You can watch and listen to the video of this doctor. It's f*cking appalling that there is absolutely no mention of anything that stops the neuronal cascade of death in the first week. No mention of following any strategy or plan. Damn these people are just flying in the dark hoping to stumble upon a useful stroke advance.And stroke survivors are paying the price of millions of dead neurons.
http://www.medscape.com/viewarticle/837604
Hello. My name is Dr Mark Alberts, vice-chair of neuroendocrine at UT
Southwestern Medical Center in Dallas, Texas. Today I would like to
present an end-of-year summary of some of the most exciting developments
in vascular neurology. Because of time constraints, we can't talk about
all of the major advances in 2014. Here are some key ones.
A
major development has been the very positive results of several studies
of endovascular therapy for acute ischemic stroke. They have been
reported at meetings and published in abstract form. These include MR
CLEAN (Multi center Randomized Clinical trial of Endovascular treatment
for Acute ischemic stroke in the Netherlands),[1]
ESCAPE (Treatment for Small Core and Proximal Occlusion Ischemic
Stroke, SWIFT PRIME (Solitaire™ FR as Primary Treatment for Acute
Ischemic Stroke, and perhaps one or two others.
All of the studies
looked at patients with acute ischemic strokes, some of whom got IV
recombinant tissue plasminogen activator (rt-PA), some of whom did not.
But the investigators all used an endovascular therapy approach which
focused on using this new generation of stent retrievers to rapidly,
safely, and effectively remove the clots and reperfuse the brain.
Typically,
the patients had lesions in the distal carotid artery or proximal M1 or
M2 artery. What the studies found is that using the stent retrievers,
the operators were able to more rapidly reperfuse the brain, with fewer
bleeding and other complications, and that reperfusion led to
improvements in clinical outcome.
Now, so far as I can tell, none
of these studies have been published in the peer-reviewed literature,
but several of them will be published in the very near future. If the
results are really as positive as have been recorded at various
meetings, I think this is a major paradigm shift because it now
proves—from different centers in different parts of the world—that this
acute endovascular therapy is safe and effective for patients with
large-vessel ischemic strokes. We will have to see how this plays out,
but it appears that this will be another important tool in our treatment
armamentarium for patients who either did (or in some cases could not)
get IV rt-PA.
One of the limitations of that use of stent
retrievers is that it cannot be done at all medical centers. To do it
safely and effectively, it takes more than just an interventionalist. It
really takes a diagnostic team of vascular neurologists,
neuroradiologists, and the neuro critical care folks to take care of
these patients before, during, and after the procedure. Overall, I think
this is a very positive and hopeful development.
I would also
like to briefly touch on another series of reports. These trials looked
at the efficacy of implantable monitors to detect atrial fibrillation in
patients with cryptogenic stroke. A major one of these, published by Dr
Sanna and colleagues[2] in the New England Journal of Medicine
this summer, looked at hundreds of patients with cryptogenic stroke to
compare implantable rhythm monitor with no implanted monitor in the
control group. (For full disclosure, I was an investigator in that
CRYSTAL AF study, but I did not receive any compensation for my
participation.)
What the study found was that at 6 months, the
rate of detection of AFib was 9%. At 12 months, the rate of detection of
AFib was 12.4%. And at 3 years, the rate of detection was 30%, so this
shows that these implantable rhythm monitors are really very effective
at picking up cryptogenic stroke.
Furthermore, the median time
each day during which folks were in AFib was only 4.3 minutes.
Certainly, in many of these patients, the fibrillation would never have
been detected using routine ECG monitoring.
So, those are some of
the key developments of 2014. There may be another Medscape report if
something else pops up, but that is it for now. I look forward to your
comments, and I wish everybody a happy and healthy new year. Thank you.
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