem Waziry, MD, PhD, of Harvard T.H. Chan School of Public Health in Boston, reported here at the International Stroke Conference and online in Stroke.
"It makes sense, given the amazing advances we've had in the treatment of ischemic stroke with tPA now 25 years old and endovascular therapy now 5 years old," even though most of these therapies have been aimed at reducing disability rather than mortality, commented Ralph Sacco, MD, chairman of neurology at the University of Miami and past president of the American Heart Association.
"We've had many more failures for hemorrhagic stroke," Sacco told MedPage Today. "We don't have any major breakthroughs. We've tried surgery, we've tried medications, and we have not been as successful in altering the course for hemorrhagic stroke."
There have been some positive developments in hemorrhagic stroke recently, with the STICH trial showing improved mortality with early surgical hematoma evacuation but the MISTIE III trial missing significance for a similar approach with minimally invasive surgery plus thrombolysis.
"Although, these interventions show promise in selected samples of patients in the setting of clinical trials, these advances are not yet reflected in the setting of the general population," Waziry's group wrote in the Stroke paper.
The study assessed time trends in survival after first-ever strokes among the 14,926 participants in the long-running prospective study of middle-age and older adults getting follow-up exams every 3 to 4 years. After excluding those with a past history of stroke or an unspecified stroke diagnosis during the study period, there were 162 first-ever hemorrhagic and 988 ischemic strokes recorded from 1991 through 2015.
Limitations included low power for subgroup analyses, exclusion of unspecified strokes, and a population of mainly elderly stroke survivors.
Disclosures
The researchers and Sacco disclosed no relevant relationships with industry.

Poststroke fatigue and daily activity patterns during outpatient rehabilitation: An experience sampling method study

 What FUCKING stupidity, we have known for decades about poststroke fatigue. Survivors want solutions, NOT ANOTHER STUDY.

Poststroke fatigue and daily activity patterns during outpatient rehabilitation: An experience sampling method study

Archives of Physical Medicine and RehabilitationLenaert B, et al. | February 19, 2020

A longitudinal observational study using the experience sampling method (ESM) was conducted to increase the understanding of poststroke fatigue by investigating its momentary and time-lagged relationship with daily activities. A total of 30 individuals with stroke were included. ESM is a structured diary method that provides evaluating real-time symptoms, behavior, and environmental characteristics in the flow of daily life, thereby capturing moment-to-moment variations in fatigue and related factors. In this study, individuals with stroke were followed for 6 consecutive days and were prompted at 10 random moments daily to fill in a digital questionnaire about their momentary fatigue and current activity using a mobile application: type of activity, perceived effort and enjoyment, and physical activity levels. This research demonstrates the requirement for ESM to design personalized rehabilitation programs and to capture fatigue and other patient-reported outcomes in daily life.
Read the full article on Archives of Physical Medicine and Rehabilitation

Perception of dementia risk and preventive actions among US adults aged 50 to 64 years

For dementia prevention they totally throw up their hands in defeat. 

 I'm doing this.

Dementia prevention 19 ways

Don't follow me, I'm not medically trained.

Your risk of dementia is pretty high.

Your chances of getting dementia.


1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.


2. Then this study came out and seems to have a range from 17-66%. December 2013.


3. A 20% chance in this research.   July 2013.


4. Dementia Risk Doubled in Patients Following Stroke September 2018 


5. Parkinson’s Disease May Have Link to Stroke March 2017

 

 

Perception of dementia risk and preventive actions among US adults aged 50 to 64 years

JAMAMaust DT, Solway E, Langa KM, et al. | February 18, 2020

This report examines how adults aged 50 to 64 years estimate their lifetime risk of dementia and the risk-reducing strategies they pursue. For Alzheimer disease or other dementias, disease-preventing or disease-modifying treatments do not exist. Adults may be unaware of procedures to decrease their risk and resort to marketed but ineffective options, such as ginkgo biloba or vitamin E. New preventive therapies may not be, while these so-called treatments are relatively inexpensive. Therefore, people overestimating their risk of increasing dementia could lead to inappropriate use and excessive costs.
Read the full article on JAMA

Towards more effective robotic gait training for stroke rehabilitation: a review

In the 8 years since this came out, has your hospital come up with ANY USEFUL STROKE PROTOCOLS?  You can see that in 2012 9 years after NDT/Bobath was discredited it was still in common use. I expect nothing to change in stroke rehab until survivors are in charge and we clean out all the dead wood in stroke.

Towards more effective robotic gait training for stroke rehabilitation: a review

Journal of NeuroEngineering and Rehabilitation, 2012
Andrew Pennycott
1,2*
, Dario Wyss
1,2
, Heike Vallery
1,2
, Verena Klamroth-Marganska
1,2
and Robert Riener
1,2

Abstract

Background:
 Stroke is the most common cause of disability in the developed world and can severely degrade walking function. Robot-driven gait therapy can provide assistance to patients during training and offers a number of advantages over other forms of therapy. These potential benefits do not, however, seem to have been fully realised as of yet in clinical practice.
Objectives:
 This review determines ways in which robot-driven gait technology could be improved in order to achieve better outcomes in gait rehabilitation.
Methods:
 The literature on gait impairments caused by stroke is reviewed, followed by research detailing the different pathways to recovery. The outcomes of clinical trials investigating robot-driven gait therapy are then examined. Finally, an analysis of the literature focused on the technical features of the robot-based devices is presented. This review thus combines both clinical and technical aspects in order to determine the routes by which robot driven gait therapy could be further developed.
Conclusions:
 Active subject participation in robot-driven gait therapy is vital to many of the potential recovery pathways and is therefore an important feature of gait training. Higher levels of subject participation and challenge could be promoted through designs with a high emphasis on robotic transparency and sufficient degrees of freedom to allow other aspects of gait such as balance to be incorporated.
Introduction
Stroke is the third most common cause of death and the biggest contributor to adult disability in developed countries [1]. For instance, around half a million cases of stroke occur per year in the United States [2]. Gait impairment is a large contributor to long-term disability andambulatory function in daily living[3]. Many patients, however, lose the ability to walk independently, and furthermore, a large proportion do not regain their normal walking speeds following a stroke [4,5]. Treatment for stroke is very costly and accounts for a large percentage of heath care budgets, for example, of the National Health Service in the UK [6]. The approach to stroke physiotherapy is diverse, as are the theoretical bases assumed by the physiotherapists who provide the therapy [3,7-10]. Traditional methodology includes
*Correspondence: andrew.pennycott@hest.ethz.ch1Sensory-Motor Systems Lab, ETH Z¨urich, Z¨urich, Switzerland2University Hospital Balgrist, University of Z¨urich, Z¨urich, Switzerland
neurodevelopmental training (NDT) [11], the motor re-learning programme [12], proprioceptive neuromuscular facilitation [13], and the Rood approach [14]. The effects of the different kinds of training on gait have been shown to be modest, irrespective of the exact type of training [15]. NDT is particularly prevalent [6,7,9,16], with the best well known stream being the Bobath concept. This therapy attempts a ‘holistic’ approach where emotional,social and functional problems are targeted in addi-tion to the main sensory-motor deficits [11,17]. The general aim is to suppress abnormal movement synergies and move towards normal motor patterns[17]. Despite the acceptance of neurodevelopmental training and other conventional rehabilitation techniques, evidence demonstrating their efficacy is lacking[8,10,18-23]. Better outcomes in gait rehabilitation have been elicited from the more direct approach of body weight supported treadmill training [20,24-26], where the patient walks on a
© 2012 Pennycott et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
 

Scientists have created a special toothpaste that could 'reduce heart attacks and stroke'

Do you really think your doctors and stroke hospital will followup and make sure that large scale trial is completed? What have they done in the past to give you any confidence they will initiate research?

Scientists have created a special toothpaste that could 'reduce heart attacks and stroke'

Yahoo Style UK


New research has found that a plaque-identifying toothpaste could help reduce incidence of heart attacks and strokes [Image: Getty]
New research has found that a plaque-identifying toothpaste could help reduce incidence of heart attacks and strokes [Image: Getty]
The world's first plaque-identifying toothpaste could help reduce heart attacks and strokes, according to a new study.
Scientists say that the paste, called Plaque HD, weakens the core structure of plaque and makes it easier for a person to see so it can to be removed by direct brushing.
Gum inflammation is accurately measured by high sensitivity C-reactive protein (hs-CRP), a sensitive marker for future risks of heart attacks or strokes.
For decades, researchers have suggested there is a link between oral health and inflammatory diseases that affect the entire body.
READ MORE: Eating enough fruit and veg lowers risk of memory loss, says a new study
In the study, published by the American Journal of Medicine, a group of random people were given the same brushing schedule and a 30-day supply of toothpaste containing either Plaque HD or an identical non-plaque identifying placebo brand.
The hs-CRP levels in the patients were measured using an enzyme linked with immunosorbent assay.
Plaque HD produced a statistically significant reduction in hs-CRP among those with elevations at baseline.
"The current findings are similar to those from our previous pilot trial,” said Professor Charles Hennekens, from Florida Atlantic University.
READ MORE: Practicing mindfulness can actually help ease physical pain, finds new study
"Whether this plaque-identifying toothpaste decreases heart attacks or strokes requires a large-scale randomised trial of sufficient size and duration."
Based on these findings, they are proposing a randomised trial that will test whether Plaque HD reduces the progression of atherosclerosis in the coronary and carotid arteries, where systemic inflammation is an important precursor.
A United States Centres for Disease Control report found that 47.2 per cent of American adults aged 30 or older have some form of periodontal disease, an inflammatory condition of the gums and tissues surrounding the teeth.
The condition also increases with age, affecting more than 70 percent of adults aged 65 and older.
READ MORE: Two thirds of women experience bladder leaks in the UK - here's how to help prevent them
Inflammation throughout the body may be a crucial link between periodontal and other systemic diseases.
It comes as it was revealed that two women a day are estimated to be dying needlessly because of a ‘heart attack gender gap’ where they do not receive equal treatment to men, a charity has suggested.
The British Heart Foundation (BHF) says stark inequalities in awareness, diagnosis and treatment of heart attacks contributed to an estimated 8,200 plus women dying in England and Wales over a 10-year period from 2003-2013.
According to a BHF-funded study at the University of Leeds, women are also 50% more likely than men to initially receive an incorrect diagnosis when they are experiencing a heart attack.

Saturday, February 22, 2020

Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2)

Using the Action Research Arm Test for validation is not useful, it is subjective.

I see nothing here that suggests that any objective damage diagnosis was done. Without having a valid starting point this research can't be replicated.

Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2)

  1. Keith W Muir1,
  2. Diederik Bulters2,
  3. Mark Willmot3,
  4. Nikola Sprigg4,
  5. Anand Dixit5,
  6. Nick Ward6,7,
  7. Pippa Tyrrell8,
  8. Arshad Majid9,
  9. Laurence Dunn10,
  10. Philip Bath4,
  11. Julian Howell11,
  12. Paul Stroemer11,
  13. Kenneth Pollock11,
  14. John Sinden11

Abstract

Background Human neural stem cell implantation may offer improved recovery from stroke. We investigated the feasibility of intracerebral implantation of the allogeneic human neural stem cell line CTX0E03 in the subacute—chronic recovery phase of stroke and potential measures of therapeutic response in a multicentre study.
Methods We undertook a prospective, multicentre, single-arm, open-label study in adults aged >40 years with significant upper limb motor deficits 2–13 months after ischaemic stroke. 20 million cells were implanted by stereotaxic injection to the putamen ipsilateral to the cerebral infarct. The primary outcome was improvement by 2 or more points on the Action Research Arm Test (ARAT) subtest 2 at 3 months after implantation.
Findings Twenty-three patients underwent cell implantation at eight UK hospitals a median of 7 months after stroke. One of 23 participants improved by the prespecified ARAT subtest level at 3 months, and three participants at 6 and 12 months. Improvement in ARAT was seen only in those with residual upper limb movement at baseline. Transient procedural adverse effects were seen, but no cell-related adverse events occurred up to 12 months of follow-up. Two deaths were unrelated to trial procedures.
Interpretation Administration of human neural stem cells by intracerebral implantation is feasible in a multicentre study. Improvements in upper limb function occurred at 3, 6 and 12 months, but not in those with absent upper limb movement at baseline(So dead brain areas like mine would not be helped.), suggesting a possible target population for future controlled trials.
Funding ReNeuron, Innovate UK (application no 32074-222145).
Trial registration number EudraCT Number: 2012-003482-18
View Full Text
http://dx.doi.org/10.1136/jnnp-2019-32251

Friday, February 21, 2020

Higher volumes tied to better outcomes in endovascular therapy for stroke

So you will need to be coherent enough to ask if the hospital has done more than 34 endovascular cases. If not get yourself transferred to a better hospital.  In fact this transfer should be the responsibility of the ambulance crew. They should know which hospital has enough experience. Not all stroke patients are coherent, I was but that was just me. 

Higher volumes tied to better outcomes in endovascular therapy for stroke

Operator and hospital volume were associated with lower rates of inpatient mortality and better discharge disposition among patients who underwent endovascular therapy for acute ischemic stroke, according to data presented at the International Stroke Conference.
Laura K. Stein, MD, assistant professor of neurology at Icahn School of Medicine at Mount Sinai, and colleagues analyzed 2016-2017 Medicare data to determine whether total cases predicted inpatient mortality, good disposition at discharge and 30-day readmissions.
“As it stands now, physicians at centers seeking endovascular certification from the Joint Commission must have performed 15 cases in the preceding 12 months or 30 in the preceding 24 months,” Stein said during a presentation. “We hypothesized that for endovascular thrombectomy, a volume threshold associated with better outcomes can be identified by analysis of national Medicare data.”
The analysis included 13,311 patients treated by 2,754 operators at 641 hospitals. The mean number of cases per operator was 4.8 (range, 1-82; standard deviation, 7.7) and the mean number of cases per hospital was 20.8 (range, 1-160; standard deviation, 23.6).
Among the cohort, 56% were discharged with good disposition and 16% were readmitted within 30 days, Stein said.
Regarding hospital volume, at a threshold of 28 cases, there were significantly lower odds of inpatient mortality, according to Stein. “This odds ratio becomes even lower and more favorable at each successive case volume threshold,” she said.
For example, Stein said, hospitals with at least 25 cases had 13% lower odds of inpatient mortality than hospitals with fewer than 25 cases (OR = 0.87; 95%, 0.79-0.97) while hospitals with at least 55 cases had 23% lower odds of inpatient mortality than hospitals with fewer than 55 cases (OR = 0.77; 95%, 0.69-0.86).
Odds of good disposition at discharge became significant at a threshold of 34 cases per hospital, Stein said. “Again, odds of good outcome increase with every successive case volume threshold,” she said.
Hospitals with at least 25 cases had 10% higher odds of good disposition at discharge than hospitals with fewer than 25 cases (OR = 1.1; 95%, 1.02-1.19) while hospitals with at least 55 cases had 13% higher odds of good disposition at discharge than hospitals with fewer than 55 cases (OR = 1.13; 95%, 1.04-1.22), she said.
Regarding operator volume, odds of inpatient mortality became lower at a threshold of five cases (OR = 0.86; 95% CI, 0.77-0.97), Stein said, noting that odds improved at higher volumes (OR for 35 cases vs. < 35 cases = 0.65; 95% CI, 0.55-0.77).
Odds of good disposition at discharge became significant at an operator volume of 22 cases, “with a successive increase in odds of a good outcome with each additional proceduralist case,” she said.
Extrapolating the results to all insurers, the hospital 1-year case volume threshold was 24 for lower mortality odds and 29 for higher odds of good disposition at discharge, whereas the operator 1-year case volume threshold was four for lower mortality odds and 19 for higher odds of good disposition at discharge, Stein said.
There was no relationship between operator or hospital volume and 30-day readmission rates, according to the researchers.
“These data demonstrate a linear relationship between endovascular thrombectomy case volume and outcomes of inpatient mortality and good outcome,” Stein said during the presentation. “They suggest that volume should considered in stroke center certification. I want to make it very clear that we in no way mean to suggest that we should be limiting access because of volume anywhere in this country.” – by Erik Swain
Reference:
Stein LK, et al. LB11. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.

Survival rates after ischemic stroke improved from 1991 to 2015

So fucking what! You don't mention 100% recovery results, did it improve from the abysmal low rate of 10%? You got more people alive but let them stay disabled. Not appropriate to pat yourself on the back for that failure. 

Survival rates after ischemic stroke improved from 1991 to 2015

Survival after a first ischemic stroke has improved from 1991 to 2015, according to data presented in a late-breaking science session at the International Stroke Conference.
The study also found that survival rates for hemorrhagic stroke did not improve during this time.
“Stroke unit care(Not results!) has a positive impact on case fatality and 1-year mortality,” Reem Waziry, MD, MPH, PhD, research fellow in the department of epidemiology at Harvard T.H. Chan School of Public Health, said during the presentation. “There are several factors that could have contributed to the observed favorable trends in survival following ischemic stroke in our study and the observed decline in mortality after any stroke in other settings. First, the introduction of stroke units providing timely acute medical management and dedicated rehabilitation. Second, the availability of high-quality evidence and guidelines on best practices in the acute phase, particularly on postacute stroke management in recent years. Third, the improved control of risk factors and timely counseling after stroke.”
Researchers analyzed data from the Rotterdam Study between 1991 and 2015 of 162 patients (median age at stroke, 80 years; 59% women) with first-ever hemorrhagic stroke and 988 patients (median age at stroke, 78 years; 56% women) with ischemic stroke.
Follow-up was conducted until the date of death, date of last contact during follow-up or January 2016, whichever came first. The findings were simultaneously published in Stroke.
There were 144 deaths in patients with hemorrhagic stroke during 386 person-years. In those with ischemic stroke, 711 deaths occurred during 4,897 person-years.
Mortality rates in the hemorrhagic stroke group were similar from 1991 (25 per 100 person-years) to 2015 (30 per 100 person-years). In contrast, these rates in the ischemic stroke group declined from 29 per 100 person-years in 1991 to 11 per 100 person-years in 2015.
Compared with 1991 to 1998, mortality rates for hemorrhagic stroke from 2008 to 2015 remained unchanged (HR = 0.98; 95% CI, 0.61-1.57). Favorable trends were observed when these two periods were compared for ischemic stroke (HR = 0.71; 95% CI, 0.56-0.9).
“Alongside the long follow-up duration and state-of-the-art clinical examinations, a key strength of our study includes the unselected sample of participants who were followed up prospectively, thus avoiding common biases related to institution or patient selection,” Waziry and colleagues wrote in Stroke. “These factors all together provide a close reflection of the current disease burden in the population.” – by Darlene Dobkowski
References:
Waziry R, et al. LB14. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Waziry R, et al. Stroke. 2020;doi:10.1161/STROKEAHA.119.027198.

Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

So where did you put this protocol where all 10 million yearly stroke survivors can find it and use it to train their stroke team? I do not trust top down delivery of stroke research, it has never worked.

Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

Jayme S. Knutson, PhD
1,2,3
,
Kristine Hansen, PT
3
,
Jennifer Nagy, PT
3
,
Stephanie N. Bailey,BSE
4
,
Douglas D. Gunzler, PhD
5
,
Lynne R. Sheffler, MD
1,2,3
, and
John Chae, MD
1,2,3
1
Dept of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH
2
Cleveland Functional Electrical Stimulation Center, Cleveland, OH
3
Dept of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute of Ohio,MetroHealth Medical Center, Cleveland, OH
4
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
5
Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH

 Abstract

Objective—
Compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) versus cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics.
Design—
Twenty-six stroke survivors with chronic (≥6mo) foot drop during ambulation were randomly assigned to six weeks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment, post treatment, and at 1 and 3 months post treatment.
Results—
There were no significant differences between groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile, but not in gait velocity.
Conclusions—
The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation, but do not support the hypothesis that CCNMES is more effective than cyclic NMES in chronic patients.
Keywords
Stroke Rehabilitation; Hemiplegia; Neuromuscular Electrical Stimulation; Footdrop
Correspondence:
 Jayme S. Knutson, PhD Dept of Physical Medicine and Rehabilitation MetroHealth Rehabilitation Institute of Ohio4229 Pearl Road, Suite N527 Cleveland, Ohio 44109, USA.
Disclosures:
 Financial disclosure statements have been obtained, and no other conflicts of interest have been reported by the authorsor by any individuals in control of the content of this article.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providingthis early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before itis published in its final citable form. Please note that during the production process errors may be discovered which could affect thecontent, and all legal disclaimers that apply to the journal pertain.
NIH Public Access
Author Manuscript
Am J Phys Med Rehabil
. Author manuscript; available in PMC 2014 August 01.
Published in final edited form as:
Am J Phys Med Rehabil
. 2013 August ; 92(8): 656–665. doi:10.1097/PHM.0b013e31829b4c16.
 

Jerry Lee Lewis Returns To Music After Miraculous Stroke Recovery

Since miracles don't occur the doctors have to explain EXACTLY how he recovered. The title for all stroke recoveries should be; 'By following the exact stroke protocols found in this database the survivor completely recovered.' If your hospital isn't aiming for this goal, you don't have a stroke hospital.  My directors never allowed me to say I couldn't explain a programming problem, sometimes I spent months figuring it out, failure would have meant being fired.

Jerry Lee Lewis Returns To Music After Miraculous Stroke Recovery

By Andrew Magnotta @AndrewMagnotta
February 19, 2020
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After suffering a stroke last year that paralyzed his right hand, Jerry Lee Lewis he can play the piano again.
Lewis recalled to Rolling Stone the miraculous circumstances in which he started rocking again.
Last month, for the first time in five years, Lewis booked a recording session. His idea was to do an album of gospel classics he grew up hearing. He would sing for the album but not play piano.
Lewis didn't even want a piano in the studio with him, but the engineers left it.
Of course during the first session, Lewis was drawn to the instrument. He sat on the stool, and as a force of habit, put his right hand on the keys.
To his surprise, the fingers started moving.
"I couldn't believe it, I couldn't believe it," Lewis reflected to Rolling Stone. "I never experienced anything like that. There I was playing piano with my right hand. I thought I would never play again."
Lewis had not played piano since February of 2019 when he had his stroke. Though his team initially described the episode as "minor," it proved to be serious, leaving him with mobility issues.
He spent three months in a rehab facility relearning how to walk and trying in vain to regain the use of this right hand.
After his epiphany last month, Lewis spent two more weeks in the studio recording his album with a band and playing the piano again. Lewis was so gobsmacked by his returning abilities, he admits it took him some time to loosen up.
Producer T-Bone Burnett wasn't sure what he was witnessing.
"I was in shock, for starters, that we were even there," he said. "[Jerry] went from saying, 'I can't play piano,' to sitting down, picking up his right hand and playing. His family all welled up. That's the power of love, you know?"
Lewis does not remember the stroke, only waking up in the hospital. he says his recovery has been hard, and it's not over yet. It took "some heavy praying" for him to get back on an upward trajectory.
His wife, Judith, adds that the emphasis on rehabilitation has done wonders for her husband.
"In reality, his health is better now that it's been in the past five or six years," she said, noting that Lewis no longer needs to tote oxygen around, which he did for about three years.
Lewis isn't ready to perform again, but he says he and his management are "thinking about it." Most of all, he's happy to be able to play music again.
Photo: Getty Images

Hospital: Lighting helps stroke patients deal with fatigue, depression

Maybe you also want this even though it is in mice.

Moderate ultraviolet light exposure boosts the brainpower of mice thanks to increased production of the neurotransmitter glutamate May 2018 

Or all these:

 

The latest here:

Hospital: Lighting helps stroke patients deal with fatigue, depression

Copenhagen study shows that circadian-tuned LED brights and spectrum can help, although it might depend on how you measure things.
A stroke patient under soft warm nighttime lighting at Righospitalet, with neurologist Anders West of the University of Copenhagen. (Photo credit: Image courtesy of Chromaviso.)
A stroke patient under soft warm nighttime lighting at Righospitalet, with neurologist Anders West of the University of Copenhagen. (Photo credit: Image courtesy of Chromaviso.)
Studies of 90 stroke patients in a Danish hospital indicate that LED lighting tuned to mimic the patterns of daylight can have a positive effect on depression, fatigue, anxiety, and wellbeing, although there was some amount of inconclusiveness, and lighting made no difference in cognition improvement.
The results of the observations at the Stroke Rehabilitation Unit in Copenhagen's Righospitalet from May 2014 through June 2015 were only recently published in the journal NeuroRehabilitation.
Righospitalet is part of the Copenhagen University Hospital. The studies were conducted by the the University of Copenhagen's departments of neurology and neurophysiology and by the hospital's department of ophthalmology, using specialty lighting from Chromaviso, based in Aarhus, Denmark.
The scientists generally tuned lighting in patient rooms to deliver the brighter and more blue-rich makeup associated with natural daylight during the mornings and afternoons. They toned down the brightness and delivered warmer spectral content in the evenings.
At the same time they delivered ordinary hospital lighting to control groups.
Read more like this: New studies show cycles of blue and red light promote circadian entrainment
The team worked on the hypothesis that the tuned lighting would support human circadian rhythms associated with the 24-hour cycle of day and night, whereas ordinary hospital lighting and indoor confinement deprives patients of circadian normalities and can thus cause physiological disturbances.
All patients were hospitalized for over two weeks.
In one study focused on fatigue, they concluded that “fatigue was significantly reduced in rehabilitation patients exposed to naturalistic lighting during admission.”  They based their conclusion on a couple of questionnaires, one called the Multidimensional Fatigue Inventory questionnaire, and the other the Rested Statement, noting that the experimental groups reported less fatigue compared to the control group.
However, by another measurement, the Pittsburgh Sleep Quality Index, “no differences were detected between groups in sleepiness or subjective sleep quality,” wrote the authors, led by Anders West from the neurology department.
Read more like this: Blue-light study shows promise in healing mild TBI
If those results were encouraging but mixed, the same could be said of a separate set of observations looking at a combination of depression, anxiety, wellbeing, and cognition.
“Depressive mood and anxiety was reduced, and wellbeing was increased in the (experimental) group at discharge compared to the (control group),” the authors reported.
However, “no difference was found in cognition,” the authors stated.
The team applied the Hamilton Depression Scale, the Major Depression Inventory, the WHO-Five Well-being Index, the Hospital Anxiety and Depression Scale, and the Montreal Cognitive Assessment to determine the results.
“This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients,” they concluded, adding that “further studies are needed to confirm these findings.”
Chromaviso has been very active in lighting tuned to health and recovery, in areas including dementia, psychiatric disorders, brain trauma, surgery, and others.

MARK HALPER is a contributing editor for LEDs Magazine, and an energy, technology, and business journalist (markhalper@aol.com).

Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study

Ask your doctors and therapists if they have learned anything about this in the 10 years since this came out.  The answer will tell you EXACTLY their competence.You can take that then to the board of directors and ask when competence will be provided in their 'stroke' hospital.

Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study

Physical Therapy, 2010
 Sara J. Mulroy, Tara Klassen, JoAnne K. Gronley, Valerie J. Eberly, David A. Brown,Katherine J. Sullivan
Background.
 Task specific training programs after stroke improve walking function, but it is not clear which biomechanical parameters of gait are most associated with improved walking speed.
Objective.
 The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight–supported treadmill training (BWSTT).
Design.
 A prospective, between-subjects design was used.
Methods.
 Fifteen people, ranging from approximately 9 months to 5 years after stroke, completed 1 of 3 different 6-week training regimens. These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of: lower-extremity resistive cycling; lower-extremity progressive, resistive strengthening; or a sham condition of arm ergometry. Gait analysis was conducted before and after the 6-week intervention program. Kinematics, kinetics, and electromyographic (EMG) activity  were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Changes in gait parameters were compared in participants whoshowed an increase in self-selected walking speed of greater than 0.08 m/s (high-response group) and in those with less improvement (low-response group).
Results.
 Compared with participants in the low-response group, those in the high response group displayed greater increases in terminal stance hip extension angle and hip flexion power (product of net joint moment and angular velocity) after the intervention. The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention.
Limitations.
 Only sagittal-plane parameters were assessed, and the sample size was small.
Conclusions.
 Task specific locomotor training alternated with strength training resulted in kinematic, kinetic, and muscle activation adaptations that were strongly associated with improved walking speed. Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed.

Artificial Intelligence Helps Predict Myocardial Infarction, Stroke

How long before this gets to your hospital? Do you prefer your hospital incompetence in NOT KNOWING, or NOT DOING?  Yes, I know this is a not quite a Hobson's choice but close enough.

Artificial Intelligence Helps Predict Myocardial Infarction, Stroke

Artificial intelligence (AI) has been used for the first time to instantly and accurately measure blood flow, according to a study published in Circulation.

The results were found to be able to predict chances of death, myocardial infarction (MI), and stroke, and can be used by doctors to help recommend treatments which could improve a patient’s blood flow.

International guidelines recommend a number of assessments to measure a patient’s blood flow, but many are invasive and carry a risk. Non-invasive blood flow assessments, such as cardiovascular magnetic resonance (CMR) imaging, but up until now, the images have been incredibly difficult to analyse in a manner precise enough to deliver a prognosis or recommend treatment.

For the current study, Kristopher Knott, MD, University College London Institute of Cardiovascular Science, London, United Kingdom, and colleagues took routine CMR scans from more than 1,000 patients treated at 2 UK hospitals and used a new automated artificial intelligence technique to analyse the images. By doing this, the researchers were able to precisely and instantaneously quantify the blood flow to the heart muscle and deliver the measurements to the medical teams treating the patients.

By comparing the AI-generated blood flow results with the health outcomes of each patient, the team found that the patients with reduced blood flow were more likely to have adverse health outcomes including death, MI, stroke, and heart failure.

The AI technique was able to predict which patients might die or suffer major adverse events, better than a doctor could on their own with traditional approaches.

“The predictive power and reliability of the AI was impressive and easy to implement within a patient’s routine care,” said Dr. Knott. “The calculations were happening as the patients were being scanned, and the results were immediately delivered to doctors. As poor blood flow is treatable, these better predictions ultimately lead to better patient care, as well as giving us new insights into how the heart works.”

Reference: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.119.044666

SOURCE: University College London

Mobile stroke units improve time to treatment, 3-month functionality

Why aren't we using these much much faster options?  Probably don't need a neurologist either.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

Mobile stroke units improve time to treatment, 3-month functionality 

In Berlin, mobile stroke units equipped with CT for prehospital thrombolysis not only reduced time to treatment, but had higher rates of thrombolysis and reduced risk for disability and death in patients experiencing stroke.
According to findings presented at the International Stroke Conference, the availability of mobile stroke units significantly reduced the incidence of the primary outcome, which included disability, neurological deficits and death at 3 months based on the modified Rankin Scale score (OR = 0.74; 95% CI, 0.6-0.9), compared with conventional care.
However, the intervention did not improve the coprimary outcome of living at home, living in institutional care or death at 3 months (OR = 0.75; 95% CI, 0.56-1.01) compared with the usual care.(And this is because you blithering idiots are doing nothing to stop the neuronal cascade of death.)
“While we had anticipated better outcomes in the patients treated in the mobile stroke units, we are amazed by the magnitude of the effects,” Heinrich Audebert, MD, professor in the department of neurology and Center for Stroke Research at Charité Universitätsmedizin, Berlin, said in a press release. “It is obvious that clot-busting treatment is most effective if it is applied in the ultra-early phase of stroke, ideally within the first or ‘golden hour’ of symptom onset.”
In other findings, 60% patients with stroke who were picked up by a mobile stroke unit underwent prehospital thrombolysis compared with 48% of patients who received conventional care (standardized mean difference, 0.24; P < .001).
In addition, patients who were picked up by a mobile stroke unit had a median 20-minute faster alarm to treatment time (50 vs. 70 minutes; standardized mean difference, 0.59; P < .001) compared with conventional care.
“The earlier and more frequent thrombolytic treatment is probably responsible for the majority of effects,” Audebert said during the presentation. “But other effects may have contributed such as early neurological assessment by neurologists in the mobile stroke unit with continuous monitoring and complication management during the prehospital phase and also a second medical assessment when the patient arrived in the hospital.”
For this prospective, quasi-randomized trial, researchers compared functional outcomes of patients with stroke (mean age, 74 years) who requested medical dispatch during times with (7 a.m. to 11 p.m.) vs. without mobile stroke unit availability.
“Our conclusions are that there may be different ways to advance treatment into the prehospital field, but just waiting until patients arrive at hospital is not enough anymore,” Audebert said during the presentation. “It may be that we should, in the future, apply neuroprotective therapy as well.” – by Scott Buzby
Reference:
Audebert HJ, et al. LB5. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Disclosure: Audebert reports he received research grants from Bundesministerium für Bildung und Forschung, Deutsche Forschungsgemeinschaft, Innovationsfonds des Gemeinsamen Bundesausschusses, Pfizer and Stiftung Deutsche Schlaganfall-Hilfe and honoraria from Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Novo Nordisk, Pfizer and Takeda.

Hopes for Novel Stroke Drug Dashed in Trial

WHOM is going to figure out why it didn't work AND FIX IT? I bet nothing will be done. SOMEONE ELSE WILL SOLVE THE PROBLEM!

Maybe in 50 years and your children and grandchildren will not be able to benefit from it because NO LEADERSHIP AND NO STRATEGY.

Hopes for Novel Stroke Drug Dashed in Trial

— But ESCAPE-NA1 signals neuroprotectant might work if given without thrombolytic

LOS ANGELES -- A putative neuroprotective(Call it what is really is:neuronal cascade of death
preventer. Neuroprotection doesn't sound like it needs immediate attention. Words matter.) agent failed to improve stroke patients' outcomes when given in conjunction with endovascular thrombectomy in the ESCAPE-NA1 trial, although those not given a thrombolytic did appear to benefit.
Nerinetide led to "good functional outcome," defined as a modified Rankin Scale (mRS) score of 0 to 2 at 90 days, in 64.1% of patients compared to 59.2% of patients getting placebo infusion (adjusted RR 1.04, 95% CI 0.96-1.14, P=0.35).
Nor were there benefits for mortality (12.2% vs 14.4%, adjusted RR 0.84, 0.63–1.13) or any other secondary outcomes or safety outcomes, Michael Hill, MD, of the University of Calgary, Alberta, reported here at the International Stroke Conference and online in The Lancet.
"Once again, the favourable effects of a neuroprotective drug reported consistently in preclinical models of brain ischaemia did not translate to clinical efficacy in humans with brain ischaemia," Graeme Hankey, MD, of the University of Western Australia in Perth, wrote in an accompanying editorial.
Nerinetide is a peptide drug believed to interrupt a pathway tied to excitotoxic neuron death in stroke. The agent had shown strongly positive effects in animal models including macaques with middle cerebral artery occlusion.
In exploratory analyses, however, the 40% of patients in ESCAPE-NA1 who did not receive alteplase (Activase, likely because of presenting outside the treatment window) saw a "large" treatment effect.
Rates of functional independence with an mRS of 0-2 were 10 percentage points higher with nerinetide (59.3% vs 49.8%, adjusted RR 1.18, 95% CI 1.01-1.38, number needed to treat 11), and 90-day mortality was nearly halved in this group (adjusted HR 0.56, 95% CI 0.35-0.95).
"We think that we have provided perhaps the first clear evidence in humans that neuroprotection is possible," Hill said at the late-breaking clinical trial session. "We know we're going to have to do more studies, and we're looking forward to doing that."
The trial has been closely watched for its potential implication to neuroprotection more broadly, commented American Heart Association chief medical officer Mariell Jessup, MD. "The studies of neuroprotectors in the past -- because they couldn't get to the damaged tissue because there was a clot -- there were failures. The theory was you can now open up the thrombus and deliver the neuroprotectant."
If the concept panned out, many other agents would be on the table to try and in other settings, such as aortic surgery or even transcatheter procedures, she said in an interview with MedPage Today. "In theory, you would deliver a neuroprotectant in anything that delivers the possibility of debris that goes to the brain."
The trial design wasn't to blame for the overall failure, wrote Hankey.
"Although this result might be a chance finding or confounded by the indication for alteplase, complementary pharmacokinetic data in a small number of patients treated with nerinetide showed that alteplase lowered plasma concentrations of nerinetide, probably by converting plasminogen to plasmin, which cleaves peptide bonds not only in fibrin but also in the eicosa peptide nerinetide," Hankey noted.
The researchers noted this surprise finding was not noted in the animal models. Confounding by indication couldn't be excluded, they added.
The trial included 1,105 patients with acute ischemic stroke due to large vessel occlusion treated with endovascular thrombectomy within 12 hours of onset. They were randomized double-blind to a single dose of IV nerinetide at 2.6 mg/kg as quickly as possible during treatment, up to a maximum dose of 270 mg, or saline placebo over a 10-minute period, finished before arterial access closure.
Moderate to good collaterals were required, with the idea it might have been required to deliver the drug. Treatment groups were stratified prospectively by receipt of alteplase, given according to guidelines, and physician's declared choice of endovascular device.
An ongoing pivotal trial, FRONTIER, is testing nerinetide administered by paramedics prior to hospital arrival and before alteplase would be administered.
Disclosures
The trial was funded by the Canadian Institutes for Health Research, Alberta Innovates, and NoNO.
Hill disclosed relationships with the Canadian Institutes for Health Research, Alberta Innovates, NoNO, Merck, Hoffmann-La Roche Canada, Covidien (Medtronic), Boehringer-Ingelheim, Stryker, Medtronic, a patent for systems and methods for assisting in decision-making and triaging for acute stroke patients, Calgary Scientific, the Canadian Federation of Neurological Sciences, Circle Neurovascular, Alberta Innovates Health Solutions, CIHR, the Heart & Stroke Foundation of Canada, and the National Institutes of Neurological Disorders and Stroke.
Hankey disclosed relationships with the American Heart Association, AC Immune, Bayer, Bristol-Myers Squibb, and Medscape.