Deans' stroke musings: PFO closure bested medical management alone for reduction of ischemic stroke

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.

Wednesday, February 13, 2013

PFO closure bested medical management alone for reduction of ischemic stroke

This reverses years of research that stated that PFO closure didn't show any advantage to medical management.

http://www.healio.com/cardiology/stroke/news/online/%7B26F4518A-DA1F-4EAE-BE9E-FE52040BDA74%7D/PFO-closure-bested-medical-management-alone-for-reduction-of-ischemic-stroke
Patients with a history of cryptogenic stroke had better outcomes with patent foramen ovale closure as compared with medical management alone, according to data from the RESPECT PFO trial.
Results from the overall trial, presented previously, demonstrated that PFO closure with the Amplatzer PFO Occluder device (St. Jude Medical) reduced the frequency of recurrent ischemic strokes, in comparison with medical management alone consisting of antiplatelet medication or warfarin. The trial included 980 patients (mean age, 46 years). Researchers performed detailed patient screening to exclude cardioembolism, large artery arteriopathy, small artery disease and other non–PFO-related stroke causes.At the International Stroke Conference 2013, Jeffrey L. Saver, MD, director of the stroke and vascular neurology clinics at Geffen School of Medicine, University of California, Los Angeles, and colleagues presented data on qualifying and outcome ischemic strokes in the RESPECT PFO trial. All 25 primary endpoint events were recurrent ischemic strokes; 16 in the medical management group and nine in the device group. In the device group, three ischemic strokes occurred without a device in place and three occurred in a deep penetrator artery distribution, according to the study abstract.

According to time-to-event analyses, there was a trend for benefit associated with device therapy in the intention-to-treat population (HR=0.5; 95% CI, 0.22-1.13). There was significant benefit in the per-protocol (HR=0.37; 95% CI, 0.14-0.97) and as-treated (HR=0.28; 95% CI, 0.1-0.76) populations.
The middle cerebral artery was the most commonly involved vascular territory, in 54% of the medical management group and 57% of the device group.
“The event types particularly averted in the device group were those associated with paradoxical embolic stroke mechanism: infarcts of larger size and infarcts with a superficial or multiple penetrating artery topography,” Saver said.