Deans' stroke musings: CLOSURE I: Warts and all, first PFO/stroke study is best answer so far

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.

Thursday, March 15, 2012

CLOSURE I: Warts and all, first PFO/stroke study is best answer so far

For you PFO patients, see what your doctor says about this.
http://www.theheart.org/article/1369823.do?utm_campaign=newsletter&utm_medium=email&utm_source=20120315_EN_Heartwire_R01
A device that many hoped might change the landscape of stroke prevention will likely never get the chance to prove itself properly for a host of reasons now being lamented by experts, as the first randomized clinical trial in this arena finally makes its way to print [1]. Published online today in the New England Journal of Medicine, the CLOSURE I trial of patent foramen ovale (PFO) closure for stroke/transient ischemic attack (TIA) showed no differences in outcomes between the device and medical therapy. Despite its much-discussed flaws, the trial is in the minds of many the best available evidence to date and should lead to a slowdown in the use of PFO-closure devices.

As previously reported by heartwire, principal investigator for the trial, Dr Anthony Furlan (Case Western Reserve University, Cleveland, OH), first presented the results in November 2010 at the American Heart Association Scientific Sessions.

Speaking with heartwire, Furlan recounted the hurdles the trialists faced in getting to the finish line, in particular the excruciatingly slow enrollment, hampered by rampant off-label use of the devices in patients whose physicians felt could not run the risk of being randomized to medical management.

"No randomized trial is perfect," Furlan said. "We move our understanding of the problem forward incrementally. There is a reason nobody ever did a randomized trial previously. . . . It took us nine years to get this into print, and that doesn't even include the year it took to design the trial. So 10 years of stick-to-it-ness to get to this discussion."

The rest at the link.